Cor triatriatum sinistrum: a rare congenital cardiac anomaly presenting in an elderly man with coronary artery disease

摘要

Cor triatriatum sinistrum is a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium. We describe a case of cor triatriatum sinistrum: a rare congenital cardiac anomaly presenting in an elderly man with coronary artery disease.Diagnosis is usually achieved by echocardiography, therapy of choice is excision of the membrane. Introduction Cor triatriatum sinister is a rare congenital defect in which the left atrium is divided by a fibromuscular membrane into two distinct chambers[1]. Divided left atrium or Cor Triatriatum, is a congenital cardiac malformation having low incidence during paediatric age, ranging between 0.1 - 0.4%. Its appearance in adulthood is even more exceptional and often inadvertently discovered[2]. It is usual for patients to present in infancy and early childhood, although some cases remain undetected until adult life. As a consequence of trans-membrane flow obstruction, the clinical features often mimic mitral stenosis. At present, the reasons for late presentation are poorly understood[3]. Severity of the disease depends on the size of the opening on the membrane[4]. Case Presentation Our case was a 55 years old man and he was examined at an other institution for dyspnea and increasing fatigue. He was in New York Heart Association (NYHA) functional class III at presentation.He was evaluated by clinical,hematological,electrocardiographical and echocardiographical examination preoperatively. Transthoracic echocardiography(TTE) showed mild mitral regurgitation. Diameter of left atrium(57mm) and left ventricle(54/37mm)were widened.Left ventricular EF was 50%. Echocardiographic score was found to be 9. Other valves’ functions were normal. Because he was middle-aged, coronary arteriography(CAG) and cardiac catheterization were performed. CAG showed significant stenotic lesions in LAD and CxOM1 branch. It confirmed mild mitral regurgitation(Figures 1&2).