2 CASE REPORT
A 63-year-old man with a history of mesh insertion for an abdominal
incisional hernia was admitted to the previous physician with the chief
complaint of fever. A diagnosis of mesh infection made and long-term
antibiotic therapy was initiated. Preoperative echocardiography revealed
a 39-mm mass in his left atrium. He was transferred to our hospital for
further treatment of mesh infection and LA mass. Echocardiography showed
that the LA mass was adherent to the atrial septum (Fig. 1). The
ejection fraction was 56%, and no valvular abnormalities were noted.
Computed tomography showed a 39-mm partially calcified mass in his left
atrium(Fig. 2). Brain magnetic resonance imaging showed very small
scattered infarctions; however, he did not have any neurological
disorders. Therefore, we suspected LA mass to be an cardiac tumor,
especially myxoma, and we scheduled surgery for tumor resection after a
6-week course of antibiotic therapy.
We selected the transseptal approach to reach the left atrium. A
smooth-surfaced mass was observed in the left atrium. The mass was
severely adherent to the atrial septum and was carefully resected (Fig.
3). The operation time was 4 h and 10 min. Pathophysiology revealed that
the excised specimen was a thrombus with Zahn lines composed of fibrin
and stratified calcification, indicating the long process of thrombus
formation (Fig. 4). There was no tumor component in the specimen. The
postoperative course was uneventful, and he was discharged on
postoperative day 14, after administering direct oral anticoagulants to
prevent thrombus formation. At 6 months after the surgery, follow-up
transthoracic echocardiography showed no residual mass in the left
atrium, with a preserved ejection fraction of 55%.