Cor Triatriatum Sinistrum Combined with Changes in Atrial Septum and Right Atrium in a 60-Year-Old Woman

Background and Objectives: A rare case of cor triatriatum sinistrum in combination with anomalies in the atrial septum and in the right atrium of a 60-year-old female body donor is described here. Materials and Methods: In addition to classical dissection, ultrasound and magnetic resonance imaging, computer tomography and cinematic rendering were performed. In a reference series of 59 regularly formed hearts (33 men, 26 women), we looked for features in the left and right atrium or atrial septum. In addition, we measured the atrial and ventricular wall thickness in 15 regularly formed hearts (7 men, 8 women). Results: In the case described, the left atrium was partly divided into two chambers by an intra-atrial membrane penetrated by two small openings. The 2.5 cm-high membrane originated in the upper level of the oval fossa and left an opening of about 4 cm in diameter. Apparently, the membrane did not lead to a functionally significant flow obstruction due to the broad intra-atrial communication between the proximal and distal chamber of the left atrium. In concordance with this fact, left atrial wall thickness was not elevated in the cor triatriatum sinistrum when compared with 15 regularly formed hearts. In addition, two further anomalies were found: 1. the oval fossa was deepened and arched in the direction of the left atrium; 2. the right atrium showed a membrane-like structure at its posterior and lateral walls, which began at the lower edge of the oval fossa. It probably corresponds to a strongly developed eustachian valve (valve of the inferior vena cava). Conclusions: The case described suggests that malformations in the development of the atrial septum and in the regression of the valve of the right sinus vein are involved in the pathogenesis of cor triatriatum sinistrum.

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P649 Before and after: sinus venosus atrial septal defect

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.331 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Marco Clement ◽

R Eiros ◽

R Dalmau ◽

T Lopez ◽

G Guzman ◽

...

Keyword(s):

Atrial Septal Defect ◽

Left Atrium ◽

Atrial Flutter ◽

Superior Vena Cava ◽

Right Atrium ◽

Septal Defect ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

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TYPES OF CORRECTION OF THE SUPRACARDIAC FORM OF PARTIAL ABNORMAL DRAINAGE OF THE PULMONARY VEINS. WARDEN PROCEDURE

BULLETIN OF SURGERY IN KAZAKHSTAN ◽

10.35805/bsk2021iii028 ◽

2021 ◽

pp. 28-31

Author(s):

Inkar Sagatov ◽

Nurzhan Dosmailov

Keyword(s):

Left Atrium ◽

Superior Vena Cava ◽

Right Atrium ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Artificial Circulation ◽

The Right

The article describes the types of correction of the supracardial form of abnormal drainage of the pulmonary veins. One of the methods of correcting this defect is the Warden operation, which includes: after sternotomy, connection of artificial circulation, cardioplegia, the superior vena cava is cut off, the proximal end is sutured. Next, a right atriotomy is performed, an anastomosis is formed using an autopericardial patch between the abnormal drainage and the left atrium through the ASD. Then an anastomosis is formed between the auricle of the right atrium and the distal end of the superior vena cava. As a result, blood from the abnormal pulmonary veins begins to drain into the left atrium through the ASD.

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Direct entry of the right superior vena cava into the left atrium with aneurysmal dilatation and stenosis at its entry into the right atrium with stenosis of the pulmonary veins: A rare case

Pediatric Cardiology ◽

10.1007/bf02424964 ◽

1984 ◽

Vol 5 (2) ◽

pp. 123-126 ◽

Cited By ~ 6

Author(s):

Saroja Bharati ◽

Maurice Lev

Keyword(s):

Left Atrium ◽

Superior Vena Cava ◽

Right Atrium ◽

Rare Case ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Aneurysmal Dilatation ◽

The Right

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P1464 A case of cortriatriatum dexter accidentally discovered in an adult

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.891 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

H S A Abdelgawad ◽

M Abdelnabi ◽

A Almaghrabi ◽

M Shehata ◽

M A Abdelhay

Keyword(s):

