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Medellin S, Burbano-Vera N, Alfirevic A. Obstructed Supramitral Inflow: Cor Triatriatum Sinister Presentation in Adulthood. J Cardiothorac Vasc Anesth 2024; 38:576-580. [PMID: 38072717 DOI: 10.1053/j.jvca.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Abstract
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.
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Affiliation(s)
- Sara Medellin
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Nelson Burbano-Vera
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of Pediatric Anesthesiology, Section of Pediatric Cardiac Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
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2
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Hong HJ, Kwon HW, Kwak JG, Lee SY, Lee YS. An extreme case of cor triatriatum mimicking hypoplastic left heart syndrome and combined pulmonary vein stenosis. Cardiol Young 2024; 34:205-208. [PMID: 38018154 DOI: 10.1017/s1047951123003724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
A 65-day-old girl presented to the emergency room with lethargy, requiring emergency venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock. Initially, hypoplastic left heart syndrome was suspected. However, cor triatriatum with a pinpoint opening on the membrane was diagnosed based on a detailed echocardiographic examination. After membrane resection, the left heart size was restored. However, follow-up echocardiography performed 4 months later showed occlusion of both upper pulmonary veins and stenosis in both lower pulmonary veins. Hybrid balloon angioplasty was performed in all pulmonary veins, and stents were inserted into the right upper and lower pulmonary veins. Despite repeated balloon angioplasty, all pulmonary vein stenosis progressed over 6 months and the patient expired while waiting for a heart-lung transplant. Even after successful repair of cor triatriatum, short-term close follow-up is required for detecting the development of pulmonary vein stenosis.
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Affiliation(s)
- Hee Ju Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul, South Korea
| | - Yoon Seong Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
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3
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Shiga T, Kamiya Y, Ohkubo M, Miyamoto T, Kakinuma Y, Kayanuma H, Aoki T, Fujii Y, Aihara N, Kamiie J. Cor triatriatum sinister with dextrocardia in association with ostium secundum atrial septal defect, subpulmonary ventricular septal defect and bicuspid pulmonary valve in a pig. J Comp Pathol 2023; 206:13-16. [PMID: 37742448 DOI: 10.1016/j.jcpa.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/09/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023]
Abstract
Necropsy of a 52-day-old Camborough pig revealed numerous cardiac malformations. The positional relationship of the atria, ventricles and great vessels was a mirror image type (I, L and L): inverted arrangement of the atria, with a left-sided right atrium and right-sided left atrium (situs inversus); inverted arrangement of the ventricles, with a left-sided morphological right ventricle and right-sided morphological left ventricle (L-loop); and aortic valve to the front left relative to the pulmonary valve (L-malposed). The major malformations included an ostium secundum atrial septal defect, cor triatriatum sinister (CTS), a subpulmonary ventricular septal defect and a bicuspid pulmonary valve. Histological examination revealed myocyte hypertrophy, focal myocardial necrosis and calcification in the left morphological right ventricle of the heart. To the best of our knowledge, this is the first report of CTS in pigs. Although the individual malformations found in the present case are not unique, an unusual combination of these cardiac malformations has not been described in animals.
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Affiliation(s)
- Takanori Shiga
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan
| | - Yumiko Kamiya
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan
| | - Mitsuharu Ohkubo
- Hogvet Creation Inc., 1-4-14 Sendamachi, Naka-ku, Hiroshima City, Hiroshima, Japan
| | | | - Yoko Kakinuma
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan
| | - Hideki Kayanuma
- Laboratory of Veterinary Radiology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan
| | - Takuma Aoki
- Laboratory of Veterinary Surgery, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan
| | - Yoko Fujii
- Laboratory of Veterinary Surgery, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan
| | - Naoyuki Aihara
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan
| | - Junichi Kamiie
- Laboratory of Veterinary Pathology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-city, Kanagawa, Japan.
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Zheng X, Cao J, Zhang G. Stunning tornado: severe pulmonary hypertension due to cor triatriatum sinister. Eur Heart J 2023; 44:3485. [PMID: 37554080 DOI: 10.1093/eurheartj/ehad505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Affiliation(s)
- Xuan Zheng
- Center of Structural Heart Disease, Zhongnan Hospital of Wuhan University, No. 169 Donghu Rd, Wuhan, Hubei 430071, China
| | - Jinsong Cao
- Center of Structural Heart Disease, Zhongnan Hospital of Wuhan University, No. 169 Donghu Rd, Wuhan, Hubei 430071, China
| | - Gangcheng Zhang
- Center of Structural Heart Disease, Zhongnan Hospital of Wuhan University, No. 169 Donghu Rd, Wuhan, Hubei 430071, China
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5
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Espejel-Guzman A, Cabello-Ganem A, Armendariz-Ferrari JC, Serrano-Roman J, Aparicio-Ortiz AD, Espinola-Zavaleta N. Hidden problems in a case of atrial fibrillation. Echocardiography 2023; 40:364-369. [PMID: 36964930 DOI: 10.1111/echo.15554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 03/27/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. However, the relation between congenital heart defects and the predisposition to AF is not fully understood. A 65-year-old male was admitted into the emergency department due to progressive dyspnea, orthopnea, palpitations, and edema. Transthoracic echocardiogram showed bi-atrial enlargement and dysplasia of the mitral leaflets with severe mitral regurgitation. Also, a membrane was noted in the LA, dividing the chamber into two parts, suggestive of cor triatriatum sinister. Coronary computed tomography angiography demonstrated a soft tissue septum in the left atrium. Multimodal evaluation is of vital importance for a complete approach, since, detected in time, it has an excellent prognosis.
