Cor triatriatum sinistrum: one institution's 28-year experience

Cor Triatriatum: an uncommon congenital anomaly - the experience of a tertiary care center in a developing country

Background

Cor Triatriatum is a congenital anomaly characterized by the abnormal presence of a fibromuscular junction in one of the atria, as seen on echocardiography. This anomaly can lead to major hemodynamic problems and obstruction of blood flow. This study aims to explore the risk factors, diagnostic modalities, and surgical interventions used to tackle this congenital anomaly at a tertiary care center over an 18-year period.

Materials and methods

Medical records of congenital heart disease patients at the Children's Heart Center at the American University of Beirut Medical Center between 2006 and 2024 were retrospectively reviewed. Data collection included demographic characteristics, clinical outcomes, hospitalization details, and surgical treatment. Ethical approval was obtained, and descriptive statistics were employed for data analysis using SAS 9.4.

Results

At our center, 7 patients were diagnosed with Cor Triatriatum, with a median age of 5 months. 4 of the patients were female, 3 were males, and the median hospital stay was 7 days. All patients were diagnosed with Cor Triatriatum Sinister, and respiratory symptoms were prevalent. Pulmonary vein abnormalities were observed in 4 ouf of 7 (57.1%) patients and atrial septal defects in 2 out of 7 patients (28.5%). Surgery resulted in successful membrane resection for all operated patients, with significant symptom improvement postoperatively.

Conclusion

Cor Triatriatum is a rare congenital anomaly requiring early detection and diagnosis. Surgical intervention remains the mainstay of treatment, with favorable outcomes when performed promptly. Larger studies are recommended to optimize management strategies and improve long-term outcomes for affected patients.

Obstructed Supramitral Inflow: Cor Triatriatum Sinister Presentation in Adulthood

Cor triatriatum is a rare congenital heart defect that occurs when a fibromuscular membrane divides the atrium into two chambers, which may impair blood flow to the ventricle. When it does, the symptoms usually manifest during infancy or early childhood. In this E-challenge, though, the case of a 40-year-old man is reviewed whose symptoms of shortness of breath progressed over the years and were attributed to the diminished mitral valve inflow due to the restricted cor triatriatum sinister associated with pulmonary hypertension, tachycardia-bradycardia syndrome, and atrial fibrillation. Despite routine preoperative evaluation, intraoperative transesophageal echocardiography was used to more accurately evaluate cor triatriatum sinister's morphology, hemodynamic significance, and associated anomalies.

Successful Repair of Cor Triatriatum Sinistrum in Childhood: A Single-Institution Experience of Two Cases

Cor triatriatum is a rare structural congenital cardiac anomaly in which one of the atria chambers is anatomically divided. If left untreated, cor triatriatum can eventually lead to heart failure. This case report describes our experience with two pediatric patients (a three-year-old girl and an 11-month-old male infant) who underwent surgical correction of cor triatriatum. Both patients underwent excision of the cor triatriatum membrane via cardiopulmonary bypass and had an uneventful postoperative recovery with good outcomes. Surgical repair of cor triatriatum sinister provides satisfactory short-term and long-term outcomes with a low risk of requiring additional intervention.

Surgical Outcomes of Cor Triatriatum Sinister: A Single-Center Experience

Background

We investigated surgical outcomes after the surgical repair of cor triatriatum sinister (CTS).

Methods

Thirty-two consecutive patients who underwent surgical repair of CTS from 1993 through 2020 were included in this study. The morphological characteristics, clinical features, and surgical outcomes were described and analyzed.

Results

The median age and body weight at operation were 9 months (interquartile range [IQR], 3–238 months) and 7.5 kg (IQR, 5.8–49.6 kg), respectively. There were 16 males (50%). According to the modified Lucas classification, type IA (classical CTS) was most common (n=20, 62.5%). Atrial septal defect was associated in 22 patients (68.8%) and anomalous pulmonary venous return in 8 patients (25%). Pulmonary hypertension was preoperatively suspected with a high probability in 18 patients (56.3%). There was 1 early death (3.1%) after emergent membrane excision and hybrid palliation in a high-risk hypoplastic left heart syndrome patient. There were no late deaths. The overall survival rate was 96.9% at 15 years post-repair. No early survivors required reoperation during follow-up. Most survivors (31 of 32 patients, 96.9%) were in New York Heart Association functional class I at a median follow-up of 74 months (IQR, 39–195 months). At the latest echocardiography performed at a median of 42 months (IQR, 6–112 months) after repair, no residual lesion was observed except in 1 patient who had moderate pulmonary hypertension (mean pulmonary arterial pressure of 36 mm Hg).

