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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

Intraoperatively, marked pulmonary venous congestion of the right lung was found (a). After entering the left atrium, a common drainage of the right pulmonary veins was noted, with an obstructing membrane right before the draining orifice, leaving an opening of only 3 mm (b, arrow)
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Fig2: Intraoperatively, marked pulmonary venous congestion of the right lung was found (a). After entering the left atrium, a common drainage of the right pulmonary veins was noted, with an obstructing membrane right before the draining orifice, leaving an opening of only 3 mm (b, arrow)

Mentions: The patient was operated through median sternotomy, with cardiopulmonary bypass, systemic hypothermia and cardioplegic arrest. There was marked pulmonary venous congestion of the right lung (Fig. 2a). Through a transatrial approach, the left atrium was entered. There was a common drainage of the right PVs, with an obstructing membrane right before the draining orifice, leaving an opening of only 3 mm (Fig. 2b). Intraoperatively, a balloon dilatation was attempted with a 20 mm balloon (2 atm). After several attempts, the orifice diameter was increased to 10 mm, which was deemed insufficient to ensure adequate pulmonary venous drainage of the right side. Complete resection of the membrane was then performed, with surgical enlargement of the right common PV ostium towards the atrial septum to an orifice opening of 20 mm. Reseptation of the atrial septum was performed with xenopericardium to prevent restenosis of the right PV ostium.Fig. 2


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)

Intraoperatively, marked pulmonary venous congestion of the right lung was found (a). After entering the left atrium, a common drainage of the right pulmonary veins was noted, with an obstructing membrane right before the draining orifice, leaving an opening of only 3 mm (b, arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Intraoperatively, marked pulmonary venous congestion of the right lung was found (a). After entering the left atrium, a common drainage of the right pulmonary veins was noted, with an obstructing membrane right before the draining orifice, leaving an opening of only 3 mm (b, arrow)
Mentions: The patient was operated through median sternotomy, with cardiopulmonary bypass, systemic hypothermia and cardioplegic arrest. There was marked pulmonary venous congestion of the right lung (Fig. 2a). Through a transatrial approach, the left atrium was entered. There was a common drainage of the right PVs, with an obstructing membrane right before the draining orifice, leaving an opening of only 3 mm (Fig. 2b). Intraoperatively, a balloon dilatation was attempted with a 20 mm balloon (2 atm). After several attempts, the orifice diameter was increased to 10 mm, which was deemed insufficient to ensure adequate pulmonary venous drainage of the right side. Complete resection of the membrane was then performed, with surgical enlargement of the right common PV ostium towards the atrial septum to an orifice opening of 20 mm. Reseptation of the atrial septum was performed with xenopericardium to prevent restenosis of the right PV ostium.Fig. 2

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