Correspondence Address: Dr. Sourabh Agstam Assistant Profesor, Department of Cardiology, VMMC and Safdarjung Hospital, New Delhi India
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jiae.jiae_57_19
How to cite this article: Agstam S, Gupta A, Gupta P, Bansal S. Cor Triatriatum or Pseudo Cor Triatriatum in an Elderly Patient: Are We Missing Something?. J Indian Acad Echocardiogr Cardiovasc Imaging 2020;4:393-4
How to cite this URL: Agstam S, Gupta A, Gupta P, Bansal S. Cor Triatriatum or Pseudo Cor Triatriatum in an Elderly Patient: Are We Missing Something?. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2020 [cited 2021 Apr 13];4:393-4. Available from: https://www.jiaecho.org/text.asp?2020/4/3/393/303954
Cor triatriatum is a rare congenital anomaly with an incidence of 0.1%–0.4%. It is characterized by failure of resorption of the common pulmonary vein and results in division of the left atrium by an abnormal fibromuscular membrane into a posterosuperior chamber receiving pulmonary veins and an anteroinferior chamber leading to the mitral orifice.[1]
Most of the patients with cor triatriatum present in infancy, mimicking congenital pulmonary vein stenosis or mitral stenosis. Its appearance in the elderly is very rare or even more exceptional.[2],[3],[4],[5]
A 68-year-old gentleman was referred to our cardiology department for early surgical excision of cor triatriatum. He was a chronic smoker, and had symptoms of progressive dysphagia and weight loss for 3 months. He had been evaluated in other tertiary care hospital, and had been advised for early surgical excision of cor triatriatum. At the time of presentation, the patient was gasping, altered sensorium, hypotensive with blood pressure of 80/50 mmHg. His pulse rate was 110 per minute, and respiratory rate was 30 per minute. Cardiovascular examination revealed normal S1 and S2 and no murmur; chest auscultation revealed gurgling breath sounds. Echocardiography showed the membrane in the left atrium with maximum gradient of 6 mmHg [Figure 1], [Figure 2] and [Video 1],[Video 2],[Video 3], mild enlargement of left atrium, mild eccentric mitral regurgitation, mild tricuspid regurgitation, and mild pulmonary artery hypertension (Right ventricular systolic pressure = Right atrial pressure + 28 mmHg). Low gradient across the membrane favored asymptomatic presentation of cor triatriatum in this index case. The patient was admitted in the emergency and arterial blood gas showed pH of 7.1 with increased lactate levels and total leukocyte count of 24,000/μl. He was managed on lines of sepsis with septic shock; however, he succumbed after 6 h of admission.
Figure 1: Apical four-chamber view demonstrating thick membrane in left atrium (white arrow), dividing the left atrium into two chambers. Proximal chamber receives pulmonary venous blood and distal chamber drains to the left ventricle through mitral valve (red arrow). RA: Right atrium, RV: Right ventricle, LA: Left atrium, LV: Left ventricle
Figure 2: Continuous wave Doppler signal across the opening of the cor triatriatum membrane showing maximum diastolic gradient of 6 mmHg, suggestive of non restrictive cor triatriatum
This case highlights the atypical presentation of cor triatriatum sinister in an elderly man. An echocardiography serves as a very useful tool in prompt diagnosis and management of cor triatriatum. This index patient died due to some other cause rather than cor triatriatum sinister.
Almendro-Delia M, Trujillo-Berraquero F, Araji O, de Vinuesa PG, Fernández JM. Cor triatriatum sinistrum in an elderly man. Int J Cardiol 2008;125:e27-9.
Levin D, Snider R, Andre P, Charlton G, Roldan C. Pseudo cor-triatriatum in an elderly patient with dyspnea of exertion: An undescribed condition characterized by three-dimensional transesophageal echocardiography. Poster JACC 2019;73:9.
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