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Affiliation(s)
- Adrian Espejel-Guzman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Jose C Armendariz-Ferrari
- Department of Clinical Cardiology and Echocardiography, Hospital Nacional Hipolito Unanue, Lima, Peru
| | - Javier Serrano-Roman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Alexis D Aparicio-Ortiz
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Department of Echocardiography, ABC Medical Center I.A.P., Mexico City, Mexico
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Meng L, Kong X, Wei K, Lv X, Liu C, Bing W. Corrected Transposition of Great Arteries with Cor Triatriatum and Atrial Septal Defect-Case Report. Heart Surg Forum 2023; 26:E156-E159. [PMID: 36972601 DOI: 10.1532/hsf.5173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 03/21/2023]
Abstract
A 37-year-old male patient with corrected transposition of great arteries (ccTGA) with cor triatriatum sinister (CTS), left superior vena cava, and atrial septal defects is reported in our case. None of these impacted the patient's growth or development, nor daily work until age 33. Later, the patient developed symptoms of obvious impaired heart function, which improved after medical treatment. However, the symptoms reappeared and gradually worsened two years later, and we decided to treat it with surgery. In this case, we selected tricuspid mechanical valve replacement, cor triatriatum correction, and atrial septal defect repair. During the follow-up of five years, the patient had no obvious symptoms, ECG did not change significantly from five years ago, and the cardiac color Doppler ultrasound showed RVEF 0.51.
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Affiliation(s)
- Lingwei Meng
- Qilu Hospital of Shandong University, Jinan, China.
| | | | - Kaiming Wei
- Qilu Hospital of Shandong University, Jinan, China.
| | - Xin Lv
- Qilu Hospital of Shandong University, Jinan, China.
| | | | - Weidong Bing
- Qilu Hospital of Shandong University, Jinan, China.
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Barycki M, Rola P, Kuzemczak A, Włodarczak A, Włodarczak S, Engel B, Doroszko A, Gackowski A. Coincidence of cor triatriatum sinistrum and bicuspid aortic valve in an adult patient. Kardiol Pol 2022; 80:954-955. [PMID: 35916488 DOI: 10.33963/kp.a2022.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland.
| | - Piotr Rola
- Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland
| | - Anna Kuzemczak
- Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland
| | | | | | - Barbara Engel
- Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Andrzej Gackowski
- Jagiellonian University, Medical College, Institute of Cardiology, Department of Coronary Disease and Heart Failure, John Paul II Hospital, Kraków, Poland
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8
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Lugtu IC, Hu YF, Lin YJ, Walia R, Liu CM, Chang SL, Chung FP, Liao JN, Lo LW, Chen SA. Catheter ablation of complex atrial tachyarrhythmias in adult patients with cor triatriatum. J Interv Card Electrophysiol 2020; 62:277-283. [PMID: 33078325 DOI: 10.1007/s10840-020-00888-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Reports concerning clinical characteristics of cor triatriatum and approaches for catheter ablation of complex atrial tachyarrhythmias remain limited. Here, we describe successful catheter ablation treatments for complex atrial tachyarrhythmias in patients with cor triatriatum and address the clinical caveats. METHODS Demographic characteristics, electrophysiologic findings, and ablation results in four patients with cor triatriatum were described. RESULTS Catheter ablation was performed in four patients with cor triatriatum (three sinister and one dexter) and complex atrial arrhythmias (three with persistent atrial fibrillation (AF) and one with atypical left atrial flutter). A transseptal puncture was selectively directed into the accessory compartment containing the pulmonary veins. A comprehensive preview involving transthoracic echocardiography, transesophageal echocardiography, and computed tomography of the pulmonary veins was critical for proper positioning of ablation catheters. The pulmonary veins remain the major triggers or initiators for AF, and four pulmonary vein isolation procedures were sufficient to achieve successful results with negative inducibility test in the patients with AF. Heterogeneous conduction and complex fractionated signals were observed on the fibromuscular membrane. Atypical flutter was terminated during ablation over the connection between membrane and left atrial roof. The procedure was successfully performed on all patients without complications. No acute recurrences of atrial tachyarrhythmias were observed in any of the patients during short-term follow-up. CONCLUSIONS Catheter ablation is a feasible and efficient therapeutic strategy for treating complex atrial tachyarrhythmias in patients with cor triatriatum. Atrial remodeling due to anatomical obstruction or heterogeneous conduction of the fibromuscular membrane may serve as an arrhythmic substrate.
