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. 2014:2014:674018.
doi: 10.1155/2014/674018. Epub 2014 Dec 29.

Cor triatriatum sinister identified after new onset atrial fibrillation in an elderly man

Ignacio A Zepeda  1 , Peter Morcos  2 , Luis R Castellanos  2
Affiliations

Cor triatriatum sinister identified after new onset atrial fibrillation in an elderly man

Ignacio A Zepeda et al. Case Rep Med. 2014.

Abstract

A 73-year-old man with new onset atrial fibrillation with rapid ventricular response underwent transthoracic echocardiography that revealed an echogenic linear structure along the left atrium, suggestive of cor triatriatum sinister (CTS). CTS was confirmed with transesophageal echocardiography which demonstrated a proximal accessory atrium receiving pulmonary venous flow separated from a distal true atrium by a fibromuscular membrane with a large fenestration allowing flow between the chambers. In CTS, the left atrium is divided into proximal and distal chambers by a fenestrated fibromuscular septum. This cardiac anomaly accounts for 0.1% of cases of congenital heart disease and rarely presents in adults. CTS is primarily diagnosed with echocardiography and is associated with left atrial enlargement and development of atrial fibrillation. Treatment options depend on size of the communication between proximal and distal chambers, the gradient across the membrane, and the position of pulmonary veins. In some instances, surgical resection of the membrane that divides the left atrium is warranted.

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Figures

Figure 1
Figure 1
Electrocardiogram shows irregular rhythm consistent with atrial fibrillation with a ventricular rate of 97, no ST segment, or T wave changes suggestive of ischemia.
Figure 2
Figure 2
Transthoracic echocardiogram: 2-chamber view (a) and 4-chamber view (b) showing the left atrium divided into proximal (+) and distal (∗) chambers by a fenestrated membrane (arrow).
Figure 3
Figure 3
Transesophageal echocardiogram. 2-chamber view (a), 4 chamber view (b), biplane view (c), and 3D mode (d) showing the left atrium divided by a large fenestrated fibromuscular membrane consistent with cor triatriatum sinister.
Figure 4
Figure 4
Transesophageal echocardiogram with Doppler color flow analysis. 2-chamber view showing flow from the pulmonary veins into the proximal accessory left atrium (a); flow across the fenestrated membrane into the distal true left atrium and across the mitral valve (b); biplane view showing mitral regurgitation and bidirectional flow across the membrane (c); and bicaval view showing partial attachment of the membrane to the interatrial septum (d).
See this image and copyright information in PMC

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