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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

Significant calcification of the inferior border of a cor triatriatum membrane (a, short thick arrow). After intraoperative balloon dilatation, a tear of 3 mm in the membrane was created next to the calcification (b, long thin arrow)
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Fig3: Significant calcification of the inferior border of a cor triatriatum membrane (a, short thick arrow). After intraoperative balloon dilatation, a tear of 3 mm in the membrane was created next to the calcification (b, long thin arrow)

Mentions: Intraoperatively, an obstructing membrane was found between the proximal and distal chamber, with calcification of the inferior border of the membrane and an orifice of 1 cm (Fig. 3a). A balloon dilatation was attempted with a 24 mm balloon (2–3 atm). This created a tear of 3 mm in the membrane next to the calcification (Fig. 3b), and was expanded to 5 mm after an additional dilation. The opening orifice was evidently larger after dilatation, and no extracardiac extension of the tear was noted. Subsequently, the whole membrane (3 × 5 cm) was surgically resected. In addition, bilateral PV isolation was performed (Medtronic Cardioblate irrigated radiofrequency System) with creation of a roofline and trigone line, and excision of the left atrial appendage.Fig. 3


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)

Significant calcification of the inferior border of a cor triatriatum membrane (a, short thick arrow). After intraoperative balloon dilatation, a tear of 3 mm in the membrane was created next to the calcification (b, long thin arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Significant calcification of the inferior border of a cor triatriatum membrane (a, short thick arrow). After intraoperative balloon dilatation, a tear of 3 mm in the membrane was created next to the calcification (b, long thin arrow)
Mentions: Intraoperatively, an obstructing membrane was found between the proximal and distal chamber, with calcification of the inferior border of the membrane and an orifice of 1 cm (Fig. 3a). A balloon dilatation was attempted with a 24 mm balloon (2–3 atm). This created a tear of 3 mm in the membrane next to the calcification (Fig. 3b), and was expanded to 5 mm after an additional dilation. The opening orifice was evidently larger after dilatation, and no extracardiac extension of the tear was noted. Subsequently, the whole membrane (3 × 5 cm) was surgically resected. In addition, bilateral PV isolation was performed (Medtronic Cardioblate irrigated radiofrequency System) with creation of a roofline and trigone line, and excision of the left atrial appendage.Fig. 3

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