Conclusion

Surgical repair of cor triatriatum could be performed safely and effectively with an extremely low risk of recurrence.

Surgical management of divided atrial chambers

BACKGROUND AND AIM

The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We sought to address clinical presentations, potentially misdiagnosed cases, diagnostic modalities, surgical approaches, and outcomes of this "family" of uncommon lesions.

METHODS

A total of 193 published investigations were synthesized. Diagnostic information was provided by clinical presentation, and multimodality imaging studies.

RESULTS

Almost three-quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra-cardiac defects are present in between half and nine-tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge todefinitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long-term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed.

CONCLUSIONS

Resection of the dividing shelf allows the survivors to regain near normal dimensions with a low risk of recurrence. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.

Loeffler's group 2 cor triatriatum sinistrum with mobile left atrial thrombus - a case report and literature review

We report a case of a 25-year-old man diagnosed with an unusual case of cor triatriatum sinister with a mobile left atrial thrombus. He was hospitalised with aggravating dyspnoea. Transthoracic echocardiography revealed a membrane-like structure traversing the left atrial and a small orifice of about 7.1 mm. The mean pressure gradient was 12.94 mmHg across the orifice of the membrane-like structure and there was a mobile mass in the post-erosuperior chamber. The anomaly was rectified by a surgical resection. Timely diagnosis and surgical repair may prevent stroke in patients with unusual cor triatriatum sinister.

Mid-term outcomes of cor triatriatum repair: comparison of biventricular physiology and univentricular physiology

BACKGROUND

Cor triatriatum is the rarest of all congenital cardiac diseases, accounting for 0.1-0.4% of congenital heart diseases. Atrial septal defect is the most common associated defect; however, cor triatriatum is sometimes associated with univentricular heart.

METHODS

This single-centre retrospective study involved all patients who underwent the repair of cor triatriatum at Kobe Children's Hospital between 2000 and 2020. Twenty-four patients were required surgery. We conducted a survey of survival rate, early and late pulmonary vein stenosis in each group.

RESULTS

The survival rate of 5 years after cor triatriatum resection was 100% in the biventricular group and 82.1% in the univentricular group, respectively. The free rate for pulmonary stenosis of 5 years after surgery was 100% in the biventricular group and 90.0% in the univentricular group, respectively. There was no statistical difference in survival rate and 5 years free rate for pulmonary stenosis after surgery.

CONCLUSIONS

The results showed that surgical correction offers good early and mid-term outcomes for both cor triatriatum with biventricular and univentricular physiologies.

Cor triatriatum sinister with left anomalous pulmonary venous return to innominate vein

Cor triatriatum sinister is a rare congenital abnormality, with varying signs and symptoms related to the anatomic features and the components of the accompanying cardiac abnormalities. We present a 3-year-old girl who underwent successful simultaneous operation with complete loss of the membrane and ligation of vertical vein by anomalous venous return. The principles for surgical management of cor triatriatum can be summarised as radical resection of the membrane and correction of other intracardiac anomalies.

Surgical repair of cor triatriatum sinister: the Mayo Clinic 50-year experience

BACKGROUND

Cor triatriatum is a rare congenital cardiac defect in which the atrium is divided into 2 chambers by a membrane causing obstruction to the blood flow in either the left atrium (cor triatriatum sinister) or the right atrium (cor triatriatum dexter) eventually leading to cardiac failure. We sought to review our surgical experience with cor triatriatum sinister.

METHODS

Twenty-five patients underwent surgical correction of cor triatriatum between May 1960 and September 2012. There were 11 males and 14 females with a mean age of 27.4 years (age range, 1 day to 73 years).

RESULTS

All patients underwent excision of cor triatriatum membrane using cardiopulmonary bypass. Twenty patients (80%) required concomitant cardiac surgical procedures. There was no early mortality. None of the patients had any residual atrial obstruction. Two infants who had concomitant repair of complex congenital anomalies died at 2 and 5 months postoperatively after discharge from hospital. Kaplan-Meier survival at 10 years was 83%. All patients were in New York Heart Association class I or II at a mean follow-up of 12.8 years (maximum 44 years).

