Cor Triatriatum Sinister Research Articles

Cor triatriatum sinister

A 25-year-old asymptomatic woman showed, in two-dimensional (2D) transthoracic echocardiogram (TTE), a membrane in the left atrium (LA) diagnostic of cor triatriatum sinister. A three-dimensional (3D) TTE (view from the left ventricle; Panel A and Supplementary …

A Rare Association of Cor Triatriatum Sinister With Congenitally Corrected Transposition of Great Arteries

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 32-year-old male was evaluated during a general health checkup. Clinical examination and transthoracic echocardiography revealed situs inversus with mesocardia. The details of intracardiac anatomy could not be obtained due to

On the many possible futures of atrial fibrillation

After reading the latest report of yet another case of adult cor triatriatum sinister complicated by atrial fibrillation by Siniorakis et al. [1] the following quote by the bestselling British author of heroic fantasy, David Andrew Gemmell sprang into my mind: “Life is not so simple. There are many futures. The life of a single person is like a great tree: every branch, every twig, every leaf is a possible future” [2]. This is especially true in the clinical scenario of atrial fibrillation. Clearly a multifactorial disease with many possible causes...many branches, many twigs, many leaves.... Clearlywe can add adult cor triatriatum sinister as yet another leaf to the tree of atrial fibrillation. However, we are faced with numerous clinical questions on this fairly newly discovered adult clinical entity. Why do these adult patients present so late? It can be assumed that they had fairly asymptomatic childhood years as they would present as adults with extensive clinical investigations as children otherwise, which certainly is not the case if one looks at all the currently available case reports. Secondly, by merely assuming that this entity is as simple as a congenital membrane separating various parts of the left atrium one is left with a hypothesis which is fraught with many errors and open to criticism. If this was truly the case, then why the late presentation as adults. Therefore, a reasonable question is if this presumed developmental anomaly involves the whole atrial wall with abnormal atrial musculature as a whole affecting all structural components. Thirdly, we have to ask the question if whether they may all have had atrial fibrillation since birth which was simply not diagnosed before their adulthood years. This will imply that this particular subset of atrial fibrillation is more benign than the other subsets of adult onset cases with their respective diverse causes. Fourthly, how should these cases be treated, if at all? At present we do not have any evidence based medicine on this subset of patients. Lastly, in my opinion it is essential to obtain a proper imaging study of every single case of atrial fibrillation. I still see patients in my clinic who underwent unsuccessful ablation procedures where no imaging study of the left atriumwas ever performed and hence with no specific diagnosis—my published case report of adult cor triatriatum sinister with adult onset atrial fibrillation is an example of such an unacceptable scenario [3]. In my opinion this can be compared to performing a thoracotomy on a coughing patient without obtaining a chest radiograph first to look for a possible reason for the symptom of cough. In conclusion, we are left with a fairly newly discovered clinical entity with still many unanswered clinical questions. I look forward to these being answered and adding yet another leaf to the complex tree of atrial fibrillation.

Cor triatriatum with a left upper anomalous pulmonary venous return to the innominate vein

Cor triatriatum sinister is an uncommon congenital cardiac anomaly accounting for 0.1% of all congenital cardiac malformations, with an anomalous venous return being a frequently associated condition. We present the case of a 14-year-old girl misdiagnosed as having an atrial septal defect with pulmonary hypertension who actually had a cor triatriatum with a left upper anomalous pulmonary venous return to the innominate vein.

Hybrid cutting balloon dilatation for treatment of cor triatriatum sinister in a cat

A hybrid surgical approach and balloon dilatation were performed successfully in a cat with cor triatriatum sinister and clinical signs of congestive heart failure. Left lateral thoracotomy was used to access the heart and cutting balloon followed by standard balloon dilatation were utilized to dilate the perforation in the anomalous left atrial membrane. Clinical signs resolved completely after dilation of the anomalous left atrial membrane. Based upon the outcome of this case, balloon dilatation appears to be a viable treatment option for cats affected with cor triatriatum sinister.

