We parallelly planned for Bentall procedure on high-risk basis with ongoing resuscitation and stabilization. Our approach was via median sternotomy. The aortic root and ascending aorta were aneurysmal (Figure 1). Right atrial appendage was firm on palpation. Standard aorto-bicaval cannulation was done. Cardiopulmonary bypass was established. Aortic valve with ascending aorta was replaced with aortic valved conduit with re-implantation of coronary buttons. A large, organized clot occupying right atrial appendage (Figure 2) was removed.

Immediate post-operative period was uneventful other than deranged liver function tests which were in improving trend. The patient was discharged on post-operative day ten.