Authors: Hein Htet Zaw

UNLABELLED

A woman with recurrent thromboembolic stroke was found to also have cor triatriatum. When the patient first presented with weakness, she was thought to have ischaemic stroke because she had conventional risk factors, but she was later confirmed to have cor triatriatum. The main method of treatment is surgery. However, if surgery is contraindicated, anticoagulation can be used as second-line treatment, but this can be difficult. This report describes the follow-up of a middle-aged female patient with cor triatriatum over 6 years during which she experienced multiple strokes despite different methods of anticoagulation.

LEARNING POINTS

Cor triatriatum is a rare heart condition which may not be detected by routine transthoracic echocardiography and so requires transthoracic echocardiography and CT angiography.Surgical membrane resection is the main treatment option but thromboembolic stroke should be considered when surgery is not possible.Anticoagulation may not be as effective at preventing embolic stroke in this rare heart defect as it is in other conditions.

PubMed: 36632542
DOI: 10.12890/2022_003668

Authors: Jose Danilo Bengzon Diestro, Joseph Justin Hipolito Regaldo, Eddieson Masangcay Gonzales...

Cor triatriatum sinistrum (CTS) is a congenital anomaly where the left atrium is divided into two compartments by a fibromuscular membrane. This report aims to add to the literature on a rare cardiac condition that can cause neurological morbidity. We report a case of a 19-year-old female with an infarct in the right middle cerebral artery (MCA) territory initially maintained on aspirin. Eighteen months later, she had recurrence of weakness, for which repeat transthoracic echocardiography (TTE) and re-evaluation of the first TTE demonstrated a hyperechoic membrane spanning the width of the left atrium, clinching the diagnosis of CTS. Despite anticoagulation with apixaban, she was admitted for a third stroke where she succumbed to hospital-acquired pneumonia. Among cases of CTS associated with stroke, anticoagulation and surgery were the main modes of treatment. This case has the longest follow-up and the first to demonstrate failure of antiplatelet therapy and anticoagulation.

Topics: Adult; Anticoagulants; Aspirin; Cor Triatriatum; Echocardiography; Fatal Outcome; Female; Heart Atria; Humans; Infarction, Middle Cerebral Artery; Magnetic Resonance Angiography; Middle Cerebral Artery; Tomography, X-Ray Computed; Young Adult

PubMed: 28790049
DOI: 10.1136/bcr-2017-219763

Authors: Alexander Kadner, Katharina Meszaros, Christoph Mueller...

The cor triatriatum sinister is an uncommon congenital cardiac anomaly and reports in the literature are limited. It is often associated with other cardiac malformations, such as atrial septal defect, transposition of the great arteries, tetralogy of Fallot or atrioventricular septal defect. We present here a 6-year old boy who was diagnosed with cor triatriatum sinister, initially showing symptoms similar to mitral valve stenosis and congestive heart failure, and who underwent subsequent surgical correction using a left atrial approach. The fibromuscular membrane, separating the pulmonary veins from the mitral valve, was completely resected and postoperative echocardiography showed unobstructed pulmonary venous flow.

Topics: Cardiopulmonary Bypass; Child; Cor Triatriatum; Echocardiography, Transesophageal; Heart Arrest, Induced; Heart Atria; Heart Failure; Humans; Hypertension, Pulmonary; Intraoperative Care; Male; Mitral Valve Stenosis; Postoperative Complications; Pulmonary Veins; Risk Adjustment; Sternotomy; Treatment Outcome

PubMed: 24878580
DOI: 10.1093/mmcts/mmu005

Authors: Hitesh Raheja, Vinod Namana, Norbert Moskovits...

Topics: Adult; Cor Triatriatum; Echocardiography; Humans; Male

PubMed: 29538531
DOI: 10.5935/abc.20170138

Review

Authors: Waqas Ullah, Yasar Sattar, Hiba Rauf...

Cor triatriatum is a rare congenital cardiac condition characterized by the division of one atrium into two chambers by a fibromuscular membrane, resulting in three atrial chambers. The goal of this study was to determine the associations of cor triatriatum with cyanosis, atrial fibrillation (AF), and stroke. MEDLINE (PubMed, Ovid), Embase, and Cochrane databases were searched on April 25, 2019, for relevant articles on cor triatriatum. After initial screening and removal of duplicates, 235 articles were selected. Data were extracted from these articles, including types, presentations, diagnostic findings, management, and outcomes of patients with cor triatriatum. Approximately 83% of patients with cor triatriatum had cor triatriatum sinistrum (CTS) and 17% had cor triatriatum dextrum (CTD). The mean age of all patients was 29±23 years. Mean ages at diagnosis differed significantly in patients with CTS and CTD (31±23 years vs. 21±20 years, p=0.02). CTS showed a significantly greater association with AF (14.65% vs. 12.5%, p=0.036) and had a substantially higher risk of stroke (7.9% vs. 5.0%, p=0.04) than CTD. CTS also had a numerically higher association with atrial septal defects (15.13% vs. 15.6%), but this difference was not statistically significant (p=0.89). In contrast, cyanosis at presentation was significantly more frequent in patients with CTD than CTS (5.5% vs. 5.3%, p=0.05). Management did not differ significantly between these groups (p=0.29). The overall mortality rate was 16%, with no significant difference between patients with CTS and CTD (p=0.33). The higher likelihood of AF and stroke in CTS than in CTD patients warrants treatment of the former with anticoagulation agents, irrespective of their CHA₂DS₂-VASc scores (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, age, sex category). Patients with CTS usually present at an older age due to their lower risk of cyanosis and asymptomatic AF.

PubMed: 31938652
DOI: 10.7759/cureus.6371

Authors: Kacper Milczanowski, Paweł Tyczyński, Maciej Dąbrowski...

Topics: Cardiomyopathy, Hypertrophic; Cor Triatriatum; Heart Atria; Humans

PubMed: 34125945
DOI: 10.33963/KP.a2021.0033

Authors: Dominika Zoltowska, Jagadeesh K Kalavakunta

Cor triatriatum dexter (CTD) is an extremely rare finding (<0.01%), resulting from the persistence of the right valve of sinus venosus. Echocardiography with color Doppler is the first-line tool for diagnosis and decision making.

PubMed: 29881596
DOI: 10.1002/ccr3.1526

Authors: Paweł Gać, Adrian Martuszewski, Patrycja Paluszkiewicz...

Coronary computed tomography angiography (CCTA) is a noninvasive examination whose main purpose is to exclude significant stenosis in the coronary arteries. The obtained computed tomography images may also provide information about other coexisting pathologies of the heart and vessels. The paper presents images of cardiac lesions in a 44-year-old hypertensive patient who underwent CCTA, based on which significant stenosis in the coronary arteries was excluded, the suspicion of a cor triatriatum sinister was confirmed and the presence of fibroelastoma and a variant of the anatomy of the pulmonary veins ostial was confirmed. To sum up, when performing CCTA, apart from the analysis of the coronary arteries, one should remember about lesions in the remaining visible anatomical structures of the heart and large vessels.

PubMed: 35741259
DOI: 10.3390/diagnostics12061449

Authors: Sameh M Said

PubMed: 34318035
DOI: 10.1016/j.xjtc.2020.09.005