CONCLUSIONS

Surgical repair of cor triatriatum provides satisfactory early and long-term survival with low risk for additional intervention. Cor triatriatum with complex congenital anomalies may be associated with adverse outcome.

A novel method of placing right ventricular leads in patients with persistent left superior vena cava using a conventional j stylet

BACKGROUND

Locating pacemaker electrodes can become complicated by congenital abnormalities such as persistent left superior vena cava (LSVC).

OBJECTIVE

To evaluate a technique for the implanting of ventricular electrode in patients with persistent LSVC.

MATERIALS AND METHODS

The study was carried out from June 2001 to June 2010 involving all patients who were admitted to the Hospital Universitario Mayor, Instituto de Corazon de Bogota and Hospital Universitario Clinica San Rafael (Bogota-Colombia) for implanting pacemakers or cardiac defibrillators. LSVC was diagnosed by fluoroscopic observation (anterior-posterior view) of the course of the stylet. Four steps were followed: 1) Move the electrode with a straight stylet to the right atrium. 2) Change the straight stylet by a conventional J stylet and push the electrode to the lateral or anterolateral wall of the right atrium. 3) Remove the guide 3-5 cm and 4) Push the electrode which crosses the tricuspid valve into the right ventricle and finally deploy the active fixation mechanism.

RESULTS

A total of 1198 patients were admitted for pacemaker or cardiac defibrillator implant during the 9-year study period, 1114 received a left subclavian venous approach. There were 573 males and 541 females. Persistent LSVC was found in five patients (0.45%) Fluoroscopy time for implanting the ventricular electrode ranged from 60 to 250 seconds, 40 to 92 minutes being taken to complete the whole procedure.

CONCLUSION

We present a simple and rapid technique for electrode placement in patients with LSVC using usual J guide and active fixation electrodes with high success.

Outcome after repair of cor triatriatum

Cor triatriatum represents <0.1% of all congenital cardiac malformations. Symptoms in patients with cor triatriatum are related to pulmonary venous obstruction and pressure loading of the right side of the heart. The aim of this study was to describe our institutional experience with repair of cor triatriatum. From June 1963 to June 2010, 65 patients underwent repair at a median age of 7.2 months (range 2 days to 47.6 years). Among these patients, 49 (75%) had associated congenital heart defects. Atrial septal defect (n = 29), ventricular septal defect (n = 15), partially or totally anomalous pulmonary venous return (n = 14), mitral valve abnormalities (n = 11), and supravalvar mitral ring (n = 5) were the most common associated defects. Surgical treatment consisted of excision of the membrane, along with additional procedures in 47 patients (72%). Five patients had new postoperative supraventricular arrhythmias. During a median follow-up period of 5.4 years, no patients underwent reintervention for recurrent left atrial obstruction, 7 patients were noted to have minor residual cor triatriatum without obstruction, and 8 patients (including 4 diagnosed before cor triatriatum repair) had pulmonary vein stenosis, 6 of whom underwent intervention for that reason. In conclusion, in this large surgical series of patients who underwent repair of cor triatriatum, there were no cases of significant residual or recurrent cor triatriatum. Although the association between cor triatriatum and pulmonary vein stenosis has been described previously, the relative frequency of this condition in our cohort (>10%, including patients diagnosed before and after cor triatriatum repair) is noteworthy. Abnormalities of the mitral valve and a supravalvar mitral ring were also seen more often than the existing research would suggest, which may be another important consideration in evaluating and following these patients.

Transcatheter closure of atrial septal defect in a patient with cor triatriatum sinister and atrial septal defect

Cor triatriatum sinister is a rare congenital heart disease and rarely found in adults. The authors describe an asymptomatic 20-year old man presenting with heart murmur by check up. Transthoracic and transesophageal echocardiogram demonstrate atrial septal defect (ASD) secundum 26 mm and cor triatriatum sinister with 20 mm of fenestration. Transcatheter closure of ASD using Occlutech Figulla^R device was successfully performed without complications. Echocardiogram post procedure demonstrate good position of device without obstruction of blood flow, no residual shunt and residual 12 mm of fenestration of cor triatriatum.

Cor triatriatum sinistrum in childhood. A single institution's experience

INTRODUCTION

Cor triatriatum sinistrum (CTS) is a rare congenital cardiac defect that can present with a wide range of symptoms and may be associated with other structural cardiac defects. Very limited data are available for pediatric patients.

