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Cathether-based interventional strategies for cor triatriatum in the adult - feasibility study through a hybrid approach.

Li WW, Koolbergen DR, Bouma BJ, Hazekamp MG, de Mol BA, de Winter RJ - BMC Cardiovasc Disord (2015)

Bottom Line: Occasionally, percutaneous balloon dilatation of the membrane has been successfully performed.In addition, several anatomical characteristics should be considered to predict technical success of cathether-based interventional strategies, such as the location of the membrane, the degree of pulmonary vein stenosis, the extent of calcification, and the presence of other (congenital) cardiovascular abnormalities.Furthermore, long-term efficacy of these strategies remains to be confirmed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. w.w.li@amc.uva.nl.

ABSTRACT

Background: Cor triatriatum is a rare congenital cardiac abnormality, consisting of an obstructing membrane between the pulmonary veins and the mitral valve in varying patterns. The entitiy can mimick the pathophysiology of mitral stenosis, necessitating surgical resection. Occasionally, percutaneous balloon dilatation of the membrane has been successfully performed.

Case presentation: We report two cases with cor triatriatum where intraoperative balloon dilatation of the membrane was attempted followed by surgical resection, to explore the feasibility of cathether-based interventional strategies for cor triatriatum.

Conclusions: Various anatomical variations exist of cor triatriatum, depending on the drainage of the pulmonary veins and the drainage of the proximal chamber in the right or left atrium. Only isolated forms of cor triatriatum where all pulmonary veins ultimately drain into the left atrium can be recommended for percutaneous strategies. In addition, several anatomical characteristics should be considered to predict technical success of cathether-based interventional strategies, such as the location of the membrane, the degree of pulmonary vein stenosis, the extent of calcification, and the presence of other (congenital) cardiovascular abnormalities. Furthermore, long-term efficacy of these strategies remains to be confirmed. As such, surgical treatment of cor triatriatum remains the mainstay of treatment in adult patients, especially when other cardiovascular anomalies are present which require surgical correction.

No MeSH data available.


Related in: MedlinePlus

Transthoracic apical 4-chamber view with color Doppler (a) showing turbulence in the roof of the left atrium near the right pulmonary vein suggesting pulmonary venous obstruction or stenosis. On cardiac magnetic resonance imaging (b), a membrane (arrow) was demonstrated in the left atrium, with the left pulmonary veins draining into the left atrium, and the right pulmonary veins into the accessory (proximal) atrial chamber
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Fig1: Transthoracic apical 4-chamber view with color Doppler (a) showing turbulence in the roof of the left atrium near the right pulmonary vein suggesting pulmonary venous obstruction or stenosis. On cardiac magnetic resonance imaging (b), a membrane (arrow) was demonstrated in the left atrium, with the left pulmonary veins draining into the left atrium, and the right pulmonary veins into the accessory (proximal) atrial chamber

Mentions: A 39-year-old woman with an unremarkable medical history was referred to our center with cor triatriatum. The patient was evaluated by her referring cardiologist due to complaints of progressive exertional dyspnea for the past year. Transthoracic and transesophageal echocardiography demonstrated normal left and right ventricular size and function, and a thin membrane in the left atrium dividing the left atrium into 2 compartments, with a mean gradient of 12 mmHg over the membrane. In addition, turbulence was noted in the roof of the left atrium near the right pulmonary vein (PV) suggesting pulmonary venous obstruction or stenosis (Fig. 1a). Cardiac magnetic resonance imaging (MRI) confirmed these findings, and showed that the left pulmonary veins drained in to the left atrium, while the right PVs drained into the accessory (proximal) atrial chamber (Fig. 1b) (type IIIA1 cor triatriatum [3]). Left and right cardiac catheterization revealed normal coronary arteries without significant stenoses, and a significant gradient (10–13 mmHg) between simultaneously measured right pulmonary capillary wedge and left ventricular end diastolic pressure.Fig. 1


Cathether-based interventional strategies for cor triatriatum in the adult - feasibility study through a hybrid approach.

