Education  |   January 2018
A Floating Object in the Left Atrium
Author Notes
  • From the Department of Anesthesiology, Tokyo Women’s Medical University, Tokyo, Japan.
  • Address correspondence to Dr. Seino: yu-seino@twmu.ac.jp
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia
Education   |   January 2018
A Floating Object in the Left Atrium
Anesthesiology 1 2018, Vol.128, 142. doi:10.1097/ALN.0000000000001835
Anesthesiology 1 2018, Vol.128, 142. doi:10.1097/ALN.0000000000001835
INTRAOPERATIVE, real-time, three-dimensional transesophageal echocardiography (RT 3D TEE) has become common in addition to conventional two-dimensional (2D) TEE. However, an efficient application of RT 3D TEE to cardiac surgery is still evolving.1  The images were obtained from a 36-yr-old woman with Marfan syndrome during aortic root replacement and mitral valve plasty immediately after aortic unclamping. 2D TEE detected a floating object with acoustic shadow above the mitral valve in the left atrium (arrow, midesophageal mitral commissural view; left).
Because RT 3D TEE revealed that the object was rectangular-shaped and about 6 mm per side (arrow, en-face view of mitral valve; right), it was suspected to be a pledget used as a suspended suture. A second pump run with cardioplegic arrest was performed to remove the object, and the floating object was confirmed to be a pledget.
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