cor triatriatum dexter - sinistrer · cor triatriatum - sinister •timing of presentation depends...

Cor Triatriatumdexter - sinister

Antonios P Vlahos

Associate Professor in Pediatric Cardiology

University of Ioannina

No conflict of interest

Cor triatriatum - sinister

• An oblique fibromuscular membrane subdivides the left atrium

• Proximal posterior – superior chamber ➡ accessory chamber• Receives the pulmonary veins

• Distal anterior – inferior chamber ➡ LAA and MV

• Usually there is a small communication between the accessory chamber and the LA

Cor triatriatum - sinister

• Cor triatriatum may result from abnormal incorporation of the common pulmonary vein into the LA

• This can cause obstruction between the pulmonary vein confluence and the LA

• Not a consistent theory

• There are 3 methods of classification of CorT-sinistra types!!!

Cor triatriatum - sinister

• Timing of presentation depends on the size of the communication between the accessory chamber and the distal LA, as well as the location and size of associated communicating ASDs to the RA

•⬆ RA, ⬆ RV, PH

• Membrane• curvilinear, mobile

• Above the LAA

Surgical repair

• Resection of the obstructing membrane within the LA

• Pericardial patch repair of any associated ASDs

• Postoperative evaluation • full assessment of left atrial anatomy

• visualization of unobstructed pulmonary venous return

Surgical repair

• RV hemodynamics should improve immediately

• Pulmonary hypertension and RVH may take some time to resolve

depending on the age of the infant and preoperative course

• It is unlikely that there will be long-term cardiac sequelae/residua

following successful neonatal repair of cor triatriatum

Cor triatriatum - dexter

• the valve of the sinus venosus regresses by approximately 12 weeks of gestation

• crista terminalis superiorly

• EV of the inferior vena cava and the thebesian valve of the coronary sinus inferiorly

Cor triatriatum - dexter

• cor triatriatum dexter or divided RA: attachments to the atrial septum, giving the appearance of a divided atrium

• prominent EV when the right sinus venosus valve is partly regressed, with no remaining septal attachments and without the appearance of a divided atrium.

Bibliography

• Fabiola B. Sozzi MD et al: Echocardiography. 2017;34:1725–1729 • Onur Isık, M.D et al: Turk Kardiyol Dern Ars 2016;44(1):20-23• Ajay Kumar Jha, MD, DM et al: Seminars in Cardiothoracic and Vascular

Anesthesia 2017, Vol. 21(2) 178–185• Syed T. Hussain, MD et al: J Thorac Cardiovasc Surg 2015;149:e48-50• Moss & Adams’ Heart Disease in Infants, Children, and Adolescents,

Including the Fetus and Young Adult• Nadas' Pediatric Cardiology• Eidem, Benjamin W.. Echocardiography in Pediatric and Adult Congenital

Heart Disease . Lippincot (Wolters Kluwer Health). Kindle Edition. • UpToDate®