Li WW, Koolbergen DR, Bouma BJ, Hazekamp MG, de Mol BA, de Winter RJ - BMC Cardiovasc Disord (2015)

Transthoracic apical 4-chamber view with color Doppler (a) showing turbulence in the roof of the left atrium near the right pulmonary vein suggesting pulmonary venous obstruction or stenosis. On cardiac magnetic resonance imaging (b), a membrane (arrow) was demonstrated in the left atrium, with the left pulmonary veins draining into the left atrium, and the right pulmonary veins into the accessory (proximal) atrial chamber
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4499942&req=5

Fig1: Transthoracic apical 4-chamber view with color Doppler (a) showing turbulence in the roof of the left atrium near the right pulmonary vein suggesting pulmonary venous obstruction or stenosis. On cardiac magnetic resonance imaging (b), a membrane (arrow) was demonstrated in the left atrium, with the left pulmonary veins draining into the left atrium, and the right pulmonary veins into the accessory (proximal) atrial chamber
Mentions: A 39-year-old woman with an unremarkable medical history was referred to our center with cor triatriatum. The patient was evaluated by her referring cardiologist due to complaints of progressive exertional dyspnea for the past year. Transthoracic and transesophageal echocardiography demonstrated normal left and right ventricular size and function, and a thin membrane in the left atrium dividing the left atrium into 2 compartments, with a mean gradient of 12 mmHg over the membrane. In addition, turbulence was noted in the roof of the left atrium near the right pulmonary vein (PV) suggesting pulmonary venous obstruction or stenosis (Fig. 1a). Cardiac magnetic resonance imaging (MRI) confirmed these findings, and showed that the left pulmonary veins drained in to the left atrium, while the right PVs drained into the accessory (proximal) atrial chamber (Fig. 1b) (type IIIA1 cor triatriatum [3]). Left and right cardiac catheterization revealed normal coronary arteries without significant stenoses, and a significant gradient (10–13 mmHg) between simultaneously measured right pulmonary capillary wedge and left ventricular end diastolic pressure.Fig. 1

Bottom Line: Occasionally, percutaneous balloon dilatation of the membrane has been successfully performed.In addition, several anatomical characteristics should be considered to predict technical success of cathether-based interventional strategies, such as the location of the membrane, the degree of pulmonary vein stenosis, the extent of calcification, and the presence of other (congenital) cardiovascular abnormalities.Furthermore, long-term efficacy of these strategies remains to be confirmed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. w.w.li@amc.uva.nl.

ABSTRACT

Background: Cor triatriatum is a rare congenital cardiac abnormality, consisting of an obstructing membrane between the pulmonary veins and the mitral valve in varying patterns. The entitiy can mimick the pathophysiology of mitral stenosis, necessitating surgical resection. Occasionally, percutaneous balloon dilatation of the membrane has been successfully performed.

Case presentation: We report two cases with cor triatriatum where intraoperative balloon dilatation of the membrane was attempted followed by surgical resection, to explore the feasibility of cathether-based interventional strategies for cor triatriatum.

Conclusions: Various anatomical variations exist of cor triatriatum, depending on the drainage of the pulmonary veins and the drainage of the proximal chamber in the right or left atrium. Only isolated forms of cor triatriatum where all pulmonary veins ultimately drain into the left atrium can be recommended for percutaneous strategies. In addition, several anatomical characteristics should be considered to predict technical success of cathether-based interventional strategies, such as the location of the membrane, the degree of pulmonary vein stenosis, the extent of calcification, and the presence of other (congenital) cardiovascular abnormalities. Furthermore, long-term efficacy of these strategies remains to be confirmed. As such, surgical treatment of cor triatriatum remains the mainstay of treatment in adult patients, especially when other cardiovascular anomalies are present which require surgical correction.

No MeSH data available.


Related in: MedlinePlus