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Affiliation(s)
- Isaiah C Lugtu
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Heart Institute, Chinese General Hospital and Medical Center, Manila, Philippines
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Rohit Walia
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Chih-Min Liu
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Ojeda Ramos M, Viladés Medel D, Leta Petracca R. Abnormal Pulmonary Venous Drainage With Cor Triatriatum. ACTA ACUST UNITED AC 2019; 72:341. [PMID: 30905343 DOI: 10.1016/j.rec.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Manuel Ojeda Ramos
- Sección de Imagen, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - David Viladés Medel
- Sección de Imagen, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Leta Petracca
- Sección de Imagen, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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10
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Kondo Y, Enomoto M, Kinoshita T, Suzuki T, Asai T. [Cor Triatriatum in an Adult Patient Conbined with Mitral Regurgitation and Coronary Artery Disease;Report of a Case]. Kyobu Geka 2018; 71:610-614. [PMID: 30185759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 71-year-old female, who had been diagnosed with cor triatriatum 30 years before, presented with complains of worsening dyspnea and fatigue. She was diagnosed with a combination of cor triatriatum, mitral valve disease and coronary artery disease. She underwent removal of the left atrial membrane, repair of the mitral valve and coronary artery bypass grafting. This combination of cor triatriatum, mitral valve disease and coronary artery disease is exceedingly rare. She remains well at 3 years' follow-up.
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Affiliation(s)
- Yasuo Kondo
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan
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11
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Said SM, Ibrahimiye AN, Punn R, Hanley FL. Hemoptysis as a rare presentation of cor triatriatum sinister. J Thorac Cardiovasc Surg 2015; 150:e73-5. [PMID: 26344680 DOI: 10.1016/j.jtcvs.2015.07.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Ali N Ibrahimiye
- Division of Pediatric Cardiac Surgery, Stanford University, Palo Alto, Calif
| | - Rajesh Punn
- Division of Pediatric Cardiology, Stanford University, Palo Alto, Calif
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Stanford University, Palo Alto, Calif
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12
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Kurazumi T, Suzuki T, Morita Y, Masuda J. [Diagnosis and evaluation of a patient with cor triatriatum using perioperative transesophageal echocardiography]. Masui 2014; 63:333-337. [PMID: 24724446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cor triatriatum is a rare congenital cardiac anomaly accounting for only 0.1-0.4% of all congenital heart diseases usually diagnosed in infancy or childhood and rarely found in adults. It is characterized by fibromuscular membrane dividing the left atrium into two chambers. This congenital heart disease is reported to be frequently associated with variety of cardiac anomalies such as an atrial septal defect, anomalous pulmonary venous drainage, and persistent left superior vena cava. A woman with no cardiac history was admitted to the hospital due to acute heart failure and diagnosed as severe mitral regurgitation and cor triatriatum by pre-orerative transthoracic echocardiography. Emergency mitral valve plasty was undertaken because of the severity of mitral regurgitation without determining the detailed type of cor triatriatum. Thus, diagnosis of the type of cor triatriatum with perioperative transesophageal echocardiography (TEE) was required to establish correct cardiopulmonary bypass and determine the operative procedure. Perioperative TEE revealed that the type was Lucas-Schmidt- I A, and cardiopulmonary bypass was established safely. Operation was performed without any problems. The TEE skill of our anesthesiologists could contribute to the safe management of the cardiac surgery.
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Demirkol S, Balta S, Unlü M, Yokuşoğlu M. Three-dimensional echocardiography in the evaluation of cor triatriatum sinistrum in an adult patient with atrial septal defect. Anadolu Kardiyol Derg 2013; 13:E12. [PMID: 23274210 DOI: 10.5152/akd.2013.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Sait Demirkol
- Department of Cardiology, Faculty of Medicine, Gülhane Military Medical Academy, Ankara, Turkey.
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14
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Eichholz JL, Hodroge SS, Crook JJ, Mack JW, Wortham DC. Cor triatriatum sinister in a 43-year-old man with syncope. Tex Heart Inst J 2013; 40:602-605. [PMID: 24391336 PMCID: PMC3853815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cor triatriatum sinister, a congenital cardiac anomaly involving a fibromuscular membrane that partitions the left atrium into 2 chambers, has been reported in only 0.1% to 0.4% of patients with congenital heart disease. The posterosuperior chamber receives blood from the pulmonary veins, and the anteroinferior chamber contains the left atrial appendage and mitral valve orifice. Most patients are diagnosed with the condition in infancy or childhood; adult cases are rare. We describe a case of cor triatriatum sinister in a 43-year-old man whose only presenting symptom was recurrent syncope. He underwent corrective resection of the membrane and was asymptomatic thereafter. In addition to discussing the patient's case, we review the relevant medical literature.
