A Treatise on the Surgical Management of Porcelain Atrium and Coconut Atrium

The present perspective is a synthesis of 119 published investigations in the setting of porcelain atrium and coconut atrium in the literature. We identified 60 suitable cases (porcelain atrium, n=44; coconut atrium, n=16) from 34 investigations, and reviewed the clinical presentation, diagnostic modalities utilized, surgical techniques employed and outcomes. Roentgenography, cross-sectional transthoracic and transesophageal echocardiography, computerized tomography and fluoroscopy provided the necessary diagnostic information and defined the disease entity before surgery in all patients. Magnetic resonance imaging and selective coronary angiography had been used for further clarification of the presence of intraluminal left atrial thrombus. We then grouped the lesions into two categories, namely “porcelain atrium” and “coconut atrium” that have a bearing on the appropriate surgical approach, discussing appropriate surgical or non-surgical techniques for each group. For the overall group, taking into consideration of the patients subjected to surgical intervention, the operative mortality remains high at 20.6% [porcelain atrium: hospital death 6/30 (20%), coconut atrium: hospital death 1/4 (25%). We submit that an increased appreciation of different types of left atrial wall calcification may well contribute to improved surgical management.