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

Abstract

We present 4 cases of cor triatriatum in whom the diagnosis was correctly made by 2-dimensional transthoracic echocardiography, which showed the supravalvular left atrial membrane that divides the left atrium into 2 chambers. The pulmonary veins were connected normally to the proximal left atrial chamber and the left atrial appendage was connected to the distal left atrial chamber. In 1 patient there was evidence of severe pulmonary venous obstruction to the mitral valve by Doppler examination, while in the other three, there was no venous obstruction. Patients were then examined by real-time 3-dimensional echocardiography (RT3DE, using x4 matrix array transducer connected to Sonos 7500 echocardiographic system Phillips, Andover, Mass, USA). This showed the exact morphology of the membrane and led to cancellation of planed surgical intervention in 1 case in which the membrane was only a broad band crossing the left atrial cavity. In addition to delineating the exact morphology of the intracavitary anomaly, this novel echocardiographic imaging modality should be an additive tool to better understand the natural history of these nonobstructive left atrial membranes via longitudinal follow-up of these patients.

Cor Triatriatum Evaluated by Real Time 3D TEE

“…Several authors have used transthoracic 3D echo to evaluate cor triatriatum, 7–10 but we are the first to report using RT3D TEE for this purpose. The technique has a major advantage over transthoracic 3D echo for cor triatriatum evaluation because during TEE the ultrasound probe is in the esophagus and hence is in extremely close proximity to the membrane, indeed, substantially closer than the mitral valve.…”

Cor Triatriatum Sinister in an Adult: Management Guided by Real Time Three‐Dimensional Transesophageal Echocardiography and Stress Echocardiography

“…CT is a rare congenital anomaly but is being diagnosed more frequently in adults as an incidental finding due to increased use and improved resolution of echocardiography and other imaging modalities. [1][2][3] Although usually restrictive, symptomatic and requiring surgical correction when presenting in childhood, CT may be non obstructive, asymptomatic and managed conservatively when diagnosed incidentally in adults. [1][2] However, management of CT in adults may be problematic when discovered incidentally during a work up for cardiac symptoms.…”

Congenital heart disease in children

“…Some groups of lesions such as double outlet right ventricle [38] and complex transposition of the great arteries lend themselves readily to interrogation by 3D echocardiographic techniques [36] [37]. In such patients, the development of small footprint high frequency matrix transducers has been a particularly important development because fundamental decisions with regard to type of repair are often made in infancy.…”