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Affiliation(s)
- Janet L Eichholz
- Departments of Cardiology (Drs. Crook, Eichholz, and Wortham), Internal Medicine (Dr. Hodroge), and Cardiothoracic Surgery (Dr. Mack), The University of Tennessee Medical Center, Knoxville, Tennessee 37920
| | - Samer S Hodroge
- Departments of Cardiology (Drs. Crook, Eichholz, and Wortham), Internal Medicine (Dr. Hodroge), and Cardiothoracic Surgery (Dr. Mack), The University of Tennessee Medical Center, Knoxville, Tennessee 37920
| | - Jerry J Crook
- Departments of Cardiology (Drs. Crook, Eichholz, and Wortham), Internal Medicine (Dr. Hodroge), and Cardiothoracic Surgery (Dr. Mack), The University of Tennessee Medical Center, Knoxville, Tennessee 37920
| | - John W Mack
- Departments of Cardiology (Drs. Crook, Eichholz, and Wortham), Internal Medicine (Dr. Hodroge), and Cardiothoracic Surgery (Dr. Mack), The University of Tennessee Medical Center, Knoxville, Tennessee 37920
| | - Dale C Wortham
- Departments of Cardiology (Drs. Crook, Eichholz, and Wortham), Internal Medicine (Dr. Hodroge), and Cardiothoracic Surgery (Dr. Mack), The University of Tennessee Medical Center, Knoxville, Tennessee 37920
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15
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Affiliation(s)
- N A McKeag
- The Heart Centre, Royal Victoria Hospital, Belfast, UK.
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16
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Lasa JJ, Westover T, Khandelwal M, Cohen MS. Cor triatriatum dexter and right ventricular hypoplasia in a fetus. J Ultrasound Med 2011; 30:1744-1747. [PMID: 22124011 DOI: 10.7863/jum.2011.30.12.1744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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17
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Işilak Z, Uzun M, Cay S. Cor triatriatum sinister with secundum atrial septal defect in a patient with recurrent pulmonary infections. Anadolu Kardiyol Derg 2011; 11:E26. [PMID: 21967793 DOI: 10.5152/akd.2011.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Zafer Işilak
- Clinic of Cardiology, GATA Haydarpaşa Training and Research Hospital, İstanbul-Turkey
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18
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Akintunde AA. Cor triatriatum in an 86-year-old woman: initial presentation with pulmonary hypertension discovered during preoperative evaluation. Singapore Med J 2011; 52:e203-e205. [PMID: 22009408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cor triatriatum is a congenital heart malformation that is characterised by the division of the left or right atrium into two separate chambers by a membrane or diaphragm. Reports among adults are scarce, as most cases are diagnosed during childhood. The risk of mortality is increased when cor triatriatum is complicated by pulmonary hypertension. This is a report of an 86-year-old woman with World Health Organization Group 2 pulmonary hypertension secondary to cor triatriatum, discovered during preoperative workup. Echocardiography showed a membrane dividing the left atrium into two. Doppler studies revealed a reversal of normal flow, similar to mitral stenosis. The right ventricle was dilated, with reduced long axis function.
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Affiliation(s)
- A A Akintunde
- Department of Cardiology and Angiology, Eberhard-Karls-University, Otfried-Müller-Strasse 10, Tübingen 72074, Germany.
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19
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Davlouros PA, Koutsogiannis N, Karatza A, Alexopoulos D. An unusual case of cor triatriatum sinister presenting as pulmonary oedema during labor. Int J Cardiol 2011; 150:e92-3. [PMID: 20022643 DOI: 10.1016/j.ijcard.2009.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Accepted: 11/29/2009] [Indexed: 02/08/2023]
Abstract
A 35 years old second gravida was admitted to our department with acute pulmonary oedema after labor. Echocardiography disclosed an intra-atrial membrane prolapsing through the mitral valve in diastole, with two small orifices creating a mean pressure gradient of 7.9 mm Hg. However the membrane clearly originated away from the mitral valve ring, proximal to the left atrial appendage, consistent with cor triatriatum sinister. Cor triatriatum sinister rarely presents in adulthood and although forward movement of the membrane towards the mitral valve funnel has been described, such a degree of prolapse through the valve has never been reported.
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20
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Tornic J, Jarrett C, Shiota T, Gillinov AM, Mihaljevic T. Severe mitral regurgitation in an adult patient with cor triatriatum. J Heart Valve Dis 2011; 20:234-236. [PMID: 21560829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 52-year-old female patient who presented with a history of increasing shortness of breath and fatigue was diagnosed with a combination of cor triatriatum and myxomatous mitral valve disease. Transesophageal echocardiography revealed cor triatriatum and severe mitral regurgitation (MR) due to myxomatous degeneration. The patient underwent a successful removal of the left atrial membrane and repair of the mitral valve. This combination of cor triatriatum and myxomatous mitral valve disease is exceedingly rare; in the present patient the symptoms caused by MR led to the discovery of a left atrial membrane.
