\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{Cor triatriatum in adulthood with mitral valve regurgitation and atrial
fibrillation}



\author[1]{Shinichi Ishida}%
\author[1]{Takashi Fujita}%
\author[1]{Kei Yagami}%
\author[2]{Masato Mutsuga}%
\affil[1]{Gifu Kenritsu Tajimi Byoin}%
\affil[2]{Nagoya University Graduate School of Medicine Faculty of Medicine}%


\vspace{-1em}



  
  \date{May 27, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Cor triatriatum is a rare congenital heart disease. A 57-years-old woman
had cor triatriatum with severe mitral valve regurgitation (MR) and
atrial fibrillation (AF). We perfomed mitral valve repair, left atrial
appendage resection, and maze procedure by resection of the anomalous
septum in the left atrium. At result, MR was controllable and AF
disappeared after the operation. Although there is no established maze
procedure with cor triatriatum, removing the septum was effective to
complete it.%
\end{abstract}%



\sloppy


Title:

Cor triatriatum in adulthood with mitral valve regurgitation and atrial
fibrillation

Authors:

Shinichi Ishida MD\textsuperscript{1}, Takashi Fujita
MD\textsuperscript{1}, Kei Yagami MD-PhD\textsuperscript{1}, Masato
Mutsuga MD-PhD\textsuperscript{2}

1.Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital,
161-5, Maehata-cho, Tajimi-City, Gifu 507-8532, Japan

2.Department of Cardiac Surgery, Nagoya University Graduate School of
Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-City, Aichi 466-8550, Japan

Short running title: cor triatriatum in adulthood

key words: cor triatriatum, mitral valve regurgitation, atrial
fibrillation, congenital heart disease, valve repair/replacement

Corresponding Author:

Shinichi Ishida, 5-161 Maehata-cho, Tajimi-city, Gifu 507-8522, Japan,
+81-572-22-5311, e-mail:shin1dinho@yahoo.co.jp

Abstract

Cor triatriatum is a rare congenital heart disease. A 57-years-old woman
had cor triatriatum with severe mitral valve regurgitation (MR) and
atrial fibrillation (AF). We perfomed mitral valve repair, left atrial
appendage resection, and maze procedure by resection of the anomalous
septum in the left atrium. At result, MR was controllable and AF
disappeared after the operation. Although there is no established maze
procedure with cor triatriatum, removing the septum was effective to
complete it.

A 57-year-old woman was transported to our hospital for ventricular
fibrillation after defibrillation by automated external defibrillator.
Emergency coronary angiography revealed no significant stenosis.
Transthoracic echocardiography showed severe MR and we initiated
treatment for heart failure caused by MR with cerebral hypothermia. The
treatment was successful, and the heart failure seemed well controlled
by medical therapy. However, severe MR remained, and AF developed during
the course of treatment. We performed mitral valve repair with the maze
procedure. Preoperative echocardiography revealed mitral valve P2
prolapse; additionally, an anomalous septum was found in the left
atrium, which proved to be a cor triatriatum (Figure 1). Enhanced
computed tomography showed that the accessory chamber and the left
atrium communicated via a 7-mm hole, and the four pulmonary veins
entered the heart through the accessory chamber (Figure 2). Through a
median sternotomy, we performed mitral valve repair, left atrial
appendage resection, and maze surgery. Approaching the accessory chamber
by right lateral left atriotomy, we excised as much of the anomalous
septum as possible (Figure 3). The maze procedure was completed by
radiofrequency ablation across the remaining part of the septum (Figure
4). For MR, we performed annuloplasty using a ring and artificial tendon
reconstruction. The postoperative course was uneventful; MR was
controllable and AF disappeared.

Cor triatriatum is a rare congenital heart disease. It is usually
diagnosed during childhood; a new diagnosis in adults is rare, and cor
triatriatum alone may not be an indication for
surgery\textsuperscript{1}. In this case, because of severe MR and AF,
we performed the operation. There is no established maze procedure for
cor triatriatum \textsuperscript{2}. We completed the surgery by
removing the septum; consequently, atrial fibrillation disappeared.

Author contributions

S.I., T.F., K.Y. and M.M. designed and performed the experiments,
analysed data and interpreted it. S.I. and K.Y. Drafted article. S.I.,
T.F., K.Y. and M.M. revised it critically. S.I., T.F., K.Y. and M.M.
approved of the article, collected data and supported technical and
logistical.

References

\begin{enumerate}
\tightlist
\item
  VanSon JA, Danielson GK, Schaff HV, Puga FJ, Seward JB, Hagler DJ et
  al. Cor triatriatum: diagnosis, operative approach, and late results.
  Mayo Clinic Proc. 1993;68:854-9
\item
  Nakajima H, Kobayashi J, Kurita T, Kitamura S. Maze procedure and cor
  triatriatum repair. Ann Thorac Surg. 2002;74:251-3.
\end{enumerate}

Figure 1. Transthoracic echocardiography, showed a septum (arrow) in the
left atrium. LA: left atrium, LV: left ventricular.

Figure 2. Preoperative enhanced computed tomography. A, The accessory
chamber was separated from the left atrium by the anomalous septum. B,
The accessory chamber and the left atrium communicated via a 7-mm hole
(yellow arrow). C, All four pulmonary veins entered the heart through
the accessory chamber.

Figure 3. Intraoperative pictures taken from the surgeon's perspective.
A, The septum separating the left atrium and the hole (arrow) was found.
B, After excising the septum, the mitral valve was visually recognized
(asterisk: posterior leaflet of the mitral valve).

Figure 4. The left atrial maze procedure schema. The anomalous septum
was excised, and an ablation of MV isthmus line was performed across the
remained septum after resection. LA: left atrium, LPA: left pulmonary
artery, RPA: right pulomonary artery, MV: mitral valve.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2/Figure-2}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-3/Figure-3}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-4/Figure-4}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