OBJECTIVE

To analyze the experience with CTS at a single pediatric centre, highlighting symptoms on presentation, mode of diagnosis and outcome.

METHODS

Hospital databases were searched to identify patients with CTS who were diagnosed between 1954 and 2005. Medical records with demographic data, clinical evaluation, diagnostic approach, interventions and autopsy results were reviewed.

RESULTS

Between 1954 and 2005, 82 patients (43 female children, 52%) with CTS were diagnosed at the institution. Patients were born between 1951 and 2004, and the median age at presentation was eight months (range one day to 16.1 years). The majority of patients (77%) presented with associated cardiac lesions. Of 82 patients, 57 (70%) underwent resection of the fibromuscular diaphragm, 14 (17%) did not require surgery and 11 (13%) did not survive the time to intervention. Nineteen patients (23%) died a median of two months (range one day to 5.5 years) after presentation. Nine of these patients (11%) died before surgery was attempted. Most patients were completely asymptomatic at the time of the last follow-up at a median of three years (range one day to 18 years). Echocardiography significantly facilitated the diagnosis and subsequent management of patients with CTS.

CONCLUSIONS

Despite the diversity in presentation and complexity of associated lesions, the outcome for patients with CTS is favourable.

Cor triatriatum presenting in adulthood: A case report

Cor triatriatum is a rare congenital defect in which a fibromuscular membrane divides the left atrium into two distinct chambers. We described a case of cor triatriatum with interesting Doppler flow signal in a 39-year-old female. The diagnosis was confirmed on cardiac catheterization and surgery.

Congenitally persistent left superior vena cava: a possible unpleasant problem during invasive procedures

The persistence of the left superior vena cava is the most common thoracic vein anomaly, but, nevertheless, it continues to be an unpleasant finding during invasive diagnostic cardiovascular procedures and is sometimes a challenge during invasive therapeutic interventions. Persistent left superior vena cava usually occurs in 0.5% of the normal population and 0.47% of patients undergoing pacemaker or implantable cardioverter defibrillator implantation. The incidence in congenital heart disease varies (2-5%), and it is more frequent in stenosis or pulmonary atresia, D-transposition, complete atrioventricular septal defects, and anomalous pulmonary vein drainage. The diagnosis is almost always incidental, during anaesthesiological procedures such as central vein placement, or diagnostic cardiovascular procedures, such as right heart catheterization, but it may sometimes be discovered during therapeutic paediatric cardiac catheterization, such as during patent foramen ovale or atrial septal defect transcatheter closure. Echocardiography is useful to identify patients in whom computed tomography and especially magnetic resonance imaging may pose a definitive diagnosis. In indicated cases, when cyanosis is present and the anomaly is isolated, treatment options include surgical ligation and transcatheter closure using large occluder devices, whereas more challenging surgical repairs are needed when the anomaly is associated with other complex congenital heart diseases. Different specialists at different levels such as anaesthesiologists, invasive cardiologists, electrophysiologists and cardiac surgeons should be aware of the variety of technical problems that may be caused by a persistent LSVC.

Cor Triatriatum Sinistrum: Surgical Experience in Taiwan

PURPOSE

Cor triatriatum sinister, more commonly referred to as cor triatriatum (CT), is characterized by a common pulmonary venous chamber (proximal chamber) separated from the left atrium (distal chamber) by a fibromuscular septum. This report of our experience updates the surgical results of this anomaly in the Asian population.

METHODS

Between January 1992 and May 2005, nine patients with cor triatriatum underwent surgical correction at Chang Gung Memorial Hospital. We retrospectively analyzed their cardiac anatomy, clinical data, surgical procedures and follow-up data.

RESULTS

The mean age at surgery was 260+/-215 days (range, 20-790 days), with the exception of one patient who underwent surgery at 31 years of age. Three patients had a partial anomalous pulmonary venous connection, one had a complete atrioventricular canal defect, and one had another major complex cardiac anomaly. Eight corrective operations and one palliative operation were performed. There was no surgical mortality. The mean follow-up time was 52.1+/-43.6 months (range, 17-139 months).

CONCLUSION

Our findings show that surgical correction is efficient and safe for this rare cardiac anomaly.