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Affiliation(s)
- Jure Tornic
- Department of Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio 44125, USA
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21
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Nieuwland J, Beijerink N, Szatmári V. [Resolution of ascites after successful balloon dilatation of cortriatriatum dexter in a dog]. Tijdschr Diergeneeskd 2010; 135:330-333. [PMID: 20437897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 9-month-old male American Cocker Spaniel was examined for progressive abdominal distension, tachypnoea, and decreased appetite. Physical examination revealed signs of congestion in the caudal body half only (ascites, congested saphenic vein), and abdominocentesis yielded a modified transudate. Echocardiography revealed an abnormal membrane in the right atrium and cor triatriatum dexter was diagnosed; the diagnosis was confirmed by cardiac catheterization. Successful treatment consisted of balloon dilatation of the pinpoint opening in the abnormal membrane. The dog recovered well, with the ascites resolving within a week, and its further development was normal.
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Affiliation(s)
- J Nieuwland
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, P.O. Box 80154, 3508 TD Utrecht, The Netherlands
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22
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Sen T, Guray Y, Demirkan BM, Alioglu H, Korkmaz S. Cor triatriatum sinister in a 67-year-old man with atrial fibrillation. Tex Heart Inst J 2010; 37:246-247. [PMID: 20401308 PMCID: PMC2851416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Taner Sen
- Department of Cardiology, Yuksek Ihtisas Education & Research Hospital, 06100 Ankara, Turkey.
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23
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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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24
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Maziarz A, Zabek A, Małecka B, Lelakowski J. [Pacemaker implantation in a patient with cor triatriatum sinister - preoperative evaluation]. Kardiol Pol 2009; 67:87-90. [PMID: 19253197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A case of 72 year old-male with cor triatriatum sinister, permanent atrial fibrillation and symptomatic bradycardia is presented. Patient was scheduled for pacemaker implantation. A preoperative evaluation with transesophageal echocardiography revealed a nonrestrictive membrane in left atrium, normal right superior vena cava and absence of persistent left superior vena cava and other cardiac anomalies. A right ventricular pacemaker lead was implanted through left subclavian approach. Preoperative evaluation shortened a radiation exposure and procedure time.
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Affiliation(s)
- Andrzej Maziarz
- Krakowski Szpital Specjalistyczny im. Jana Pawła II, ul. Pradnicka 80, 31-202 Kraków.
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25
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McLean MK, Kung GC, Polimenakos A, Wells WJ, Reemtsen BL. Cor Triatriatum Associated with ASD and Common Atrium in 7-Month-Old With Tachypnea and Failure to Thrive. Ann Thorac Surg 2008; 86:1999. [PMID: 19022036 DOI: 10.1016/j.athoracsur.2008.01.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 01/09/2008] [Accepted: 01/11/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Michael K McLean
- Department of Cardiothoracic Surgery, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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26
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Gaio G, Santoro G, Iacono C, Palladino MT, Russo MG, Calabrò R. Left cor triatriatum: a rare potential cause of total anomalous pulmonary vein connection obstruction. Int J Cardiol 2008; 129:e41-2. [PMID: 17869357 DOI: 10.1016/j.ijcard.2007.06.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 06/23/2007] [Indexed: 11/26/2022]
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27
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Sahin T, Bildirici U, Kandemir C, Celikyurt U, Ural D, Komsuoglu B. Infective endocarditis in the setting of infundibular-valvular pulmonary stenosis with incomplete cor triatriatum dextrum and patent foramen ovale. Int J Cardiol 2008; 127:e129-31. [PMID: 17692958 DOI: 10.1016/j.ijcard.2007.04.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
Cor triatriatum dextrum is a rare congenital malformation, usually associated with complex right heart abnormalities, characterized by a membrane that divides the right atrium into two chambers. It is considered the result of the incomplete and abnormal regression of the embryonic right valve of the sinus venosus. With an incomplete regression, a fenestrated or an unfenestrated membrane may persist in the right atrium. Cor triatriatum dextrum may be seen with congenital cardiac defects associated with the right heart. We have diagnosed infective endocarditis in a 19 year old male patient with asymptomatic incomplete cor triatriatum dextrum, PFO and valvular-infundibular severe pulmonary stenosis based on the Duck criteria, with a positive blood culture and 3 minor criteria. Echocardiography did not reveal any vegetations. Antibiotherapy was given and then regions responsible of the stenosis were resected surgically. After surgery a small outlet type VSD development was observed.
