Cor triatriatum sinistrum. Diagnostic features on cross sectional echocardiography.

Abstract

M mode and cross sectional echocardiography was carried out in three cases of cor triatriatum sinistrum (two infants and one adult). In two cases a peculiar double arch appearance, not previously reported, was found. All three cases were referred for surgery without cardiac catheterisation, and the diagnosis proved to be correct. The characteristic echocardiographic feature of cor triatriatum is an intra-atrial membrane detected in multiple planes of examination, curving anteroinferiorly and inserting some distance away from the mitral valve ring, proximal to the left atrial appendage. Superiorly the membrane runs parallel to, and a short distance behind, the aortic root creating a superior recess of the distal left atrial chamber. These features differentiate cor triatriatum from a supravalvar mitral ring. During diastole the membrane moves forward towards the mitral valve funnel. This, together with the arching appearance of the membrane on four chamber views and the more superior position of the membrane, makes it possible to distinguish cor triatriatum from total anomalous pulmonary venous drainage to the coronary sinus. From a review of past experience at the Brompton Hospital of the diagnostic accuracy of cardiac catheterisation in this condition, it is concluded that cross sectional echocardiography is superior to angiography as a technique for diagnosing cor triatriatum.

Diagnostic features and pitfalls in the two-dimensional echocardiographic evaluation of a child with cor triatriatum

“…Despite improvements in angiographic techniques, cor triatriatum has been frequently overlooked or misdiagnosed [2,4,5] . Two-dimensional echocardiography appears to be a reliable, accurate method to detect cor triatriatum 11,4,8] .…”

“…This anomaly has been characteristically diagnosed by the clinical presentation and the angiographic appearance of an abnormal left atrial membrane . Cor triatriatum has been successfully diagnosed by two-dimensional echocardiography in adults and children, and patients have now been referred for surgery on the basis of the clinical and echocardiographic findings without cardiac catheterization and angiography [1,4,8] . This report describes a child with cor triatriatum who was referred for surgery on the basis of the twodimensional echocardiographic evaluation .…”

Cor triatriatum sinistrum: Diagnosis by Doppler Echocardiography

“…The clinical man ifestations are dependent on the degree of obstruction to pulmonary venous return and the occurrence of additional cardiac malfor mations. Other causes of LV inflow obstruc tion such as mitral stenosis, supra-valvular mitral ring, total anomalous pulmonary ve nous drainage into the coronary sinus and additional associated cardiac defects must be excluded before surgery is recommended [1], Early diagnosis and surgery in hemodynamically significant obstruction are impor tant to prevent pulmonary edema and the development of irreversible pulmonary ar terial hypertension. However, early surgery in hemodynamically insignificant cases may be hazardous.…”

“…Cor triatriatum (CTT) is a rare congenital cardiac malformation with a prevalence of approximately 0.1 % of all congenital heart diseases [1], Diagnosis of this abnormality has been greatly aided by the use of echocar diography, both M-mode and two-dimen sional (2-D), but mainly the latter [2,3]. In adults transesophageal 2-D echo has been suggested as the most accurate procedure in diagnosing and evaluating the morphology of CTT [4], Doppler echocardiography is a relatively new technique that has become an integral part of the cardiovascular ultra sound examination.…”

Echocardiographic Finding of Non-Obstructive Fibromuscular Band in Right Atrium

“…Other congenital conditions like tetralogy of Fallot, double outlet right ventricle, coarctation of the aorta, partial anomalous pulmonary venous connection, persistent left superior vena cava with unroofed coronary sinus, ventricular septal defect, atrioventricular cushion defects and common atrioventricular canal., Asplenia or polysplenia have been reported in adults. In adults, cortriatriatum is frequently an isolated finding (Figures 2 and 3) [21][22][23][24][25][26][27][28][29][30].…”