Clear Morphological Depiction of Cor Triatriatum in a Child by Transthoracic 3-Dimensional Echocardiography

Abstract

A 3-year-old boy had a history of cor triatriatum, which was diagnosed incidentally when he was 1 year old during workups for failure to thrive and funnel chest. Initial echocardiographic evaluation revealed no evidence of obstruction through the orifice (mean pressure gradient, 3 mm Hg). However, progressive flow obstruction was noted at follow-up. At 3 years of age, 2-dimensional echocardiography at the apical 4-chamber view demonstrated a membrane-like structure traversing the left atrium (LA) (Figure 1A; see Movie I in the online-only Data Supplement). Doppler echocardiography revealed a mean pressure gradient of 8.9 mm Hg across the orifice of this membrane (Figure 1B). However, depiction of the relationships between this membrane and the surrounding structures was not clear. Therefore, transthoracic 3-dimensional echocardiography (3DE) was performed (iE33; Philips, Andover, MA) with an X-7 matrix array transducer. The 3DE images cropped from the posterior and superior aspects of the LA toward the atrioventricular groove clearly showed that this membrane extended from the fossa ovalis area of the atrial septum to the LA free …