Multimodality Imaging of Cor Triatriatum Sinister in an Octagenerian

Bezgin, Tahir; Çanga, Yiğit; Karagöz, Ali; Yılmaz, Fatih; Doğan, Cem; Elveran, Ali; Kaymaz, Ci̇hangi̇r

doi:10.1111/echo.12660

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…Finally, the MRI allows getting more and more detailed images, especially in pre-surgical setting. Cine-MRI clearly depicts the fenestration within the membrane with the associated flow turbulence, seen as a low intensity signal contrasted with the high-signal intensity of normal blood flow [5,7,8]. In conclusion, we hope that in all cases of peripheral embolism a transthoracic echocardiogram is performed as first line imaging approach to rule out favoring cardiac abnormalities.…”

Section: Case Reportmentioning

confidence: 88%

An Unusual Cause of Thromboembolism in a 52 Year Old Man

Zuffada¹

2015

JCTCD

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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.

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Section: Case Reportmentioning

confidence: 88%

An Unusual Cause of Thromboembolism in a 52 Year Old Man

Zuffada¹

2015

JCTCD

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“…In this case report, the location of the atrial membrane differentiates CTS from a supravalvular mitral ring. In CTS, the LAA is part of the distal (mitral valve) atrial chamber, whereas the LAA is part of the proximal (pulmonary vein) atrial chamber in patients with a supramitral ring [ 24 ]. Additionally, three-dimensional TTE has been used as a less invasive alternative to TEE for the evaluation of CTS [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Cor Triatriatum Sinister Identified after New Onset Atrial Fibrillation in an Elderly Man

Zepeda

Morcos

Castellanos

2014

Case Reports in Medicine

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A 73-year-old man with new onset atrial fibrillation with rapid ventricular response underwent transthoracic echocardiography that revealed an echogenic linear structure along the left atrium, suggestive of cor triatriatum sinister (CTS). CTS was confirmed with transesophageal echocardiography which demonstrated a proximal accessory atrium receiving pulmonary venous flow separated from a distal true atrium by a fibromuscular membrane with a large fenestration allowing flow between the chambers. In CTS, the left atrium is divided into proximal and distal chambers by a fenestrated fibromuscular septum. This cardiac anomaly accounts for 0.1% of cases of congenital heart disease and rarely presents in adults. CTS is primarily diagnosed with echocardiography and is associated with left atrial enlargement and development of atrial fibrillation. Treatment options depend on size of the communication between proximal and distal chambers, the gradient across the membrane, and the position of pulmonary veins. In some instances, surgical resection of the membrane that divides the left atrium is warranted.

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“…Nonetheless, elderly patients with CTS have been described. 5,6 If patients do not have restriction of blood flow through the membrane, their disease may be evidenced later in life as the fibrosis or calcification of the membrane progresses, causing obstruction of pulmonary venous blood flow. [5][6][7][8] As a result, older patients may first be seen with new-onset atrial fibrillation, syncope, shortness of breath, and orthopnea.…”

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confidence: 99%

“…5,6 If patients do not have restriction of blood flow through the membrane, their disease may be evidenced later in life as the fibrosis or calcification of the membrane progresses, causing obstruction of pulmonary venous blood flow. [5][6][7][8] As a result, older patients may first be seen with new-onset atrial fibrillation, syncope, shortness of breath, and orthopnea. [5][6][7][8] Apart from mitral stenosis, a spectrum of congenital anomalies may result in pulmonary venous blood flow obstruction and have similar clinical presentations.…”

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confidence: 99%

“…[5][6][7][8] As a result, older patients may first be seen with new-onset atrial fibrillation, syncope, shortness of breath, and orthopnea. [5][6][7][8] Apart from mitral stenosis, a spectrum of congenital anomalies may result in pulmonary venous blood flow obstruction and have similar clinical presentations. A supramitral membrane (Figure 1, A) is distinguished from the membrane in CTS by its location below the left atrial appendage.…”

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confidence: 99%

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