Transesophageal Echocardiography ◽

Right Atrium ◽

Vena Cava ◽

Interatrial Septum ◽

Right Atrial ◽

Cor Triatriatum ◽

Free Wall ◽

3D Transesophageal Echocardiography ◽

Cor Triatriatum Dexter ◽

The Right

Abstract Introduction Cor triatriatum dexter, or partitioning of the right atrium (RA) to form a triatrial heart, is an extremely rare congenital anomaly that is caused by the persistence of the right valve of the sinus venosus. The incidence of cor triatriatum is approximately 0.1% of congenital heart malformation. Typically, the right atrial partition is due to exaggerated fetal eustachian and the besian valves, which together form an incomplete septum across the lower part of the atrium. This septum may range from a reticulum to a substantial sheet of tissue Case report: 45-years old female patient with history of surgical closure of an atrial septal defect at the age of 14 years .She presented to our medical facility complaining of exertional dyspnea and bilateral lower limb edema for 4 years. On clinical examination, she had bilateral congested neck veins, a pansystolic murmur over the tricuspid area and a tender hepatomegaly. 2D Transthoracic Echocardiography revealed an unusual membranous structure that stretched across the right atrium with attachments superiorly at the free wall and inferiorly at the inter-atrial septum with a severe tricuspid regurgitation (Panel A)Intravenous agitated saline injection revealed an incomplete membrane. (Panel B).2D Transesophageal echocardiography showed an unusually prominent eustachian valve arose normally from the ostium of the inferior vena cava (IVC) and was pointing towards the interatrial septum just below the level of the fossa ovalis and no residual ASD could be seen. (Panel C) . 3D transesophageal echocardiography with zoomed mode from right atrial perspective confirmed the presence of an incomplete membrane extending transversely from the ostium of IVC and interatrial septum immediately below the fossa ovalis but not reaching RA free wall (arrow), no obstruction to the flow of the IVC, superior vena cava (SVC) , coronary sinus (CS) and the tricuspid valve (TV) was seen .(Panels D,E,F). Conclusion Since many patients are asymptomatic, the diagnosis of cor triatriatum dexter often is determined at postmortem examination. Antemortem diagnosis can be determined by echocardiography. 3D transesophageal echocardiography was able to detect cor triatriatum dexter that can be easily missed by 2D echocardiography. Abstract P1464 Figure.

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Cardiac Tumors: Eight-Year Experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500109 ◽

1997 ◽

Vol 5 (1) ◽

pp. 39-42

Author(s):

Kadali Venkata Nagaraja Kamalakar ◽

Sadashivan Jaishankar ◽

Tirumalai Nallam Chakravarthi Padmanabhan ◽

Damera Seshagiri Rao ◽

Challa Sundaram ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Inferior Vena Cava ◽

Left Atrium ◽

Right Atrium ◽

Inferior Vena ◽

Vena Cava ◽

Therapeutic Interventions ◽

Cardiac Tumors ◽

Diagnostic Modalities ◽

The Right

Because of the scarcity of reports of cardiac tumors in Indian patients, we analyzed retrospectively all cases of tumors of the heart from the records of our institute during the period from January 1988 to December 1995. There was a total of 28 patients with cardiac tumors, of which 26 were primary. The majority were myxomas; 20 in the left atrium, 4 in the right atrium, and 1 biatrial. Rhabdomyoma was seen in one patient. There were 2 cases of hepatocellular carcinoma with propagation of the tumor along the inferior vena cava into the right atrium. Salient clinical features, diagnostic modalities, therapeutic interventions, and outcome are discussed.

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Cor triatriatum or divided atriums: which approach provides the better understanding?

Cardiology in the Young ◽

10.1017/s1047951114000572 ◽

2014 ◽

Vol 25 (2) ◽

pp. 193-207 ◽

Cited By ~ 14

Author(s):

Tara Bharucha ◽

Diane E. Spicer ◽

Timothy J. Mohun ◽

David Black ◽

G. William Henry ◽

...

