Usefulness of multidetector-row computed tomography in evaluating adult cor triatriatum

Abstract

Cor triatriatum is a rare congenital cardiac disease in which a fibromuscular membrane divides the left atrium into 2 distinct chambers. The most common presenting symptoms in adults are dyspnea, hemoptysis, and orthopnea, which mimic mitral stenosis in presentation. Cor triatriatum is commonly evaluated and diagnosed by echocardiography.Herein, we describe the case of a 39-year-old woman who had experienced worsening dyspnea for 7 months. Cor triatriatum was diagnosed by transthoracic and transesophageal echocardiography. A 3-dimensional reconstruction image produced by multidetector-row computed tomography (40 slices) clearly showed the intra-atrial membrane and the communicating fenestration, in conjunction with coronary and whole-heart evaluation in a single study. On the basis of our findings, we conclude that multidetector-row computed tomography may be a useful tool, as an adjunct to echocardiography, for whole-heart evaluation before operative correction of cor triatriatum.

Keywords: Cor triatriatum/diagnosis; heart atria/abnormalities; heart defects, congenital/diagnosis; hypertension, pulmonary; tomography, X-ray computed.

Fig. 1 A) Transthoracic echocardiography (apical 4-chamber view) reveals a membrane (arrows) that subdivides the dilated left atrium into 2 chambers—the true left atrium and an accessory left atrium. B) Transesophageal echocardiography revealsa thin intra-atrial membrane (arrows) attached to the interatrial septum medially and atrial appendage laterally, which divides the left atrium into posterior–superior (accessory left atrium) and anterior–inferior (true left atrium) compartments. aLA = accessory left atrium; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle

Fig. 2 Multidetector-row computed tomography. A) Four-chamber view reveals an intra-atrial membrane with an opening of approximately 1.7 cm in diameter. B) A 3-dimensional slab volume-rendering image reveals a dilated left atrium with double chambers (an accessory left atrium and a true left atrium), divided by a fibrous membrane between the interatrial septum and the lateral atrial wall. aLA = accessory left atrium; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle