Corresponding author
Magdy M. El-Sayed Ahmed
Mail address: 4500 San Pablo Rd S, Jacksonville, FL 32224
Email:ahmed.magdy@mayo.edu
Phone: 904-953-2190
Fax: 904-953-73
Cor triatriatum is abnormal septation within the atrium. It exits in two
different varieties; cor triatriatum sinister (CTS) in the left atrium
and cor triatriatum dexter (CTD) in the right atrium. Cor triatriatum
sinister is an uncommon congenital cardiac anomaly with an incidence of
about 0.1- 0.4% of patients with congenital cardiac disease. CTS
usually associated with other congenital cardia anomalies such as ostium
secondum, patent foramen oval, atrial septal defect, left superior vena
cava, anomalous pulmonary venous return, and mitral valve regurgitation.
CTD is commonly associated with right ventricular hypoplasia, pulmonary
valve atresia, pulmonary valve stenosis, and Ebstein anomaly. Symptoms
typically mimic mitral and tricuspid in CTS and CTD respectively.
Surgical resection is the standard treatment, however, balloon
dilatation may be considered in certain circumstances as heart failure,
pregnancy or as a bridge to definitive management.
We report an incidentally discovered CTS during heart transplant in a
51-year-old male patient with heart failure due to ischemic
cardiomyopathy. He had been experiencing intermittent angina. His past
medical and surgical history were remarkable for coronary stenting and
coronary artery bypass grafting. His echocardiography revealed a thin
band-like structure in the left atrium (Fig. 1A). A suitable donor was
available and the patient successfully underwent orthotopic heart
transplant. During explanation of the native heart, CTS was discovered
as a semicircular membrane within the left atrium (Fig. 1B). CTS was
completely excised and careful inspection of the pulmonary veins and
both superior and inferior vena cavae showed no anomalies. His
postoperative course was uneventful and he was discharged from the
hospital on postoperative day 13.
Although CTS is a rare congenital cardiac anomaly, adult cardiac
surgeons should be aware of the potential associated other anomalies
specially left superior vena cava and anomalous pulmonary venous return
during heart transplant procedure.