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28
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Sevimli S, Gündoğdu F, Arslan S, Senocak H. [Cor triatriatum sinister in a 19-year-old patient]. Turk Kardiyol Dern Ars 2008; 36:259-262. [PMID: 18765971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Cor triatriatum sinister is a rare congenital cardiac anomaly in which the left atrium is divided into two chambers by a fibromuscular septum. Although the disease is generally diagnosed in early childhood, some patients remain asymptomatic until adulthood. A 19-year-old female patient presented with dyspnea that increased in severity for the past year. Her functional capacity was NYHA class II. She had no other complaints in history. Cardiac auscultation revealed a grade 2/6 apical diastolic murmur. Findings of electrocardiography and chest radiography were normal. Transthoracic echocardiography showed a thin membrane dividing the left atrium, but no transmembrane flow was visualized. The flow could be visualized by transesophageal echocardiography, but the area of membrane fenestration could not be determined. The diagnosis was made as cor triatriatum sinister and the patient underwent cardiac catheterization, which revealed a pressure gradient of 10 mmHg between the pulmonary capillary wedge pressure and left ventricular end-diastolic pressure. The patient was submitted to surgical correction.
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Affiliation(s)
- Serdar Sevimli
- Department of Cardiology, Medicine Faculty of Atatürk University, Erzurum, Turkey.
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29
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Abstract
An asymptomatic 10-year-old boy presented with reduced exercise tolerance and an echocardiographic diagnosis of cor triatriatum. Transthoracic and transesophageal echocardiography failed to reveal the persistent levoatrial cardinal vein discovered at surgery. In patients with late presentation of cor triatriatum with severe mitral inflow obstruction and a small patent foramen ovale, an alternative communication between the posterior collecting chamber and the systemic venous circulation should be sought with alternative imaging techniques.
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Affiliation(s)
- Cristiana Feltri
- Cardiac Unit, Royal Liverpool Children's NHS Trust, Alder Hey, Eaton Road, Liverpool L12 2AP, United Kingdom
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30
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Bladt O, Vanhoenacker R. Cor triatriatum. JBR-BTR 2008; 91:62. [PMID: 18549152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- O Bladt
- Department of Radiology, OLVH, Aalst, Belgium
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31
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Kehl HG, Maintz D, Fischbach R, Kotthoff S, Tjan TD, Zahn PK, Wichter T. Cor triatriatum sinistrum combined with supracardiac anomalous pulmonary venous return in an adult causing arrhythmogenic heart failure. Clin Res Cardiol 2007; 96:752-4. [PMID: 17701367 DOI: 10.1007/s00392-007-0554-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Accepted: 05/29/2007] [Indexed: 11/25/2022]
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32
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Chakraborty PP, Bandyopadhyay D, Mandal SK, Subhasis RC. A rare variant of Ellis van Creveld syndrome. Singapore Med J 2007; 48:684-6. [PMID: 17609834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A nine-year-old boy presented with progressively-increasing exertional dyspnoea for the last three months. The only significant finding in the general survey was polydactyly. His vital signs were normal. He had a prominent apical diastolic thrill, a prominent S1 with a low-pitched grade 4/6 mid diastolic rumbling murmur over the apex. The S2 was widely split, fixed and the second component was louder than the first one. There was a grade 3/6 ejection systolic murmur over the left second intercostal space. Electrocardiography showed features of left axis deviation, bi-atrial enlargement and right ventricular hypertrophy. Transthoracic echocardiography identified a thin undulating intra-atrial membrane on the left side along with an ostium-primum defect. In this patient, the diagnosis of a variant of Ellis van Creveld syndrome was made.
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Affiliation(s)
- P P Chakraborty
- Department of Medicine, Midnapore Medical College, PO Midnapore, Dist. Pashim Medinipur, West Bengal 721101, India.
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33
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Ozkökeli M, Kayacioğlu I, Sensöz Y, Uslu N, Kanca A. Cor triatriatum sinistrum in adults: surgical treatment of two cases. Anadolu Kardiyol Derg 2007; 7:200-1. [PMID: 17513222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Mehmet Ozkökeli
- Department of Cardiovascular Surgery, Izzet Baysal Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey.
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34
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Greve G, Leirgul E. [Tachyarrhythmia and cor triatriatum]. Tidsskr Nor Laegeforen 2007; 127:1058. [PMID: 17469212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
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35
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Karthik S, Kelpis TG, Abela CB, Weerasena NA. "Asthma": an unusual presentation of cor triatriatum. Hellenic J Cardiol 2007; 48:50-2. [PMID: 17388112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
We discuss an extremely unusual presentation of a 19-month-old child with cor triatriatum and an intact interatrial septum, who presented for the first time at the age of 16 months with wheezing and repeated lower respiratory tract infections. At surgery, a thick fibromuscular membrane with a 2-3 mm eccentrically placed orifice was identified, and following surgical resection of the membrane the child made an uneventful recovery. This case demonstrates the need for investigating children with "asthma" who do not respond to conventional medical management. A rare but potentially correctable underlying cause may be found.