Keyword(s):

Left Atrium ◽

Right Atrium ◽

Cor Triatriatum ◽

Cardiac Malformations ◽

Morphological Method ◽

Venous Valves ◽

The Right

AbstractIt is frequent, in the current era, to encounter congenital cardiac malformations described in terms of “cor triatriatum”. But can hearts be truly found with three atrial chambers? The morphological method, emphasised by Van Praagh et al, states that structures within the heart should be defined on the basis of their most constant components. In the atrial chambers, it is the appendages that are the most constant components, and to the best of our knowledge, hearts can only possess two appendages, which can be of either right or left morphology. The hearts described on the basis of “cor triatriatum”, nonetheless, can also be analysed on the basis of division of either the morphologically right or the morphologically left atriums. In this review, we provide a description of cardiac embryology, showing how each of the atrial chambers possesses part of the embryological body, along with an appendage, a vestibule, a venous component, and a septum that separates them. We then show how it is, indeed, the case that the hearts described in terms of “cor triatriatum” can be readily understood on the basis of division of these atrial components. In the right atrium, it is the venous valves that divide the chamber. In the left atrium, it is harder to provide an explanation for the shelf that produces atrial division. We also contrast the classic examples of the divided atrial chambers with the vestibular shelf that produces supravalvar stenosis in the morphologically left atrium, showing that this form of obstruction needs to be distinguished from the fibrous shelves producing intravalvar obstruction.

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P1703 Cardiac metastasis of germ cell tumor "like beads" in the right heart chambers and also left atrium

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1066 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Akturk ◽

T S Tan ◽

A Mammadli ◽

M Mammadov ◽

I Dincer ◽

...

Keyword(s):

Germ Cell ◽

Left Atrium ◽

Germ Cell Tumor ◽

Right Atrium ◽

Germ Cell Tumors ◽

Vena Cava ◽

Cell Tumor ◽

Right Atrial ◽

Mobile Mass ◽

The Right

Abstract Introduction Testis tumors constitute 1-2% of all malignant tumors in men. But it is the most common solid tumor in men between 15-35 years of age. Germ cell tumors constitute for almost 90% of all testis tumors. Intracardiac metastasis of testicular carcinomas is rare. We now report a case of a testicular germ cell tumor with right atrial metastasis. Case report A 30-year-old male patient was diagnosed with B-cell ALL.Chemotherapy and radiotherapy were completed in 2016. In January 2017, the patient applied to the hospital with pain in the right testicle.A mass detected and orchiectomy was performed.Pathologic examination revealed mixed germ cell tumor and B-cell ALL infiltration.Chemotherapy was started. The patient was admitted to our hospital with fever, in March 2018.Antibiotics were started but fever contuniued.Transthoracic echocardiography showed a large,hypoechogen,mobile mass in the right atrium.Then transesophageal echocardiography revealed a 2x3,3 cm mobile mass within the right atrium that prolapsed through the tricuspid valve into the right ventricle in diastole.We could not distinguish if it is a vegetation or a metastatic mass. The patient underwent cardiac surgery.Pathologic examination revealed mixed germ cell tumor metastasis. After the surgery, the patient was transferred to the intensive care unit because of sepsis. Antibiotics were expanded due to fever. Control transthoracic echocardiography and also transesophageal echocardiography showed a 1,8 x 0,6 cm mobile mass extending from the inferior vena cava into the right atrium and through the patent foramen ovale into the left atrium. One week after the surgery, a mass was detected in the transthoracic echocardiography. But no further examination was done. We thought that the mass may not have been completely removed in the the operation (residual tumor?). The patient was evaluated with the department of oncology and cardiovascular surgery. It was decided that reoperation would be very risky. Conclusion Metastatic tumors of the heart are seen more frequently than primary tumors. Although intracardiac metastasis of testicular germ cell tumors are rare (less than %1), it has been related to short survival. They may lead to the congestive heart failure, paradoxical systemic emboli and vena cava superior syndrome. Most cases in the literature are associated with right atrial mass. But in our case, the mass was extending from the inferior vena cava into the right atrium and through the patent foramen ovale into the left atrium. We wanted to share our experience and also wanted to discuss the treatment modality for similar patients. Abstract P1703 Figure.

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