Surgical Outcomes of Cor Triatriatum Sinister: A Single-Center Experience

Abstract

Background We investigated surgical outcomes after the surgical repair of cor triatriatum sinister (CTS). Methods Thirty-two consecutive patients who underwent surgical repair of CTS from 1993 through 2020 were included in this study. The morphological characteristics, clinical features, and surgical outcomes were described and analyzed. Results The median age and body weight at operation were 9 months (interquartile range [IQR], 3–238 months) and 7.5 kg (IQR, 5.8–49.6 kg), respectively. There were 16 males (50%). According to the modified Lucas classification, type IA (classical CTS) was most common (n=20, 62.5%). Atrial septal defect was associated in 22 patients (68.8%) and anomalous pulmonary venous return in 8 patients (25%). Pulmonary hypertension was preoperatively suspected with a high probability in 18 patients (56.3%). There was 1 early death (3.1%) after emergent membrane excision and hybrid palliation in a high-risk hypoplastic left heart syndrome patient. There were no late deaths. The overall survival rate was 96.9% at 15 years post-repair. No early survivors required reoperation during follow-up. Most survivors (31 of 32 patients, 96.9%) were in New York Heart Association functional class I at a median follow-up of 74 months (IQR, 39–195 months). At the latest echocardiography performed at a median of 42 months (IQR, 6–112 months) after repair, no residual lesion was observed except in 1 patient who had moderate pulmonary hypertension (mean pulmonary arterial pressure of 36 mm Hg). Conclusion Surgical repair of cor triatriatum could be performed safely and effectively with an extremely low risk of recurrence.

Correspondence on Surgical Outcomes of Cor Triatriatum Sinister

“…If an experienced surgical team follows a good surgical strategy, the outcome will be positive. The observation by Kim et al [ 1 ] confirms the previous report by Fuchs et al [ 2 ]. A longer observation period might be needed to draw conclusions regarding recurrence.…”

“…We would like to correspond about and share ideas related to the publication “Surgical outcomes of cor triatriatum sinister: a single-center experience” [ 1 ]. According to Kim et al [ 1 ], surgical correction of cor triatriatum can be done safely and successfully with a very low risk of recurrence. We agree that surgery is required to treat cor triatriatum.…”

“…According to a previous report, this condition might occur after surgical manipulation of cor triatriatum [ 3 ]. Finally, an early diagnosis and correction, as described in the report by Kim et al [ 1 ], might lead to favorable management outcomes. If the diagnosis and surgical management occur too late and the patient has severe clinical problems, fatal outcomes after surgical management are still reported [ 4 ].…”

The Mashadi-Narasimhan-Said Classification for Cor Triatriatum Sinister: Applicable to All

“…We read with great interest the article by Kim et al [1] describing a single-center surgical experience with cor triatriatum sinister (CTS), a rare congenital cardiac anomaly. In the study, 32 patients were treated surgically over a 27year span.…”

The author's reply

“…We thank Sookaromdee and Wiwanitkit [ 1 ] for their correspondence regarding our study investigating the outcomes after repair of cor triatriatum sinister [ 2 ]. Cor triatriatum sinister itself, unless it is associated with inflow obstruction, generally has a benign prognosis [ 3 ], although surgical intervention might be required mostly owing to associated defects, such as anomalous pulmonary venous connection, atrial septal defect, mitral valve anomalies, and so forth.…”