Absent Right Superior Vena Cava with Persistent Left Superior Vena Cava Which Drains to Unroofed Coronary Sinus in a Child with Atrioventricular Septal Defect and Cor Triatriatum Sinister: Preop Correct Diagnosis and Successful Surgery in a Single Session

We report a unique case of a 4-year-old boy with intermediate-type atrioventricular septal defect, cor triatriatum sinister, persistent left superior vena cava, unroofed coronary sinus, and absent right superior vena cava. Persistent left vena cava draining into the unroofed coronary sinus was demonstrated easily using the agitated saline-contrast echocardiography. After conformation with angiographic evaluation, surgery was performed at a single session. Roofing of the coronary sinus with polytetrafluoroethylene patch, mitral cleft repair, tricuspid annuloplasty, atrioventricular defect repair with pericardial patch, and resection of the membrane in the left atrium was succeeded without complication.

English

A 43-year-old man, who was an elite triathlete, was referred to our sports medical centre for pre-participation screening and abilitation in the triathlon competition. This athlete has been active in racing triathlon and long distance cycling competitions for the last 10 years. His family history revealed no known congenital or other cardiovascular disease and no known causes of premature sudden cardiac death among close relatives. He had no relevant past medical history and physical examination was unremarkable. Peripheral blood pressure was 110/70 mmHg. Resting 12-lead electrocardiogram showed a sinus bradycardia and incomplete right bundle block. The cycloergometre and treadmill maximal exercise test showed a good performance and absence of any electrocardiographic abnormality, with a peak cycling workload of 330 watt, 15 METS on the treadmill Astrand protocol and a maximal heart rate of 165–170 bpm. Twodimensional trans-thoracic echocardiogram demonstrated a left atrium divided into two compartments by an incomplete membrane appearing in an incomplete thin diaphragm in all echocardiographic windows (Figures 1, 2 and 3). The mitral valve appeared slightly dysplastic with mild regurgitation. Pulmonary artery pressure was estimated to be 25 mmHg. Hence, the filling pressure was not elevated and the athlete was asymptomatic. Suspected diagnosis of nonobstructive cor triatriatum sinister was performed. Subsequently, a two-dimensional echocardiogram

Cor triatriatum sinister presenting with adult onset atrial fibrillation—Another rare cause for a common clinical problem

Cor triatriatum – which may present as classical cor triatriatum or cor triatriatum sinister – is a rare form of congenital heart disease where the left atrium is divided by a fibromuscular septum [1]. First described by Church in 1868 [2], this is an entity which is rarely found in adults and accounts for approximately 0.1% of cases of congenital heart disease [3].

Combined 2D and 3D Transthoracic and Transesophageal Echocardiography in the Evaluation of Nonobstructive and Obstructive Cor Triatriatum Sinister

Cor triatriatum sinister is a rare congenital condition in which the left atrium is partitioned into two chambers by a fibromuscular membrane. Two-dimensional transthoracic echocardiography and 2D transesophageal echocardiography are the standard tests of choice for the assessment of function and physiology, although with complex pathology, evaluation of specific structures may be limited. We are reporting the additional use of 3D transesophageal echocardiography to delineate the anatomical features of the membrane in a comprehensive way not possible by conventional 2D imaging.

Unusual case of new‐onset heart failure due to cor triatriatum sinister

We report the case of a 30-year old man who came to the emergency department of our hospital with acute left heart failure, and was diagnosed with a rare congenital anomaly (cor triatriatrum sinister), which can mimic a severe mitral stenosis. Cor triatriatum sinister is a rare anomaly (0.1% of all cases of congenital heart disease) that is seldom diagnosed in adult patients. The hallmark of this congenital defect is the presence of a fibromuscular membrane that divides the left atrium (LA) into two chambers: a postero-superior chamber into which the pulmonary veins drain and an infero-anterior chamber (true LA) containing the mitral valve and atrial appendage. Both chambers communicate through a membrane in which one or more drain holes can be found. When the hole is significantly obstructive, it results in increased venous and arterial pressures. Even though the definitive treatment of cor triatriatum is the surgical excision of the membrane, we present a balloon dilatation case with a good response to percutaneous therapy, both initially and in the ensuing months.

