Intraoperative transesophageal echocardiography detection of a mobile echogenic structure at the left atriotomy suture line - A case report -

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Left atrial myxoma and atrial fibrillation with intraoperative mobile echogenic structure at the left atriotomy suture line (n=1). Intervention: Intraoperative transesophageal echocardiography-guided surgical revision with external reinforcing sutures. Primary outcome: Resolution of protruding mobile echogenic structure at the left atriotomy suture line and absence of postoperative embolic complications.

Q: What does this research mean for the field?

Systematic post-cardiopulmonary bypass intraoperative transesophageal echocardiography can detect potentially embolic mobile tissue flaps protruding from atriotomy suture lines to guide immediate surgical correction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Boeun Kwon; Boohwi Hong; Soomin Lee; Chahyun Oh; Yoon Hee Kim; Man-Shik Shim

doi:10.17085/apm.26712

November 12, 2026Anesthesia and Pain MedicineOpen Access

Intraoperative transesophageal echocardiography detection of a mobile echogenic structure at the left atriotomy suture line - A case report -

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Key result

Intraoperative TEE identifies left atriotomy tissue flap, guiding suture revision to prevent embolic complications.

n=1

Why the study?

Intraoperative transesophageal echocardiography provides real-time anatomical and functional assessment during cardiac surgery and may detect abnormalities that require surgical intervention.

Key Points

To describe the intraoperative transesophageal echocardiography (TEE) detection and surgical management of a mobile echogenic structure originating from a left atriotomy closure line.
A case report of an 80-year-old woman undergoing minimally invasive left atrial myxoma excision and a concomitant cryoablation maze procedure via right anterolateral thoracotomy.
Multiplane intraoperative TEE was performed at baseline and during weaning from cardiopulmonary bypass to assess surgical repair and identify residual intracardiac abnormalities.
Post-bypass TEE revealed a small, highly mobile echogenic structure near the right superior pulmonary vein, localized by external finger palpation to the superior end of the left atriotomy closure line.
Placement of reinforcing sutures externally inverted and incorporated the redundant tissue flap into the atriotomy closure, resulting in complete disappearance of the lesion on repeat TEE.
The patient was successfully weaned from cardiopulmonary bypass, and the postoperative course was uneventful without neurological, coronary, or systemic embolic complications.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 80-year-old woman with atrial fibrillation, hypertension, diabetes mellitus, and prior cerebrovascular accident undergoing minimally invasive excision of a 14 x 17 mm left atrial myxoma and maze procedure, followed through hospital discharge.

I

Intervention

Comprehensive intraoperative post-cardiopulmonary bypass multiplane transesophageal echocardiography (TEE) evaluation extending to the left atriotomy closure line, followed by external finger palpation and placement of external reinforcing sutures to invert and incorporate a protruding redundant atrial tissue flap.

O

Outcome

Complete disappearance of the mobile echogenic structure on repeat intraoperative TEE and postoperative recovery without neurological, coronary, or systemic embolic complications during hospitalization.safety

Systematic intraoperative post-bypass transesophageal echocardiography assessment of surgical closure sites can detect incidental mobile tissue flaps at the atriotomy suture line and guide immediate surgical correction to prevent potential systemic embolization.

Limitations

Histopathological confirmation of the echogenic structure was unavailable.
As a single case report, the findings cannot establish incidence or causality.
The patient's pre-existing atrial fibrillation and prior cerebrovascular accident elevated baseline embolic risk, so the absence of postoperative embolic complications cannot confirm or exclude the lesion's embolic potential.
Because the patient had pre-existing atrial fibrillation and a prior cerebrovascular accident, her baseline risk of embolic events was already elevated, so the absence of postoperative embolic complications cannot definitively confirm or exclude the embolic potential of the lesion itself.

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Implication

May prompt targeted post-bypass TEE at atriotomy sites; leaves open whether routine use reduces embolization in larger cohorts.

Abstract

Background: Intraoperative transesophageal echocardiography (TEE) provides real-time anatomical and functional assessment during cardiac surgery and may detect abnormalities that require surgical intervention. Case: An 80-year-old woman underwent minimally invasive left atrial myxoma excision combined with a maze procedure under general anesthesia. After weaning from cardiopulmonary bypass, routine TEE revealed a small but highly mobile echogenic structure near the right superior pulmonary vein. The operating surgeon was notified, and external palpation localized the finding to the superior left atriotomy, consistent with a redundant atrial tissue flap protruding through the suture line. Reinforcing sutures were placed to incorporate the flap into the closure and eliminate its protrusion into the left atrium. Repeat TEE confirmed complete disappearance of the lesion. The patient recovered without embolic complications. Conclusions: Careful post-bypass TEE examination, including systematic assessment of atriotomy closure sites, may identify potentially embolic mobile echogenic structures and guide surgical management, thereby contributing to perioperative patient safety.

Discussion

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Cite This Study

Kwon et al. (2026) conducted a case report in Left atrial myxoma and atrial fibrillation with intraoperative mobile echogenic structure at the left atriotomy suture line (n=1). Intraoperative transesophageal echocardiography-guided surgical revision with external reinforcing sutures was evaluated on Resolution of protruding mobile echogenic structure at the left atriotomy suture line and absence of postoperative embolic complications. Intraoperative transesophageal echocardiography detected a mobile echogenic tissue flap at the left atriotomy suture line in an 80-year-old woman, guiding suture revision with 0 embolic complications.

synapsesocial.com/papers/6af73ac79badce7b6084da34 https://doi.org/10.17085/apm.26712

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Intraoperative transesophageal echocardiography detection of a mobile echogenic structure at the left atriotomy suture line - A case report -

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Intraoperative transesophageal echocardiography detection of a mobile echogenic structure at the left atriotomy suture line - A case report -

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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