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Sankhyan LK, Anderson RH, Chowdhury UK, George N, Pradeep D, Vaswani P, Pandey NN, Arvind B. Surgical management of divided atrial chambers. J Card Surg 2021; 36:4267-4279. [PMID: 34392568 DOI: 10.1111/jocs.15896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Lakshmi K Sankhyan
- Cardiothoracic Centre, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ujjwal K Chowdhury
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niwin George
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Doniparthi Pradeep
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Vaswani
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Bojanić K, Bursać D, Zmijanac J, Duić Ž, Scavonetto F, Weingarten TN, Sprung J. Isolated cor triatriatum sinistrum and pregnancy: case report and review of the literature. Can J Anaesth 2013; 60:577-83. [DOI: 10.1007/s12630-013-9922-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/15/2013] [Indexed: 11/25/2022] Open
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Willens HJ, Ferrer PL, Tamer DF, Labrador E, Agatston AS, Keith K, Torres S. Cor triatriatum sinister in an adult: management guided by real time three-dimensional transesophageal echocardiography and stress echocardiography. Echocardiography 2011; 27:E132-6. [PMID: 20553320 DOI: 10.1111/j.1540-8175.2010.01214.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 39-year-old female had cor triatriatum (CT) detected as an incidental finding on transthoracic echocardiography performed to evaluate chest pain. By conventional two- and real time three-dimensional transesophageal echocardiography, the CT membrane had a communicating orifice connecting the accessory and main left atrial chambers that measured 1.3 × 0.8 cm. The resting mean transmembrane gradient was 2 mm Hg. The postexercise mean transmembrane gradient and pulmonary artery pressure were 6 and 40 mm Hg. Extrapolating from cutoff values for postexercise gradients and pulmonary pressures in patients with mitral stenosis, we advised deferring surgery and close clinical and echocardiographic follow up.
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Affiliation(s)
- Howard J Willens
- Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Pericas P, Rodríguez-Fernández A, Melis G, Forteza JF, Figuerola AA, Bethencourt A. Real-time three-dimensional transesophageal echocardiographic imaging of cor triatriatum and persistent left superior vena cava. J Am Soc Echocardiogr 2010; 24:706.e1-3. [PMID: 20833506 DOI: 10.1016/j.echo.2010.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Indexed: 10/19/2022]
Abstract
The authors describe the case of a 54-year-old woman with the association of two rare congenital cardiac anomalies: cor triatriatum and persistent left superior vena cava with the special characteristic of direct drainage to the right atrium. Real-time three-dimensional transesophageal echocardiography offered a comprehensive anatomic and functional evaluation of these infrequent entities.
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Affiliation(s)
- Pere Pericas
- Cardiology Department, Hospital Son Dureta, Andrea Doria 55, Palma de Mallorca, Spain.
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Park KJ, Park IK, Sir JJ, Kim HT, Park YI, Tsung PC, Chung JM, Park KI, Cho WH, Choi SK. Adult cor triatriatum presenting as cardioembolic stroke. Intern Med 2009; 48:1149-52. [PMID: 19571448 DOI: 10.2169/internalmedicine.48.2148] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cor triatriatum is a rare congenital cardiac malformation characterized by a fibromuscular membrane that divides the left atrium into two distinct chambers. In almost all cases, it is diagnosed in childhood, whereas adult cases are extremely rare. Herein, we describe an unusual case of cor triatriatum in a 55-year-old woman who presented with embolic cerebral infarction. The patient experienced sudden-onset, transient left-sided homonymous hemianopsia and echocardiography and multidetector computed tomography detected a membrane-like structure across the left atrium, confirming the diagnosis of a cor triatriatum. The laboratory examination for hypercoagulopathy was negative. She was conservatively treated with anticoagulation and her neurological manifestation gradually improved.
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Affiliation(s)
- Kyung-Jun Park
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University, Seoul, Republic of Korea
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Frogel J, Vodur S, Applefield D, Kruba R, Raman J, Mitter N. Case 6--2008. An unusual case of right ventricular failure after orthotopic heart transplantation. J Cardiothorac Vasc Anesth 2008; 22:913-9. [PMID: 19038739 DOI: 10.1053/j.jvca.2008.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan Frogel
- Department of Anesthesiology, Henry Ford Hospital, Detroit, MI 48202, USA.
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Huang YK, Chu JJ, Chang JP, Lu MS, Tseng CN, Chang YS, Tsai FC, Lin PJ. Cor Triatriatum Sinistrum: Surgical Experience in Taiwan. Surg Today 2007; 37:449-54. [PMID: 17522760 DOI: 10.1007/s00595-006-3341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 05/30/2006] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linko, Kaohsiung and Chia-Yi Center, Chang Gung University of Medicine, 5 Fu-Hsing Street, Kweishan, Taoyuan, 333, Taiwan
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Cor triatriatum. COR ET VASA 2006. [DOI: 10.33678/cor.2006.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mercer-Rosa L, Fedec A, Gruber P, Seliem M. Cor Triatriatum Sinister with and without Left Ventricular Inflow Obstruction: Visualization of the Entire Supravalvular Membrane by Real-time Three-dimensional Echocardiography. Impact on Clinical Management of Individual Patient. CONGENIT HEART DIS 2006; 1:335-9. [DOI: 10.1111/j.1747-0803.2006.00059.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bassil R, Plat G, Marcoux MO, Zabalawi A, Lelong-Tissier MC, Daussac E, Taktak A, Dulac Y, Acar P. Cœur triatrial gauche : une cause inhabituelle de détresse respiratoire néonatale. Arch Pediatr 2006; 13:1129-31. [PMID: 16766166 DOI: 10.1016/j.arcped.2006.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 04/19/2006] [Indexed: 11/29/2022]
Abstract
We report the case of a newborn presenting with neonatal respiratory distress due to acute pulmonary edema, the underlying diagnosis being cor triatriatum sinister. This rare anomaly can be lethal in the short term. However, it can be completely cured surgically provided that diagnosis is made on time.