Cor triatriatum sinister with significant pressure gradient in an adult patient

Kor triatriatum sinistra, nadir gorulen dogustan bir kardiyak malformasyondur. Dogustan kalp hastaligi olan tum hastalarin yaklasik olarak %0.1-0.4 kadarini olusturur. Olgularin bircoguna cocukluk caginda tani konulurken, yetiskin hasta sayisi cok azdir. Hastalik sol atriyumu superior-posterior ve anterior-inferior bosluklar olarak iki ayri bosluga bolen fibromuskuler bir membran ile karakterizedir. Otuz yasinda erkek hasta klinigimize son iki yildir progresif artan egzersiz dispnesi ile basvurdu. Renkli Doppler ultrasonografide internal septumdan membranin karsi tarafina dogru uzanan egzantrik, mozaik patern olusturan turbulan akim saptandi. Akimin membran capindaki pik velositesi 2.70 m/sn olup, iki bosluk arasindaki basinc gradyentinin 11.5 mmHg oldugunu gosteriyordu. Membranin cerrahi olarak duzeltilmesi onerildi. Membran eksize edildi ve hastanin ameliyattan bir ay sonraki takip vizitinde tum semptomlar iyilesmisti. Bu yazida membran uzerinde ciddi basinc gradiyenti saptanan eriskin bir tamamlanmamis kor triatriatum sinistra olgusu sunuldu. Anah tar soz cuk ler: Kor triatriatum sinistra; cerrahi duzeltme; transozofageal ekokardiyografi. Cor triatriatum sinistrum is rare congenital cardiac malformation. It accounts for approximately 0.1-0.4% of all patients with congenital heart disease. Most cases are diagnosed in childhood, while adult cases are very rare. The condition is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers a superior posterior chamber and an inferior anterior chamber. A 30-year-old male presenting with progressive exertional dyspnea for the past two years was admitted to our clinic. Color Doppler ultrasonography revealed an eccentric, mosaic pattern of continuous turbulent flow near the interatrial septum across the membrane. The peak velocity of the flow across the membrane was 2.70 m/s, indicating that the pressure gradient between two chamber was 11.5 mmHg. Surgical correction of the membrane was recommended. The membrane was excised and all symptoms resolved in the scheduled visit at one month following surgery. In this article, we report an adult case of incomplete cor triatriatum sinister with a significant pressure drop.

Unusual Case of Cor Triatriatum Sinister

A 26-year-old man was evaluated for progressive shortness of breath on mild exertion. Physical examination was unremarkable. The electrocardiogram revealed left atrial (LA) enlargement. Transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) demonstrated normal biventricular size and systolic function with severely dilated LA and no significant valvulopathy. A thin mobile complex septated membrane was noted within the LA with no clear fenestrations (Fig. 1A and B, Supplementary movie 1 and 2). Transesophageal echocardiogram (TEE) revealed that the membrane is attached to the lateral wall at the coumadin ridge with color turbulence at the site of attachment yet no fenestrations were seen. Medially, the membrane was attached to the inter-atrial septum just above the fossa ovalis with possible multiple fenestrations by color Doppler. The calculated peak/mean gradients were 13-14/9-10 mmHg respectively at both ends. A septum within the membrane was visualized extending from its lateral wall and attached to the inter-atrial septum just above the fossa ovalis (Fig. 1C, D and ​and2,2, Supplementary movie 3-7). A decision was made to proceed with surgical correction. The findings of the TTE/TEE/CMR were confirmed and the atrial membrane was excised around its periphery. Recovery from the surgery was uneventful and he was asymptomatic 6 months afterwards. Echocardiography revealed neither residual membrane nor stenosis of the pulmonary veins. Fig. 1 Transthoracic echocardiography apical 4-chamber view revealing a complex membrane (arrow) with its septum (arrowhead) subdividing the LA into two chambers (A). Cardiovascular magnetic resonance 4-chamber steady-state free precession image showing the ... Fig. 2 Transesophageal echocardiogram modified mid-esophageal views showing the lateral (A) and medial (B) attachments of the membrane with color turbulence and possible multiple fenestrations (B, arrows). Continuous wave Doppler through the lateral edge of ... Cor triatriatum sinister is a rare congenital anomaly wherein the LA is subdivided by a fibromuscular membrane into two chambers. It usually manifests early in life, nonetheless, it might remain asymptomatic till adulthood. Clinical scenario can imitate that of mitral stenosis due to the obstructive nature of the fenestrations. Surgical resection of the membrane is the treatment of choice for symptomatic patients.1-3)

