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 ::  Introduction
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CASE REPORT
Year : 1979  |  Volume : 25  |  Issue : 4  |  Page : 233-235

Cor triatriatum : Echocardiographic error in diagnosis


Department of Cardiology and Thoracic Surgery, K.E.M. Hospital and Seth G. S. Medical College, Parel, Bombay-400 012, India

Correspondence Address:
A S Vengsarkar
Department of Cardiology and Thoracic Surgery, K.E.M. Hospital and Seth G. S. Medical College, Parel, Bombay-400 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 529184

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 :: Abstract 

Echocardiographic features in a sixteen year old female patient with primary pulmonary hypertension, and a persistent left superior vena cava draining into the coronary sinus are discussed; they led to a false positive diagnosis o f an infra-aerial fibromuscular membrane (cor triatriatum)



How to cite this article:
Vengsarkar A S, Dalal J J, Katdare A V, Bhattacharya S, Nair K G. Cor triatriatum : Echocardiographic error in diagnosis. J Postgrad Med 1979;25:233-5

How to cite this URL:
Vengsarkar A S, Dalal J J, Katdare A V, Bhattacharya S, Nair K G. Cor triatriatum : Echocardiographic error in diagnosis. J Postgrad Med [serial online] 1979 [cited 2020 Jul 2];25:233-5. Available from: http://www.jpgmonline.com/text.asp?1979/25/4/233/42226



 :: Introduction Top


Cor triatriatum is a rare congenital heart malformation in which the left at­rium is subdivided into a proximal and a distal chamber. [7]

Echocardiographic features of cor tria­triatum have been reported both in the M-mode, [1],[3],[4],[5] as well as in the real time two dimension technique . [5]

This report relates to a patient in whom a false positive diagnosis of cor triatria­tum was made mainly on the basis of M­mode echocardiography.


 :: Case report Top


Miss R.S., a 16 year old school girl presented with complaints of marked exertional dyspnoea and palpitations of one years' duration.

On general examination, she was found to have a regular pulse rate of 85/min. and a blood pressure of 120/76 mm Hg. There was no cya­nosis or clubbing. There were prominent `a' waves in the jugular venous pulse. Precordial examination revealed the apex beat in the 5 th left intercostal space within the midclavicular line. A significant right ventricular lift was present. At auscultation, a grade 2/6 ejection systolic murmur along with a very loud P2 was heard in the pulmonary area.

The electrocardiogram showed a QRS axis of + 120° with marked right ventricular hyper­trophy.

The X-ray showed a normal sized heart with a prominent main pulmonary artery and pul­monary venous congestion (See [Figure 1] on page 23213). The left atrium was not enlarged.

The cardiac catheterization data are depict­ed in [Table 1]. The presence of a left superior vena cava draining into the coronary sinus and an anomalous pulmonary vein entering the right atrium was detected by catheter passage.

Echocardiogram

The echocardiogram in M-mode (See [Figure 2] on page 232B), in the base apex scan showed presence of an abnormal echo in the left atrium. It was an intense uninterrupted linear echo situated midway between the anterior and posterior limits of the left atrium; it made its appearance in the downward scan behind the inferior part of the aortic root and continued in the lower region of the left atrium behind the mitral valve echo, but separated from it by a distance of 7 mm. in systole. This echo moved anteriorly in diastole and posteriorly in systole resembling atrioventricular valve movement. The excursion of movement measured 9 mm. The left atrial dimension (20 mm) was normal for the age and bodyweight; the anterior mitral leaflet echoes were normal and the EF slope was 75 mm/sec; however the posterior mitral leaflet was not discernible.

At surgery no evidence of cor triatriatum was detected.


 :: Discussion Top


There are reports in the litera­ture [1],[3],[4],[5] which underline the import­ance of echocardiography in differentiat­ing the various lesions causing pulmon­ary venous obstruction.

This case report relates to a patient who had severe pulmonary hypertension with the chest X-ray suggesting pulmon­ary venous obstruction. Partial opacifi­cation of the left atrium in the angio­gram, due to severe pulmonary vascular disease was erroneously interpreted as suggestive of cor triatriatum (See [Figure 3] on page 232B). This diagnosis was mainly entertained however on account of the in­tense, easily recorded linear echo in the left atrium. An abnormal uninterrupted linear echo in the left atrium with a mo­tion pattern associated with the mitral valve echo similar to our case has been reported in cor triatriatum [5] The abnor­mal echo was thought to originate from an intra-atrial membrane as it moved with atrial events, for the same reason it was not attributed to the persistent left superior vena cava. The standard beam angulation ruled out linear intra-atrial echoes observed at times in healthy sub­jects. [2]

P.S.

While submitting this report we have come across an excellent documentation of material of similar nature by Orsmond et al [6] the authors have conclusively pro­ved that such echoes originate from the coronary sinus by using contrast echocardiography after saline injection. Our findings appear similar to them.


 :: Acknowledgement Top


We are thankful to Dr. C. K. Desh­pande, Dean, K.E.M. Hospital for allow­ing us to publish this material.

 
 :: References Top

1.Ehrich, D. A., Vieweg, W. V. R., Alpert, J. S., Folkerth, T. L. and Hagan, A. D.: Cor triatriatum-Report of a casa in a young adult with special reference to the echocardiographic features and aetio­logy of the systolic murmur. Amer. Heart J., 94: 217-221, 1977.  Back to cited text no. 1    
2.Feigenbaum, H.: "Echocardiography", 2nd Edition, Lea and Febiger, `Philadelphia, 1976. p. 252.  Back to cited text no. 2    
3.Gibson, D. G., Hovey, M. and Lenox, S. C.: Cor triatriatum-diagnosis by echo­cardiography. Brit. Heart J., 36: 835-838, 1975.  Back to cited text no. 3    
4.Lundstrom, N. R.: Ultra-sound cardio­graphic studies of the mitral valve region in young infants with mitral atresia, mitral stenosis, hypoplasia of the left ventricle and cor triatriatum. Circulation, 45: 324-334, 1972.  Back to cited text no. 4    
5.Nimura, Y., Matsumoto, M., Beppu, S., Matsuo, H., Sakakibara, H. and Abe, H.: Non-invasive pre-operative diagnosis of cor triatriatum with ultra sonocardiotomo­gram and conventional echocardiogram. Amer. Heart J., 88: 240-250, 1974.  Back to cited text no. 5    
6.Orsmond, G. S., Ruttenberg_ H. D., Bes­singer, F. B. and Moller, J. H.: Echocar­diographic features of total anomalous pu'monary venous connection to the coronary sinus. Amer. J. Cardiol., 41: 597-601, 1978.  Back to cited text no. 6    
7.Thilenius, O. G., Bharati, S. and Lev. M.: Sub-divided left atrium; an expanded concept of cor-triatriatum sinistrum. Amer. J. Cardiol., 37: 743-752, 1976.  Back to cited text no. 7    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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