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Affiliation(s)
- Shishir Karthik
- Yorkshire Paediatric Cardiothoracic Centre, Leeds General Infirmary, United Kingdom
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36
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Erkut B, Koçak H, Kaygin MA, Ceviz N. Cor triatriatum associated with severe valvular pulmonary stenosis and patent ductus arteriosus: An unreported constellation. Int J Cardiol 2006; 113:108-10. [PMID: 16289372 DOI: 10.1016/j.ijcard.2005.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 08/06/2005] [Indexed: 10/25/2022]
Abstract
A divided left atrium because of cor triatriatum is a relatively rare cardiac anomaly requiring corrective surgery. Although association of cor triatriatum with different congenital heart diseases had been reported, to our knowledge, its association with severe valvular pulmonary stenosis and patent ductus arteriozus had not been reported previously. In this paper, an asymptomatic case with cor triatriatum, severe valvular pulmonary stenosis and patent ductus arteriosus is defined.
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37
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Rhodes J, Bacha EA, Geggel RL. Coexistence of three rare congenital heart defects in a single patient: a unique case with important embryologic implications. Pediatr Cardiol 2006; 27:503-7. [PMID: 16830079 DOI: 10.1007/s00246-006-1275-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Accepted: 02/27/2006] [Indexed: 10/24/2022]
Abstract
The unique anatomy, physiology, and surgical repair of a patient with features of three rare congenital heart defects (total anomalous pulmonary venous return to the coronary sinus, cor triatriatum, and unroofed coronary sinus with persistent left superior vena cava to the left atrium) is described. Analysis of this case suggests that these three conditions are linked in that they all may result as a consequence of a defect in the same embryologic process (i.e., incorporation of the pulmonary venous confluence into the left atrium).
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Affiliation(s)
- Jonathan Rhodes
- Departments of Cardiology and Cardiovascular Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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38
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Caputo S, Santoro G, Morelli C, Sarubbi B, D'Alto M, Russo MG, Calabrò R. Subtotal Anomalous Pulmonary Venous Connection and Left Cor Triatriatum: A Rare Diagnosis in Adulthood. J Am Soc Echocardiogr 2006; 19:836.e1-4. [PMID: 16762767 DOI: 10.1016/j.echo.2005.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Indexed: 11/28/2022]
Affiliation(s)
- Salvatore Caputo
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
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39
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Ieva R, Riccardo I, Correale M, De Luca G, Di Biase M. Cor triatriatum sinister complicated by a voluminous thrombus. Am J Geriatr Cardiol 2006; 15:120-1. [PMID: 16525227 DOI: 10.1111/j.1076-7460.2006.04677.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Riccardo Ieva
- Department of Cardiology, University of Foggia, Foggia, Italy
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40
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Tansel T, Harmandar B, Dayioglu E, Onursal E. Anomalous dual drainage of the right pulmonary veins in a patient with cor triatriatum: report of a case without scimitar sign. J Cardiovasc Surg (Torino) 2006; 47:75-8. [PMID: 16434950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The majority of patients with partial anomalous drainage of pulmonary veins are asymptomatic during infancy and childhood. Patients with significant left-to-right shunt develop symptoms and benefit from early corrective surgery. Anomalous pulmonary veins draining into inferior vena cava is very rare and frequently encountered in association with scimitar syndrome. The purpose of this case report is to describe a non-scimitar patient with cor triatriatum who had anomalous dual drainage of right pulmonary veins into inferior vena cava/left atrium and anomalous connection of persistent left superior vena cava with a common pulmonary venous chamber. The patient underwent an operation with redirection of anomalous pulmonary venous drainage into left atrium and ligation of persistent left superior vena cava.
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Affiliation(s)
- T Tansel
- Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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41
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Troxclair D, Ross KF, Newman WP. Cor triatriatum sinistrum: a rare congenital cardiac anomaly presenting in an adult with chronic atrial fibrillation. Am J Forensic Med Pathol 2005; 26:282-4. [PMID: 16121087 DOI: 10.1097/01.paf.0000176278.76218.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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).
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Affiliation(s)
- Dana Troxclair
- Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.
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42
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Abstract
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.
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Affiliation(s)
- Yu-Jan Lin
- Department of Pediatric Cardiology, Taipei Veterans General Hospital and Yang-Ming University, Taiwan
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43
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Sugimori H, Noma M, Ikeda A, Tokunaga C, Imazuru T, Hiramatsu Y, Matsushita S, Shigeta O, Sakakibara Y. [Cor triatriatum diagnosed in adulthood; report of a case]. Kyobu Geka 2005; 58:893-5. [PMID: 16167816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Cor triatriatum is a rare congenital cardiac anomaly especially in adulthood. A 68-year-old female was diagnosed as a cor triatriatum classified to Lucas-Schmidt IA, severe degree of mitral regurgitation and atrial fibrillation. Resection of the abnormal diaphragm in the left atrium and miral valve replacement were performed. Although the reason of sudden death of this patient after discharge is unknown, surgical intervention for atrial fibrillation should have performed to prevent a thromboembolism in such cases.
