An 83-year-old man was found unconscious and was successfully resuscit
ated. Progressive cardiac failure developed. After 42 hours of observa
tion echocardiography revealed cardiac tamponade and a discontinuity i
n the left atrial wall. Exploration showed a laceration of the left at
rium at the junction of the left pulmonary veins, which was closed wit
h a direct suture on cardiopulmonary bypass. The postoperative course
was uneventful.