: A right atrial myxoma extending to inferior vena cava (IVC) with associated right-to-left shunting leading to systemic desaturation is an exceedingly rare clinical entity. The number of such cases reported in literature till date is not more than five. This case study presents a 45-year lady who was referred to our Centre with symptoms of breathlessness, easy fatigability, generalized weakness and bluish discoloration of lips, fingers and skin. On routine blood investigation, polycythemia was noted. On preoperative 2D-Transthoracic Echocardiography (TTE), the diagnosis of right atrial myxoma was confirmed but the reason for cyanosis was not revealed. Tumor thrombus in a branch of right lower pulmonary artery with small locoregional pulmonary infarct along with right atrial myxoma was reported in CT angiography of heart and great vessels and CT pulmonary angiography. On-table Transesophageal Echocardiography (TEE) showed patent foramen ovale (PFO) with right-to-left shunting because of raised right atrial pressure and dynamic obstruction of the tricuspid valve by the myxoma. The myxoma was resected completely via right atrial approach along with primary closure of PFO. The postoperative period was uneventful and the saturation at room air of the patient was 100% and she was discharged on day 7. The Patient is doing well during the 3-month follow-up.

Though the incidence of aneurysms involving the aortic root and/or ascending aorta is common, the combination of aortic root aneurysm and the right atrial clot is extremely rare. No such case is reported in literature till date. This case report presents a 52-year gentleman who came to our emergency department with complaints of breathlessness, abdominal distention, pedal swelling, and decreased urine output with extremely poor general condition. After hemodynamic stabilization and preoperative optimization and workup, he was managed with Bentall procedure with right atrial clot removal. The immediate postoperative course was normal except for deranged liver function tests. The patient was discharged on postoperative day ten.

Cerebrovascular Accidents represent a dangerous complication of cyanotic children with tetralogy of fallot with incidence of 8.6%.Tetralogy of Fallot has been associated with raised haematocrit with low arterial Saturation. Here we describe an 18 months old female child of Tetralogy of Fallot with Cyanotic spells acute onset right sided hemiplegia with Right Atrial thrombus who underwent emergency surgery with intraoperative predicament.