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Affiliation(s)
- R Bassil
- Cardiologie pédiatrique, hôpital des Enfants, Toulouse
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Jacobs A, Weinert LC, Goonewardena S, Gomberg-Maitland M, Lang RM. Three-Dimensional Transthoracic Echocardiography to Evaluate Cor Triatriatum in the Adult. J Am Soc Echocardiogr 2006; 19:468.e1-4. [PMID: 16581489 DOI: 10.1016/j.echo.2005.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Indexed: 11/20/2022]
Abstract
Cor triatriatum is a rare congenital condition in which the left atrium is partitioned into two chambers by a fibrous or fibromuscular septum. The diagnosis is often made early in childhood, but can rarely be discovered later in adulthood. This delay in diagnosis is likely because of the number and size of the fenestrations in the septum. Echocardiography is the modality most often used to diagnose cor triatriatum. Generally, transesophageal echocardiography (TEE) is superior to transthoracic imaging. Three-dimensional echocardiography, however, is a modality that offers additional information not offered by 2-dimensional echocardiography. Although 3-dimensional TEE has previously been described, we report what we believe to be the first case of 3-dimensional transthoracic echocardiography used to diagnose cor triatriatum. This modality offers an advantage over TEE, as it allows the septum to be viewed easily without the risks or inconvenience of TEE.
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Affiliation(s)
- Avrum Jacobs
- Division of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA
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Avula S, Salazar M, Alturk N, Kukafka S, Ritter S, Grodman RS. Cor Triatriatum with Single Atrium Presenting in Adulthood. Echocardiography 2005; 22:839-43. [PMID: 16343168 DOI: 10.1111/j.1540-8175.2005.00105.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We present the case of an asymptomatic 21-year-old woman referred because of an abnormal routine electrocardiogram. Transthoracic and transesophageal echocardiography revealed a complete absence of the atrial septum, a common atrium septated posteriorly from the pulmonary venous chamber, a partial atrioventricular canal, a cleft mitral valve and a persistent left superior vena cava draining into an enlarged coronary sinus. These findings were confirmed during surgical correction. Our patient presented with an unusual and fascinating combination of congenital malformations that remained well tolerated and undiscovered into adulthood.
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Affiliation(s)
- Satyanarayana Avula
- Division of Cardiology, Saint Vincent Catholic Medical Centers of New York, Staten Island Region, 355 Bard Avenue, Staten Island, New York 10310, USA
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Baweja G, Nanda NC, Kirklin JK. Definitive Diagnosis of Cor Triatriatum with Common Atrium by Three-Dimensional Transesophageal Echocardiography in an Adult. Echocardiography 2004; 21:303-6. [PMID: 15053799 DOI: 10.1111/j.0742-2822.2004.03095.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe an adult patient, in whom three-dimensional transesophageal echocardiography was able to make a definitive diagnosis of cor triatriatum associated with common atrium. The lesion mimicked a classical partial atrio-ventricular septal defect on both transthoracic and transesophageal two-dimensional echocardiography. We found only two cases in the literature describing the existence of cor triatriatum with common atrium, none diagnosed by echocardiography.
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Affiliation(s)
- Gurpreet Baweja
- Division of Cardiovascular Disease, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 35249, USA
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Rorie M, Xie GY, Miles H, Smith MD. Diagnosis and surgical correction of cor triatriatum in an adult: combined use of transesophageal echocardiography and catheterization. Catheter Cardiovasc Interv 2000; 51:83-6. [PMID: 10973026 DOI: 10.1002/1522-726x(200009)51:1<83::aid-ccd19>3.0.co;2-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This is an unusual case of a 37-year-old male whose initial presentation to medical care was for dyspnea. A transthoracic echocardiogram was suspicious for cor triatriatum, which was confirmed by transesophageal echocardiography. Since the resting transmembrane gradient was low, a cardiac catheterization with exercise hemodynamics was performed and demonstrated a marked increase in pulmonary capillary wedge and pulmonary artery pressures. The cor triatriatum was successfully resected at surgery. We have reviewed the English literature and find this to be a unique approach to diagnosis and management.
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Affiliation(s)
- M Rorie
- Division of Cardiovascular Medicine, University of Kentucky and Veterans Administration Medical Centers, Lexington, Kentucky 40536, USA
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Peces R, Pobes A, Rodriguez M, Simarro C, Iglesias G, Simarro E. Left atrial calcification in a hemodialysis patient with cor triatriatum. Am J Kidney Dis 2000; 35:E27. [PMID: 10793056 DOI: 10.1016/s0272-6386(00)70292-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Myocardial calcification is a rare manifestation of abnormal calcium metabolism seen in some patients with chronic renal failure. This report describes the transesophageal echocardiographic and spiral computed tomography (CT) findings in a young hemodialysis female with severe secondary hyperparathyroidism. These findings included calcification of the multiperforated membrane of a cor triatriatum and the wall of the left atrium.
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Affiliation(s)
- R Peces
- Services of Nephrology and Cardiology, Hospital Central de Asturias, Oviedo, Spain.
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