Cor triatriatum sinistrum: a rare congenital cardiac anomaly presenting in an adult with chronic atrial fibrillation

Cor triatriatum is a rare congenital cardiac anomaly in which the left atrium is divided into proximal (dorsal or upper) and distal (ventral or lower) chambers by a fibromuscular septum. The upper chamber receives the pulmonary veins and the lower chamber contains the atrial appendage and the mitral valve. The 2 chambers communicate through a defect in the membrane. Cor triatriatum is often associated with other congenital cardiac anomalies. Most frequently, the upper chamber communicates with the right atrium through a patent foramen ovale or atrial septal defect, and the clinical symptoms simulate anomalous pulmonary venous return. Less commonly, the foramen ovale communicates with the distal chamber and the clinical features mimic mitral stenosis. When cor triatriatum is the only abnormality, the clinical findings are also similar to mitral stenosis with development of pulmonary hypertension and subsequent right ventricular hypertrophy and atrial enlargement. The diagnosis is usually made in infancy or childhood, and the lack of treatment results in death in 75% of patients. We report the case of a woman who presented much later in life. The patient was a 57-year-old female with a clinical history of chronic atrial fibrillation who presented to the emergency department because of a "funny sensation" in her chest, though she denied chest pain, nausea, vomiting, or diaphoresis. EKG revealed atrial fibrillation with a rapid ventricular response and a tachycardic rate of 157. She had a therapeutic level of digoxin, and cardiac enzymes were normal. The patient was admitted and placed on Cardizem drip. Serial EKGs remained normal and heart rate control was achieved. On hospital day 2, the patient became dyspneic and cyanotic. She went into cardiac arrest and died.Autopsy revealed cardiomegaly (610 g) with 4-chamber dilatation. A septum divided the left atrium into 2 chambers. The defect in the dividing membrane measured 1 cm in diameter. No other congenital defects were noted. The large size of the defect in the membrane likely accounted for the late onset of symptoms that allowed this patient to survive into adulthood without previous diagnosis or surgical intervention (which is usually required in childhood).

Cor triatriatum with repeated episodes of syncope in an eighteen month-old girl: a rare cause of cardiogenic syncope

Syncope can be caused by either cardiogenic or noncardiogenic causes. Structural heart diseases should be considered as a possible cause of recurrent episodes of syncope if no other causes are found. We report an 18 month-old girl who presented with recurrent syncope as well as dyspnea, failure to thrive, and frequent episodes of pulmonary infections, suggesting congestive heart failure. A prominent pulmonic component of the second heart sound and congested lungs noted from chest X-rays indicated pulmonary hypertension. An echocardiogram revealed an abnormal membrane with a small orifice in the left atrium (LA). An intact atrial septum and no evidence of other congenital heart diseases were observed. The result after surgical resection of the membrane was good during follow-up. Cor triatriatum may be one of the structural heart diseases responsible for repeated unexplained syncope. An echocardiogram performed by an experienced cardiologist would facilitate the diagnosis considerably and an excellent prognosis can be achieved via surgical resection of the obstructing membrane.

Cor Triatriatum: Presentation, Diagnosis and Long-Term Surgical Results

BACKGROUND

Cor triatriatum sinister is a rare, surgically correctable, congenital cardiac anomaly. Fewer than 250 cases have been reported. It can occur as an isolated defect (classic) or in association with other congenital cardiac anomalies (atypical).

METHODS

A retrospective review of 28 consecutive patients diagnosed at the Royal Children's Hospital in Melbourne, Australia during a 22-year span from 1981 to 2003.

RESULTS

There were 13 men (46%) and 15 women (54%). Fifteen patients were less than 1 year of age (neonates, [n = 7], 25%; infants, [n = 8], 29%). 17 patients (61%) had a communication between the right atrium and either the proximal or distal chamber. Fifteen patients (54%) had atypical cor triatriatum. Median age at presentation was 6 months (range, 0.6 to 240). Twenty-four patients (86%) had presented by 5 years of age. Five patients (18%) underwent emergency surgery. Median age at operation was 7 months (range, 1 to 243). Twenty-seven patients (96%) underwent preoperative transthoracic echocardiography. Nine patients (32%), all with atypical cor triatriatum, required cardiac catheterization for diagnosis. Twenty-seven patients (96%) were correctly diagnosed before treatment. Twenty-seven patients (96%) were treated surgically. The defect was approached through the right atrium in 26 patients (93%). There was 1 early death and 1 patient died 10 years after repair. Follow-up was 86% complete. At a median follow-up of 98 months (range, 0.2 to 284), all patients including those with atypical cor triatriatum were in New York Heart Association's function class 1. Post-repair survival was 96% and 88% at 5 and 15 years, respectively.

