An unexpected left atrial mass was found during routine postoperative transthoracic echocardiogram in an infant following surgical closure of ventricular septal defect. Thrombus could not be excluded. At reoperation it was found to be an inverted left atrial appendage. This case demonstrates the echocardiographic appearance of an inverted left atrial appendage.

No abstract

Between 1977 and 1988, 27 patients between the ages of 4 and 22 years (mean 8.9) underwent a Fontan procedure with the use of an antibiotic sterilised aortic homograft. There were 15 patients with tricuspid atresia, 9 with univentricular heart and 3 others. The homograft was anastomosed to a right-sided pulmonary artery in ten, to a left-sided main pulmonary artery in eight and in nine patients the homograft connected the right atrium to the right ventricle. There were five early deaths (18.5%) unrelated to the homograft and two late deaths at 7 and 10 years postoperatively. Five patients have required removal of the calcified obstructed homograft with no death. In three patients patches were inserted, but in two patients with good right ventricles a second homograft was inserted. In three of the re-operated patients the homograft lay directly behind the sternum and the femoral artery was exposed and in two of them the femoral artery was cannulated before the chest was opened to control haemorrhage. Of the patients 74% are alive up to 15 years later, 15 with their original homograft. Eight (57%) of those still have their original homograft more than 10 years post-operatively.