The Use of Transesophageal Echocardiography in the Diagnosis of Cor Triatriatum
Sinister RV Zhang, MD, PhD and YS Tang, MD
Dept of Anesthesiology, University of Florida
Introduction. Cor triatriatum sinister is a rare cardiac
malformation that may lead to left atrial inflow obstruction.
Cardiac catheterization and angiography may not be a reliable
means of differentiating cor triatriatum from other causes of
left ventricular inflow obstruction.1 Prior to the advent of
echocardiography, the diagnosis of this malformation was often
made at necropsy.2 More recently, cor triatriatum has been
successfully diagnosed with the aid of echocardiography.1,3,4 We
present a rare case of cor triatriatum sinister in an adult who
was diagnosed with transesophageal echocardiography.
Clinical Course. A 66 yr old white male presented to his primary
care physician with an 8-week history of worsening dyspnea. He
was diagnosed with new onset atrial fibrillation and was
referred to a cardiologist. A transesophageal echocardiogram was
obtained which revealed a membrane in the left atrium (Figure),
and the diagnosis of cor triatriatum sinister was made. The
patient was scheduled for surgical resection of the left atrial
membrane. On peri-operative transesopha-geal echocardiography,
multiple large openings (1 1.5 cm in diameter) in the membrane
were noted. When the cardiac surgeons accessed the left atrium,
they discovered that the membrane was more like a web of
fibromuscular tissue. The malformation was resected easily, and
the patient had an uncomplicated postoperative course.
Discussion. Cor triatriatum sinister is a rare cardiac
malformation with an incidence of 0.1%.1 This malformation
occurs as a result of the embryologic failure of the common
pulmonary vein to become incorporated into the atrium.3 In most
instances, the diagnosis is made during childhood secondary to
the development of symptoms consistent with restricted left
ventricular inflow. Cardiac catheterization and angiography may
not be helpful and, in fact, may be detrimental to the already
compromised child.1 A review of the literature supports the use
of echocardiography as a sensitive and relatively non invasive
tool for the diagnosis of cor triatriatum sinister.
References: 1) Br Heart J 1984; 51: 211 219. 2) Am J Cardiol
1975; 35:59 66. 3) Am J Cardiol 1982; 49:780 786. 4) Am J
Cardiol 1987; 59:484 485
