Transesophageal echocardiographic evaluation of cor triatriatum in children

Multimodality imaging of cor triatriatum dexter complicated with hypertrophic cardiomyopathy of restrictive phenotype

Cor triatriatum dexter (CTD) is an extremely rare congenital cardiac malformation in which a membrane divides the right atrium into 2 chambers. Hypertrophic cardiomyopathy (HCM) with restrictive phenotype is also a rare cardiomyopathy. We report a case with an 18-year history of chest discomfort, fatigue and syncope following intense physical activity was finally diagnosed with CTD complicated with HCM, and the HCM is a special type, restrictive phenotype. Multimodal imaging was used to diagnose this complex disease and analyzed the main cause of her heart failure, which provided accurate evidence for clinical treatment and prognosis.

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 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.

Cor Triatriatum: A Review

Cor triatriatum is a rare congenital cardiac anomaly defined by an abnormal septation within the atrium (left or right) leading to inflow obstruction to the respective ventricles. It exists either in isolated classical form or may be associated with simple to complex congenital cardiac anomalies. Several anatomical variants exist even in the classical form, and therefore, it may require multimodal diagnostic modalities to characterize and differentiate for better percutaneous interventional or surgical planning. It commonly presents in infancy but may remain undetected till death. Symptomatology typically mimics mitral and tricuspid stenosis in sinister and dexter varieties, respectively. However, features of systemic embolization, heart failure, atrial fibrillation, cyanosis, cardiac asthma, syncope, and sudden cardiac arrest have also been reported in the literature. Surgical correction under cardiopulmonary bypass is the preferred treatment. Nevertheless, balloon dilatation may be considered in anatomically compatible variants and in special circumstances, such as heart failure, pregnancy, or as a bridge to definitive treatment.

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.

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.

[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 in association with tricuspid atresia and discordant ventriculo-arterial connections

Division of the morphologically left atrium is a rare abnormality, constituting around 0.1% of congenital heart disease. It may coexist with other cardiac abnormalities, and this association may obscure its recognition. We report an uncommon association with tricuspid atresia and discordant ventriculo-arterial connections, the latter dominating the clinical picture. Accurate diagnosis was made by transthoracic cross-sectional echocardiography, and the patient was referred to surgery without need for cardiac catheterisation.

Cor triatriatum in a 70-year-old woman: role of transesophageal echocardiography and dynamic three-dimensional echocardiography in diagnostic assessment

In this report we describe a 70-year-old woman with unrecognized nonobstructive cor triatriatum (CT). She had concomitant mitral regurgitation and coronary artery disease. Diagnosis of CT and its hemodynamic assessment were accomplished by transesophageal echocardiography. Dynamic three-dimensional echocardiography demonstrated multiple fenestrations in the left atrial membrane. Intraoperative findings confirmed the diagnostic accuracy of three-dimensional echocardiography. To our knowledge, this is the first case of CT that has anatomic correlation with three-dimensional echocardiography.

[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.