IMAGING IN CARDIOLOGY
Cor triatriatum
J. Walpot, P. Peerenboom
A
Figure 1. AJ TEE multiplane image at 97°. B: TEE multipane image at 35°. LA = left atrium, RA = rght atrium, RV= right ventrickr, TV= tricuspid valve, AO = ascending aorta, D = diaphragm subdividing the LA in two chambers.
A70-year-old man with a history of recent transient Fischaemic attack and atrial fibrillation was admitted for transoesophageal echocardiography (TOE) to exclude cardiac emboligenic foci. He was treated with acenocoumarol, sotalol and digoxin. At time of the procedure sinus rhythm was documented. No intracardiac trombi were found. Transoesophageal echocarciography revealed a cor triatriatum. Cor triatriatum is rare, with an incidence
of 0.4% in autopsied patients with congenital heart disease. It is characterised by a fibromuscular membrane that subdivides the left atrium. In its most common form, there is a proximal chamber which receives the pulmonary veins, and a distal chamber which communicates with the mitral valve. One or more small or larger openings in this membrane connect the two subdivided chambers, allowing the left ventricular filling. The membrane results in a varied J. Walpot P. Peorenboom Departrnent of Cardiology, Walcheren Hospital, Koudekerkse Weg 88, 4382 EE Vlissingen Correspondence to: J. Walpot E-mail: [email protected]
Netherliands Heart Journal, Volume 12, Number 6, June 2004
degree of left ventricular inflow obstruction, with a subsequent rise in pulmonary wedge pressure, pulmonary artery pressure and right ventricular pressure.
Associated congenital heart defects, such as patent foramen ovale, atrial septal defect and total or partial anomalous venous return, are described. The clinical picture ofpatients with cor triatriatum has never been either constant or characteristic. Most reported patients had fatigue or dyspnoea, secondary to pulmonary congestion and subsequent right ventricular failure. Haemoptysis has been reported. Cor triatriatum has been termed 'supravalvular mitral stenosis' because of its pathophysiological behaviour, which is similar to mitral valve stenosis. In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands. This section is edited by M.J.M. Cramer andj. Bax.
299
Cor triatriatum
J. Walpot, P. Peerenboom
A
Figure 1. AJ TEE multiplane image at 97°. B: TEE multipane image at 35°. LA = left atrium, RA = rght atrium, RV= right ventrickr, TV= tricuspid valve, AO = ascending aorta, D = diaphragm subdividing the LA in two chambers.
A70-year-old man with a history of recent transient Fischaemic attack and atrial fibrillation was admitted for transoesophageal echocardiography (TOE) to exclude cardiac emboligenic foci. He was treated with acenocoumarol, sotalol and digoxin. At time of the procedure sinus rhythm was documented. No intracardiac trombi were found. Transoesophageal echocarciography revealed a cor triatriatum. Cor triatriatum is rare, with an incidence
of 0.4% in autopsied patients with congenital heart disease. It is characterised by a fibromuscular membrane that subdivides the left atrium. In its most common form, there is a proximal chamber which receives the pulmonary veins, and a distal chamber which communicates with the mitral valve. One or more small or larger openings in this membrane connect the two subdivided chambers, allowing the left ventricular filling. The membrane results in a varied J. Walpot P. Peorenboom Departrnent of Cardiology, Walcheren Hospital, Koudekerkse Weg 88, 4382 EE Vlissingen Correspondence to: J. Walpot E-mail: [email protected]
Netherliands Heart Journal, Volume 12, Number 6, June 2004
degree of left ventricular inflow obstruction, with a subsequent rise in pulmonary wedge pressure, pulmonary artery pressure and right ventricular pressure.
Associated congenital heart defects, such as patent foramen ovale, atrial septal defect and total or partial anomalous venous return, are described. The clinical picture ofpatients with cor triatriatum has never been either constant or characteristic. Most reported patients had fatigue or dyspnoea, secondary to pulmonary congestion and subsequent right ventricular failure. Haemoptysis has been reported. Cor triatriatum has been termed 'supravalvular mitral stenosis' because of its pathophysiological behaviour, which is similar to mitral valve stenosis. In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands. This section is edited by M.J.M. Cramer andj. Bax.
299
