An Unusual Cause of Thromboembolism in a 52 Year Old Man

Abstract

course parallel to the mitral valve that separated the atrium into postero-superior and anterior-inferior halves ( Figure 4). 3D ultrasound revealed a large opening in the infero-posterior side with a regular flow without hemodynamically significant stenosis ( Figure 5). The cine-MRI confirmed the presence of a small leftright jet flow owing to the traction of the inter-atrial septum by the intra-atrial membrane. Due to the huge communication and the absence of symptoms, currently we didn't consider invasive diagnostic tests or surgery intervention for correction of the defects. We decided to put the patient on therapy with low-dose of acetylsalicylic acid and follow him periodically. DiscussionOur report emphasizes some observations about Cor Triatriatum Sinister (CTS). This congenital defect is a condition in which the left atrium is divided into two chambers by a fenestrated fibromuscular septum [1]. CTS are generally diagnosed in pediatric populations, with age at presentation depending on the size of the membrane fenestration and the resulting obstruction to inflow Case ReportA 52-year-old asymptomatic patient was referred to our Centre after performing a pre surgical ECG for nasal septoplasty. The ECG documented isolated negative T wave in aVL and small r wave in the inferior leads (Figure 1). His mother was suffering from hyperhomocysteinemia and he was affected too, so he was treated with folic acid since he was a child. About 20 years before the patient had a previous retinal arterial thrombosis conditioning partial reduction of the visual field. The physical examination was normal. No arrhythmias were discovered during monitoring. A 2D transthoracic echocardiography revealed a slight hypertrophy of a left ventricle with preserved systolic function. Left atrium was not dilated and there was a mobile membrane-like echogenic structure dividing it into two compartments: a proximal one receiving the pulmonary venous flow and a distal one containing left atrial appendage ( Figure 2). The microbubbles test, performed through transesophageal echocardiography, showed small inter-atrial right to left shunt (Figure 3). MRI documented the presence of the membrane withFigure 1: The ECG shows sinus rhythm, normal heart rate and A-V conduction with isolated negative T wave in aVL and small r wave in the inferior leads.