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Cardiovascular Disease |

Isolated Cor-Triatriatum Sinister Presenting as New Onset Atrial-Fibrillation in a 53-Year-Old Female

Priyank Shah*, MD; Vipin Mittal, MD; Nishant Gupta, MD; Sharad Bajaj, MD; Fadi Alattar, MD; Aderemi Soyambo, MD; Mahesh Bikkina, MD; Fayez Shamoon, MD
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St. Joseph's Regional Medical Center, Pateron, NJ


Chest. 2012;142(4_MeetingAbstracts):119A. doi:10.1378/chest.1388838
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Abstract

SESSION TYPE: Cardiovascular Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Cor-triatriatum sinister is a rare congenital disorder, where left atrium is divided into two chambers by a fibromuscular membrane. It occurs in 0.1-0.4% of all patients with congenital heart disease (1). We report a case where isolated cor-triatriatum sinister was incidentally diagnosed in a patient with new onset atrial fibrillation.

CASE PRESENTATION: 53-year-old Hispanic female with past medical history of diabetes mellitus and hypertension presented with complaint of palpitations. There was associated intermittent sub-sternal chest pain, lasting for 3 to 4 minutes with no specific aggravating and relieving factors. She refused shortness of breath, diaphoresis, dizziness, syncope or any previous similar symptoms. Home medications included losartan and metformin. There was a strong family history of coronary artery disease and stroke and she smoked 3 cigarettes per day. On examination, she had pulse rate of 130 bpm with irregularly irregular rhythm. Rest of the physical examination was normal. Electrocardiogram showed atrial fibrillation with rapid ventricular response. Initial laboratory data including two set of cardiac enzymes and thyroid function tests were normal. Chest radiograph was normal. She was admitted to telemetry floor for rate control and anticoagulation therapy. Transesophageal doppler echocardiogram revealed cor-triatriatum sinister and a concomitant jet of blood across the orifice (Image 1) and confirmed absence of thrombus. Subsequently, a cardiac MRI was performed which showed a larger proximal chamber measuring 3.9 x 5.4 cm with all four pulmonary veins draining into it. The distal chamber measured 4 x 4 cm and the orifice (Image 2) measured approximately 1.5 cm in diameter. The patient was referred for cardiothoracic surgery and was continued on anticoagulation.

DISCUSSION: Isolated cor-triatriatum presenting as new onset atrial fibrillation in an adult patient is rare since most cases are diagnosed in infancy. The age and severity of presentation depends on the size of the communicating orifice. If the defect is large, patients may remain asymptomatic until adulthood (2). Symptoms occur mainly due to fibrosis and calcification of the orifice or development of atrial fibrillation.

CONCLUSIONS: Presentation of cor triatriatum as new onset atrial fibrillation in an adult patient is an uncommon finding. Corrective surgery is required to provide the relief of symptoms in majority of cases (3).

1) Krasemann Z, Scheld HH, Tjan TD, Krasemann T. Cor triatriatum: short review of the literature upon ten new cases. Herz. 2007; 32(6):506-510.

2) Chen Q, Guhathakurta S, Vadalapali G, Nalladaru Z, Easthope RN, Sharma AK. Cor triatriatum in adults: three new cases and a brief review. Tex Heart Inst J. 1999; 26(3):206-210.

3) Lam CR, Green E, Drake E. Diagnosis and surgical correction of 2 types of triatrial heart. Surgery. 1962; 51:127-137.

DISCLOSURE: The following authors have nothing to disclose: Priyank Shah, Vipin Mittal, Nishant Gupta, Sharad Bajaj, Fadi Alattar, Aderemi Soyambo, Mahesh Bikkina, Fayez Shamoon

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St. Joseph's Regional Medical Center, Pateron, NJ

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