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Claassen H, Busch C, May MS, Schicht M, Scholz M, Schulze M, Paulsen F, Wree A. Cor Triatriatum Sinistrum Combined with Changes in Atrial Septum and Right Atrium in a 60-Year-Old Woman. MEDICINA-LITHUANIA 2021; 57:medicina57080777. [PMID: 34440984 PMCID: PMC8402230 DOI: 10.3390/medicina57080777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: A rare case of cor triatriatum sinistrum in combination with anomalies in the atrial septum and in the right atrium of a 60-year-old female body donor is described here. Materials and Methods: In addition to classical dissection, ultrasound and magnetic resonance imaging, computer tomography and cinematic rendering were performed. In a reference series of 59 regularly formed hearts (33 men, 26 women), we looked for features in the left and right atrium or atrial septum. In addition, we measured the atrial and ventricular wall thickness in 15 regularly formed hearts (7 men, 8 women). Results: In the case described, the left atrium was partly divided into two chambers by an intra-atrial membrane penetrated by two small openings. The 2.5 cm-high membrane originated in the upper level of the oval fossa and left an opening of about 4 cm in diameter. Apparently, the membrane did not lead to a functionally significant flow obstruction due to the broad intra-atrial communication between the proximal and distal chamber of the left atrium. In concordance with this fact, left atrial wall thickness was not elevated in the cor triatriatum sinistrum when compared with 15 regularly formed hearts. In addition, two further anomalies were found: 1. the oval fossa was deepened and arched in the direction of the left atrium; 2. the right atrium showed a membrane-like structure at its posterior and lateral walls, which began at the lower edge of the oval fossa. It probably corresponds to a strongly developed eustachian valve (valve of the inferior vena cava). Conclusions: The case described suggests that malformations in the development of the atrial septum and in the regression of the valve of the right sinus vein are involved in the pathogenesis of cor triatriatum sinistrum.
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Affiliation(s)
- Horst Claassen
- Department of Anatomy, Rostock University Medical Center, Gertrudenstrasse 9, 18057 Rostock, Germany; (M.S.); (A.W.)
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Universitätsstrasse 19, 91054 Erlangen, Germany; (M.S.); (M.S.); (F.P.)
- Correspondence: ; Tel.: +49-381-494-8438
| | - Christian Busch
- Department of Internal Medicine, Federal Armed Forces Hospital, Lesserstrasse 180, 22049 Hamburg, Germany;
| | - Matthias Stefan May
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Maximiliansplatz 3, 91054 Erlangen, Germany;
- Imaging Science Institute Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Martin Schicht
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Universitätsstrasse 19, 91054 Erlangen, Germany; (M.S.); (M.S.); (F.P.)
| | - Michael Scholz
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Universitätsstrasse 19, 91054 Erlangen, Germany; (M.S.); (M.S.); (F.P.)
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Gertrudenstrasse 9, 18057 Rostock, Germany; (M.S.); (A.W.)
- AG 3 Anatomie und Zellbiologie, Medizinische Fakultät OWL Universität Bielefeld, Morgenbreede 1, 33615 Bielefeld, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Universitätsstrasse 19, 91054 Erlangen, Germany; (M.S.); (M.S.); (F.P.)
- Department of Topographic Anatomy and Operative Surgery, Sechenov University, Rossolimo Street 15/13, 119992 Moscow, Russia
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Gertrudenstrasse 9, 18057 Rostock, Germany; (M.S.); (A.W.)
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Sabade S, Vagrali A, Patil S, Kalligudd P, Dhulked V, Dixit MD, Gan M, Dayal A. Anaesthetic management of a child with "cor-triatriatum" and multiple ventricular septal defects - A rare congenital anomaly. Indian J Anaesth 2010; 54:242-5. [PMID: 20885873 PMCID: PMC2933485 DOI: 10.4103/0019-5049.65375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cor-triatriatum is a rare congenital cardiac anomaly. It accounts for 0.1% of congenital heart diseases. Its association with multiple ventricular septal defects (VSD) is even rarer. A five-month-old baby was admitted with respiratory distress and failure to thrive. Clinical examination revealed diastolic murmur over mitral area. Chest X-ray showed cardiomegaly. Haematological and biochemical investigations were within normal limits. Electrocardiogram showed left atrial enlargement. 2D echo showed double-chambered left atrium (cor-triatriatum), atrial septal defect (ASD) and muscular VSD with moderate pulmonary arterial hypertension. The child was treated with 100% oxygen, diuretics and digoxin and was stabilized medically. We used balanced anaesthetic technique using oxygen, air, isoflurane, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB) with moderate hypothermia. Through right atriotomy abnormal membrane in the left atrium was excised to make one chamber. VSD were closed with Dacron patches and ASD was closed with autologous pericardial patch. Patient tolerated the whole procedure well and was ventilated electively for 12h in the intensive care unit. He was discharged on the 10(th) postoperative day.
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Affiliation(s)
- Sriram Sabade
- Consultant Cardiac Anaesthesiologist, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
- Department of Anaesthesiology, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
| | - Anand Vagrali
- Consultant Cardiac Anaesthesiologist, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
- Department of Anaesthesiology, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
| | - Sharan Patil
- Consultant Cardiac Anaesthesiologist, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
- Department of Anaesthesiology, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
| | - Praveen Kalligudd
- Consultant Cardiac Anaesthesiologist, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
- Department of Anaesthesiology, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
| | - Vithal Dhulked
- Consultant Cardiac Anaesthesiologist, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
| | - M D Dixit
- Director, KLES Heart Foundation, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
- Professor, Department of CVTS, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
| | - Mohan Gan
- Professor, Department of CVTS, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
| | - A Dayal
- Professor, Department of CVTS, J. N. Medical College, Nehru Nagar, Belgaum – 590 010, Karnataka, India
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Salazar González JJ, Galache Osuna JG, Molinero Herguedas E, Salazar González E, Placer Peralta LJ, Salazar Mena J. [Clinical presentation, diagnosis and treatment of four cases of cor triatriatum]. Rev Esp Cardiol 2001; 54:1013-6. [PMID: 11481120 DOI: 10.1016/s0300-8932(01)76441-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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.
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Balselga P, Cazzaniga M, Gómez R, Collado R, Pérez De León J, Villagrá F, Vellibre D, Azcárate MM. [Divided left atrium: operative results and follow-up in the cor triatriatum]. Rev Esp Cardiol 2000; 53:1607-12. [PMID: 11171483 DOI: 10.1016/s0300-8932(00)75286-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- P Balselga
- Servicio de Cardiología Pediátrica, Hospital Ramón y Cajal, Madrid
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