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Affiliation(s)
- H Sugimori
- Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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44
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Wojtarowicz A, Peregud-Pogorzelska M. [Cor triatriatum diagnosed in a patient with severe mitral insufficiency]. Kardiol Pol 2005; 62:283-5. [PMID: 15830028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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45
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Kanbara T, Miyake T, Murao K, Jomura S, Yamada M, Sato N, Nakao S, Shingu K. [Anesthesia for cesarean section in a patient with cor triatriatum]. Masui 2005; 54:160-2. [PMID: 15747512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Cor triatriatum is a rare congenital cardiac anomaly, in which left ventricular filling is impeded by obstructive membrane in the left atrium. We administered spinal anesthesia for cesarean section in a patient with cor triatriatum (type III A1) with congestive heart failure. We optimized hemodynamics with the aid of pulmonary artery cathter. In general, cor triatriatum involves similar hemodynamic profiles to mitral stenosis and thus tachycardia should be avoided during anesthesia. However, in our patient, increasing the heart rate to 80-90 beats x min(-1) was beneficial in maintaining adequate systemic blood pressure and cardiac output. Spinal anesthesia could be a method of choice for cesarean section in a patient with cor triatriatum when adequate hemodynamic monitoring is available.
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Affiliation(s)
- Tomoko Kanbara
- Department of Anesthesiology, Kansai Medical University, Moriguchi 570-8506
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46
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Affiliation(s)
- Allison M Heaney
- College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA.
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Leslie SJ, Jilaihawi H, Ruddell W, Hargreaves AD. Case of a late presentation of cor triatriatum in a woman born with an imperforate anus. Scott Med J 2004; 49:107-8. [PMID: 15462228 DOI: 10.1177/003693300404900312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cor triatriatum and imperforate anus are rare. We describe, for the first time, the coexistence of these conditions in a 43 year old woman.
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Affiliation(s)
- S J Leslie
- Medical Unit, Falkirk and District Royal Infirmary, Major Loan, Falkirk.
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Nishimoto H, Beppu T, Komoribayashi S, Konno H, Tomizuka N, Ogasawara K, Ogawa A, Kikuti M, Oikawa K. [A case of multiple cerebral infarction accompanied by a cor triatriatum]. No Shinkei Geka 2004; 32:257-60. [PMID: 15148800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A cor triatriatum is a congenital malformation of the heart which, in almost all cases, is diagnosed in childhood, whereas adult cases are very rare. The hemodynamics of the cor triatriatum is similar to that of mitral stenosis, which sometimes, but rarely, causes embolism. We present a case of multiple cerebral infarctions accompanied with a cor triatriatum. A 57-year-old female suddenly displayed impaired consciousness and hemiparesis immediately after cranioplasty for another disease, and was diagnosed by a diffusion weighted MRI as having multiple infarctions. A transesophageal echocardiography detected a membrane-like, echo-dense structure across the left atrium, suggesting a cor triatriatum. We suspect that her multiple infarctions were caused by embolism due to a cor triatriatum. Here, we discuss the relationship between her embolic stroke and the cor triatriatum, with references to literature on the subject.
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Affiliation(s)
- Hideaki Nishimoto
- Department of Neurosurgery, Iwate Medical University, Uchimaru 19-1, Morioka, Iwate 020-8505, Japan
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Hamawaki M, Tomino T, Sato H, Imura M, Suzuki K, Nakashima K, Okamoto Y. [Prostacyclin oral internal therapy for severe pulmonary hypertension after total correction of cor triatriatum with partial anomalous pulmonary venous return; report of a case]. Kyobu Geka 2004; 57:147-50. [PMID: 14978912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 37-day-old girl having cor triatriatum with partial anomalous pulmonary venous return was found on emergent admission. Echocardiography and angiography revealed severe pulmonary hypertension with anomalous pulmonary venous return to inominate vein. She still was in respiratory failure after emergent surgical repair because of severe pulmonary hypertension following pulmonary venous obstruction. Prostacyclin is the first Food and Drug Administration (FDA)-approved treatment for advanced primary pulmonary hypertension, which has antithrombotic properties related to its effect on platelets and is a potent vasodilator of both the systemic and pulmonary arteries, and has positive inotropic properties. We started prostacyclin oral internal therapy for her and she recovered from respiratory problems very quickly. Prostacyclin might be effective for pulmonary hypertension before and after surgical repair as primary pulmonary hypertension.
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Affiliation(s)
- M Hamawaki
- Department of Cardiovascular Surgery, National Nagasaki Medical Center, Omura, Japan
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