A Surgical Strategy for Cor Triatriatum Atrial Septal Defect—A1 Lam Subclass
DOI:
https://doi.org/10.1532/HSF98.20111186Abstract
Atrial fibrillation and a heart murmur were diagnosed in a 68-year-old woman during a routine medical examination. She presented 2 years later with pulmonary edema. A transthoracic echocardiography examination revealed a tunneled atrial septal defect (ASD) and severe tricuspid regurgitation. Transesophageal echocardiography and 3-dimensional computed tomography evaluations revealed multiple intracardiac defects, including abnormal atrial septation suggestive of a typical cor triatriatum sinistrum (A1 Lam subclass), a rare congenital defect in adults. The patient underwent tricuspid valve repair with concomitant closure of the ASD by using the cor triatriatum curtain to form an autologous transposition flap. The intraoperative transesophageal and predischarge imaging evaluations confirmed an excellent repair. The patient made a swift recovery and demonstrated improvement in her symptoms at follow-up. This previously undescribed technique eliminates the need for a prosthetic implant and is applicable in >80% of cor triatriatum cases in which an ASD exists.References
Alphonso N, Norgaard MA, Newcomb A, d'Udekem Y, Brizard CP, Cochrane A. 2005. Cor triatriatum: presentation, diagnosis and long-term surgical results. Ann Thorac Surg 80:1666-71.nDas SN, Kiran U, Bhan A, Sahu T. 2006. Perioperative management of cor triatriatum with congenitally corrected transposition of great arteries. Ann Card Anaesth 9:49-52.nKaminishi Y, Watanabe Y, Hattori T, Jikuya T. 1999. A case of cor triatriatum with atrial septal defect in an adult [in Japanese]. Kyobu Geka 52:492-5.nLâcis A, Zidere V, Lubaua I, et al. 2004. Cor triatriatum associated with complex heart defects. Acta Med Lituan 11:59-63.nMcLean MK, Kung GC, Polimenakos A, Wells WJ, Reemtsen BL. 2008. Cor triatriatum associated with ASD and common atrium in 7-month-old with tachypnea and failure to thrive. Ann Thorac Surg 86:1999.nOzkökeli M, Kayacio?lu I, Sensöz Y, Uslu N, Kanca A. 2007. Cor triatriatum sinistrum in adults: surgical treatment of two cases. Anadolu Kardiyol Derg 7:200-1.nRodefeld MD, Brown JW, Heimansohn DA, et al. 1990. Cor triatriatum: clinical presentation and surgical results in 12 patients. Ann Thorac Surg 50:562-8.nVan Praagh R, Corsini I. 1969. Cor triatriatum: pathologic anatomy and a consideration of morphogenesis based on 13 postmortem cases and a study of normal development of the pulmonary vein and atrial septum in 83 human embryos. Am Heart J 78:379-405.n
