Cor triatriatum with atrial flutter in an adult
Qiang Fan* MD, Yunfei Ling* PhD, Xiao Li PhD, Changping
Gan#PhD
Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan, People’s Republic of China
*These authors contributed equally to this article and should be
considered as co-first author.
#Corresponding author: Tel: +86 28 85422897, Fax: +86 28 85422897,
E-mail: ganchangping@hotmail.com, Add: No. 37 Guo Xue Xiang, Chengdu,
Sichuan 610041, People’s Republic of China.
Keywords: Cor triatriatum, atrial flutter.
Funding : none.
Abstract Cor triatriatum is a rare congenital heart
malformation with different natural history which depends on the size of
the aperture in the partition between the proximal and distal chambers.
In classic cor triatriatum all pulmonary veins return to proximal
chamber (accessory left atrium, aLA), but this case we reported with
left upper pulmonary vein returned to distal chamber (true left atrium,
tLA). The partition had one 5mm aperture that allowed this patient grown
up to adulthood without any symptoms, but finally resorted to hospital
with symptomatic atrial flutter and detected this cor triatriatum
accidentally. Atrial flutter may be a long-term complication of cor
triatriatum during its natural history, surgical correction of cor
triatriatum and radiofrequency ablation for atrial flutter is
recommended once diagnosed.
A 29-year-old man with symptomatic atrial flutter was admitted to our
hospital for cryoablation. A routine preoperative transthoracic
echocardiogram detected the cor triatriatum. A diaphragm structure
dividing the left atrium into proximal (aLA) and distal (tLA) chambers
which communicating via a 5mm aperture on the diaphragm (panels
A-D). Heart computed tomography scan showed the aLA contained all
pulmonary vein connections except for left upper pulmonary vein which
connected to tLA (panels E-H). The patient underwent surgical resection
of the diaphragm (panel I) and radiofrequency ablation under
cardiopulmonary bypass. The postoperative course was uneventful and the
patient was discharged 7 days after surgery.
Consent The study were approved by the relevant ethics
committees, and oral informed consent was obtained for the participant.
Figure legend: tLA , true left atrium; aLA ,
accessory left atrium; RA , right atrium; RV , right
ventricle; LV , left ventricle; Ao , aorta; LAA , left
atrial appendage; LLPV , left lower pulmonary vein; LUPV ,
left upper pulmonary vein; RLPV , right lower pulmonary vein;RUPV , right upper pulmonary vein. White arrow , atrial
septum; arrow head , the diaphragm; black arrow , the
aperture on the diaphragm.