A70-year-old woman was evaluated for worsening angina. Physical examination disclosed a harsh diastolic murmur. Transesophageal echocardiography (TEE) showed a membrane (A, arrow) attached laterally to the junction of the left upper pulmonic vein and left atrial appendage. This membrane divided the left atrium into 2 chambers: (1) a posterosuperior chamber that received blood from the pulmonic veins (PS-LA) and (2) an anteroinferior (AI-LA) chamber that contained the left atrial appendage and mitral valve. The presence of a large communicating orifice together with multiple fenestrations of the membrane was clearly visualized from the 3-dimensional reconstruction of the TEE-acquired images (B, reconstructed left atrium and C, view from the roof of the posterosuperior chamber). The atrial membrane was excised during surgery, which was recommended because of the presence of associated significant coronary artery disease. D corresponds to the surgical view from the roof of the posterosuperior chamber showing the identical membrane perforations previously diagnosed by 3-dimensional echocardiography (C). LV indicates left ventricle; AML, anterior mitral leaflet; and PML, posterior mitral leaflet.
Dr Godoy is a recipient of a grant from the Pontificia Universidad Catolica de Chile.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal 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 Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 1998 by American Heart Association