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A new cardiac mass after cardiac transplantation.

A 62-year-old man with a history of nonischemic cardiomyopathy presented to us for orthotopic cardiac transplantation. Informed consent for presentation of this case was obtained from the patient. The intraoperative course was uneventful until weaning from cardiopulmonary bypass (CPB) when the transesophageal echocardiogram (TEE) examination revealed a 3 cm 2 cm, homogenous mass originating from the anterolateral wall of the left atrium (Fig. 1) (Video 1, see Supplemental Digital Content 1, http://links.lww.com/AA/A191, and Video 2, see Supplemental Digital Content 2, http://links.lww.com/AA/A192; see Appendix for video legends). It had smooth, regular contours with well-defined borders and soft tissue reflectance similar to the echogenicity of the left atrial wall. The mass was mobile and synchronous with the adjacent left atrial wall. The cavity of the left atrial appendage (LAA) could not be visualized in any standard TEE imaging plane. Although in close proximity to the left upper pulmonary vein and the mitral valve apparatus, the mass did not appear to impinge on these structures. These findings were discussed with the surgeon, who, after digital inspection, confirmed that the mass in question was most likely an inverted LAA. Being in close proximity to the left atrial anastomotic suture line (Fig. 2), and not causing any hemodynamic compromise, re-exploration of the atria was not performed. The patient was uneventfully weaned off of CPB, with a plan to observe the mass. A follow-up transthoracic echocardiogram (TTE) on postoperative day 9 was consistent with a persistent inverted LAA with no hemodynamic compromise (Fig. 3). The patient had an uneventful recovery and was discharged on day 15, with plans for close follow-up.