CONCLUSIONS

Surgery offers good early and long-term results for both classic and atypical cor triatriatum.

Doppler echocardiographic findings in 2 identical variants of a rare cardiac anomaly, "subtotal" cor triatriatum: a critical review of the literature

Improved diagnostic procedures of echocardiography and better awareness of the anomaly and its possible variants lead the examiner to the right diagnosis of the rare cor triatriatum sinister. We describe two cases of a variant of "subtotal" cor triatriatum sinister. A uniform classification system is desirable to compare cases, treatment, and outcome.

[Clinical presentation, diagnosis and treatment of four cases of cor triatriatum]

We report four cases of cor triatriatum. In two of them the fibromuscular membrane was obstructive and associated with an atrial septal defect between the left atrial accessory chamber and the right atrium; in those cases the clinical findings were due to the pulmonary hypervascularity. The third case was associated to a small patent foramen ovale, and the clinical findings were due to the obstruction to flow through the membrane in the left atrium, producing venocapilar pulmonary hypertension. In these three cases surgical treatment was carried out through a right atriotomy. In all of them a good corelationship was found between the echocardiographic and the surgical findings. The follow-up has been good, all previous symptoms disappearing, remaining symptom free. The fourth case is an asymptomatic 5-year-old girl, with a non-obstructive membrane and without any associated anomalies.

[Divided left atrium: operative results and follow-up in the cor triatriatum]

INTRODUCTION AND OBJECTIVES

A divided left atrium because of cor triatriatum is a relatively rare cardiac anomaly requiring corrective surgery. We describe here our clinical and surgical experience with this congenital heart defect as well as the different medium and long term diagnostic, surgical and evolution aspects.

PATIENTS AND METHODS

From 1981 to 1999, 15 children with cor triatriatum without complex associated cardiovascular defects underwent surgery at a mean age of 13 months (excision of the obstructive membrane). The surgical reports were reviewed and the clinical and echocardiographic data were analyzed before and after the intervention; six of these patients (40%) were referred to operating room only with the 2-D echo Doppler technique and color flow mapping information. The follow-up period ranged from 8 months to 19.3 years.

RESULTS

Diagnosis was confirmed during the surgical procedure. One 9 month old patient died 60 days after a successful corrective surgery because of sepsis (7%). No late deaths or reoperations were found in the follow-up period. All 14 patients who survived the operation have a functional class I (NYHA), and they are asymptomatic in the follow-up. The overall survival rate was 93% (70% CI: 87-90).

CONCLUSIONS

Corrective surgery with excision of the obstructive membrane dividing the left atrium restores normal anatomic, hemodynamic and clinical status in children with cor triatriatum without complex associated defects.

Divided left atrium associated with supravalvar mitral ring

Reported is a case with a rare association of divided left atrium, supramitral stenosing ring of the left atrium, connection of the left superior caval vein to the roof of the left atrium, unroofed coronary sinus with an interatrial communication at the mouth of the unroofed sinus and ventricular septal defect. The need for a complete echocardiographic examination in the presence of pulmonary venous obstruction is emphasized. Surgery was successful in spite of significant preoperative pulmonary hypertension.

Ascites and weight loss in a child: due to congenital division of the right atrium

Congenital division of an atrial chamber is a very rare congenital malformation that more commonly affects the left atrium but which may, in rare circumstances, involve the right atrium. Such a divided right atrium may present with symptoms consistent with increased portal venous pressure. Reported is a case with unusual clinical presentation. The patient underwent resection of the dividing shelf with good postoperative results.

[Cor triatriatum with interventricular communication: Doppler color ultrasonography and magnetic resonance diagnosis. Repair in the first months]

We report a case of left cor-triatrial with ventricular septal defect and patent ductus arteriosus in a lactant of six months of age. It was diagnosed using color-coded Doppler echocardiography and magnetic resonance imaging. The intracardiac defects were successfully corrected through right atriotomy.

Transesophageal echocardiographic evaluation of cor triatriatum in children

Four children with cor triatriatum underwent intraoperative transesophageal echocardiography. Two patients had cor triatriatum alone and two had associated complex congenital heart disease. Transesophageal echocardiography provided optimal imaging of these defects and provided unique information that facilitated surgical management in these children.