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(Circulation. 1995;92:3574.)
© 1995 American Heart Association, Inc.

Articles

Adult Congenital Heart Disease

Obstructive and Nonobstructive Cor Triatriatum

Brian O'Murchu, MB, MRCPI; James B. Seward, MD

From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn.

Correspondence to Brian O'Murchu, MB, MRCPI, San Francisco Heart Institute, 1900 Sullivan Ave, Daly City, CA 94015.

	Introduction

 
Among 4000 transesophageal echocardiograms in adult patients, we have found cor triatriatum in 7.

	Obstructive cor triatriatum

 
A 41-year-old man presented with dyspnea on exertion. A transthoracic echocardiogram demonstrated a linear echodensity in the left atrium (LA) of questionable significance. Transesophageal echocardiography (TEE, Fig 1A) showed a discrete membrane (thick white arrows) attached medially to the atrial septum at the inferior margin of the fossa ovalis membrane (thin white arrows) and laterally to the junction of the left upper pulmonary vein and LA appendage. This membrane divided the left atrium into posterosuperior (PS-LA) and anteroinferior (AI-LA) chambers. The pulmonary veins are posterior and the left atrial appendage anterior to the membrane. Color Doppler (Fig 1B) showed an aliased high-velocity flow jet (white arrowheads) across the membrane. The peak gradient was 8 mm Hg and the mean gradient, 4 mm Hg. The findings were those of obstructive cor triatriatum. Surgical correction was recommended.

View larger version (28K): [in this window] [in a new window]   Figure 1.

	Nonobstructive cor triatriatum

 
A 70-year-old man with coronary artery disease was evaluated for worsening angina without dyspnea. Transthoracic echocardiography, performed to assess left ventricular function, revealed a poorly delineated linear echodensity in the LA. TEE showed a membrane (Fig 1C, thick white arrows) that had attachments similar to those seen in Fig 1A (thin white arrows, fossa ovalis membrane). Doppler examination showed low velocity flow across the membrane orifice (Fig 1D, white arrowheads). This represents a nonobstructive form of cor triatriatum. No specific treatment was recommended for this abnormality. RA indicates right atrium; AV, aortic valve; LV, left . . . [Full Text of this Article]

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