A10-month-old boy born at 32 weeks’ gestation required ventilatory support for 1 week after birth. He was discharged from the hospital 2.5 weeks later, and subsequently was admitted multiple times for reactive airway disease. Physical examination revealed a heart rate of 120 per minute, a respiratory rate of 50 per minute, good peripheral pulses, and a soft grade ii/vi, short systolic murmur at the apex. The liver was palpable 2.5 cm below the right costal margin and the lungs were clear. An ECG revealed right axis deviation with an axis of +135°, right atrial enlargement, and right ventricular hypertrophy. Fig 1A⇓ and 1B⇓ are the echocardiographic images of this patient at the time, which revealed cor triatriatum. This is a condition in which a fibromuscular diaphragm divides the left atrium into a proximal venous chamber and a distal true left atrial chamber, resulting in pulmonary venous hypertension. An atrial septal defect is commonly associated with this condition but was not present in our patient. This child underwent open heart surgery under cardiopulmonary bypass and the membrane was successfully excised. The patient tolerated the operation well and was discharged home on the fourth postoperative day. The postoperative echocardiographic images are shown in Fig 2A⇓ and 2B⇓.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
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