Cor triatriatum sinister with non-fenestration in a seven-month-old patient

Cor triatriatum sinister with non-fenestration in a seven-month-old patient

A Case of Complete Repair of Type-B Atrioventricular Canal Defect and Cor Triatriatum

The association of atrioventricular canal defect and cor triatriatum sinister is very rare and only a few anecdotal reports of successful surgical repair and outcome have been reported. We report a case of Rastelli type-B atrioventricular canal defect with cor triatriatum which was successfully repaired.

Isolated Cor-Triatriatum Sinister Presenting as New Onset Atrial-Fibrillation in a 53-Year-Old Female

Isolated Cor-Triatriatum Sinister Presenting as New Onset Atrial-Fibrillation in a 53-Year-Old Female

Cor triatriatum sinister demonstrated by 3D-transesophageal echocardiography

Cor triatriatum sinister demonstrated by 3D-transesophageal echocardiography

A very rare case: Cor polyatriatum, a variant of cor triatriatum.

Cor triatriatum sinister is a rare congenital heart anomaly. We present an elderly patient with cor polyatriatum, which is a variant of cor triatriatum. The patient was admitted to our hospital with symptoms of congestive heart failure. Echocardiographic evaluation revealed that the left atrium was divided into three spaces of the fibromuscular membrane, resembling a railway. Diagnosis was confirmed by cardiac magnetic resonance imaging. The patient did not accept surgical treatment and was followed medically.

Cor triatriatum sinister versus bowed septum primum in an infant with total anomalous pulmonary venous connection: a difficult imaging distinction

In cor triatriatum sinister, a membrane divides the left atrium into a posterior chamber that receives the pulmonary veins and an anterior chamber that communicates with the mitral valve. With right-side chamber overload, the septum primum can separate from the muscular septum and bow toward the left atrial cavity, leading to a thin membrane within the left atrium and imaging findings that may mimic cor triatriatum. We report the multidetector CT findings of a 3-month-old infant with a supracardiac total anomalous pulmonary venous connection with a bowed septum primum. A description of the imaging findings that distinguish cor triatriatum and bowed septum primum will be discussed. This case demonstrates the usefulness of MDCT in the assessment of supracardiac vascular anomalies and intracardiac anatomy.

Concordant Ventriculoarterial Connections With Parallel Arterial Trunks, Divided Left Atrium, and Juxtaposed Atrial Appendages

We describe a patient with concordant ventriculoarterial connections with parallel arterial trunks, divided left atrium (cor triatriatum sinister), ventricular septal defect, bilateral superior caval veins, and juxtaposed atrial appendages. The aorta was anterior and left sided. We discuss the morphological features of this rare condition, and the diagnostic dilemma it produced.

Cor Triatriatum Sinister in a French Bulldog

A 3-year-old male French Bulldog was evaluated due to recent history of intolerance to exercise and coughing. The clinical, radiographic, and echocardiographic findings were consistent with cor triatriatum sinister (CTS), a congenital heart anomaly in which the left atrium is subdivided into two compartments by an abnormal fibromuscular membrane. This defect has been rarely recognized in humans and in domestic cats. To the best of our knowledge, this is the first report of the disorder in the canine species.