Successful management of perforating injury of right atrium by chest tube.

Tube thoracostomy is an invasive procedure caring about 1% complication rate. Most confronted complications include diaphragm or lung laceration [1-3], damage to intrabdominal organ, intercostal artery bleeding and unilateral pulmonary edema. Here we present another rare complication of perforation of the right atrium which occurred in a patient with rheumatic heart disease (RHD) who had received mitral valve replacement (MVR) and tricuspid annuloplasty. Severe tricuspid regurgitation (TR) with huge right atrium was noted. Chest tube was inserted for pleural effusion drainage. The lesion was proved to be in the right atrium by echocardiography and computerized tomography three days later. The penetrated hole was repaired with bovine pericardium patch with minimal blood loss. This case attests to the extreme caution warranted when performing tube thoracostomy in patient with huge cardiomegaly.