C 2006, the Authors
C 2006, Blackwell Publishing, Inc. Journal compilation
Cor Triatriatum Sinister: Assessment by Live/Real Time Three-Dimensional Transthoracic Echocardiography Vinod Patel, M.D.,∗ Navin C. Nanda, M.D.,∗ Iliana Arellano, M.D.,† Pridhvi Yelamanchili, M.D.,∗ Sanjay Rajdev, M.D.,∗ and Oben Baysan, M.D.∗ ∗ Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama, †Montgomery Cardiovascular Associates, P.C., Montgomery, Alabama
We report a 49-year-old morbidly obese female with a poor acoustic window in whom live/real time three-dimensional transthoracic echocardiography was able to make a confident diagnosis of cor triatriatum sinister. En face views of the membrane facilitated accurate assessment of the size and shape of the large nonobstructing opening in the membrane. Maximum dimensions of the opening were 3.06 × 1.03 cm and area was 2.3 cm2 . (ECHOCARDIOGRAPHY, Volume 23, October 2006) three-dimensional transthoracic echocardiography, cor triatriatum sinister, intraatrial membrane Cor triatriatum sinister is a rare congenital anomaly characterized by a fibromuscular membrane located in the left atrium superior to left atrial appendage. This differenAddress for correspondence: Navin C. Nanda, M.D., Division of Cardiovascular Diseases, University of Alabama at Birmingham Heart Station, SWB/S102 619, 19th Street, South Birmingham, Alabama 35249. Fax: 205-934-6747; Email:
[email protected]
tiates it from a supravalvular mitral membrane, which is located inferior to left atrial appendage.1 The opening in the cor triatriatum membrane may be small producing obstruction to blood flow or large with no hemodynamically significant obstruction. We have previously used three-dimensional transesophageal echocardiography (3DTEE) to assess the exact shape and size of the opening in the cor triatriatum membrane, which cannot be
Figure 1. Live/real time three-dimensional transthoracic echocardiography in cor triatriatum sinister. A. Arrowhead points to cor triatriatum membrane (M), which is located superior to left atrial appendage (LAA). B. Arrowhead points to a large opening in cor triatriatum membrane visualized en face. The dimensions were 3.06 × 1.03 cm and area was 2.3 cm2 . LA = left atrium; LV = left ventricle; LVO = left ventricular outflow tract; RA = right atrium; RV = right ventricle. Vol. 23, No. 9, 2006
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done by two-dimensional transthoracic echocardiography (2DTTE) or two-dimensional transesophageal echocardiography (2DTEE).2,3 The recent advent of live/real time 3DTTE has made it possible to view various intracardiac defects en face resulting in accurate assessment of their shape and size.4 This has obviated the need for 2DTEE in many of these patients. We report a 49–year-old morbidly obese female with a poor acoustic window in whom live/real time 3DTTE (performed using a Philips iE 33 system, Andover, MA and 4X matrix transducer) was able to make a confident diagnosis of cor triatriatum sinister since the membrane in the left atrium could be visualized superior to the appendage by cropping an apically acquired 3D dataset.5 In addition, an en face view of the membrane could be obtained by cropping the same four chamber dataset from top to the level of the membrane and tilting it. This facilitated accurate assessment of the shape and size of the large nonobstructing opening in the membrane (Fig. 1). Maximum dimensions of the opening were 3.06 × 1.03 cm and area was 2.3 cm2 . 2DTTE/Doppler done using the same ultrasound system also demonstrated the membrane located superior to left atrial appendage with no significant gradient across it, but the shape and size of the opening could not be delineated. It was concluded that the pa-
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tient’s long duration symptom of dyspnea on exertion was not associated with this congenital anomaly but was most likely due to her obesity. This case illustrates the potential usefulness of live 3DTTE as an adjunct to 2DTEE in the evaluation of cor triatriatum sinister. References 1.
2. 3.
4.
5.
Kirklin J, Barratt-Boyes B: Congenital mitral valve disease. In: Kouchoukos N, Blackstone E, Doty D, Hanley F and Karp R (eds): Cardiac Surgery. Philadelphia, Churchill Livingstone, 2003, pp. 1401–1414. Samal AK, Nanda NC, Thakur AC, et al: Threedimensional echocardiographic reconstruction of atrial membranes. Echocardiography 1998;15:605–610. Baweja G, Nanda NC, Kirklin JK: Definitive diagnosis of cor triatriatum with common atrium by threedimensional transesophageal echocardiography in an adult. Echocardiography 2004;21:303–306. Mehmood F, Vengala S, Nanda NC, et al: Usefulness of live three-dimensional transthoracic echocardiography in the characterization of atrial septal defects in adults. Echocardiography 2004;21:707–713. Sinha A, Nanda NC, Khanna D, et al: Live threedimensional transthoracic echocardiographic delineation of patent ductus arteriosus. Echocardiography 2004;21:443–448.
Supplementary Material The following supplementary material is available online: Figure 1B.
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