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Year : 2014  |  Volume : 17  |  Issue : 3  |  Page : 240-241
Mitral regurgitation secondary to infective endocarditis of the mitral valve in a patient with cor triatriatum sinistrum


1 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesiology, Hospital Mexico, CCSS, University of Costa Rica, San Jose, Costa Rica, USA

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Date of Web Publication3-Jul-2014
 

How to cite this article:
Bardia A, Montealegre-Gallegos M, Owais K, Mahmood F. Mitral regurgitation secondary to infective endocarditis of the mitral valve in a patient with cor triatriatum sinistrum. Ann Card Anaesth 2014;17:240-1

How to cite this URL:
Bardia A, Montealegre-Gallegos M, Owais K, Mahmood F. Mitral regurgitation secondary to infective endocarditis of the mitral valve in a patient with cor triatriatum sinistrum. Ann Card Anaesth [serial online] 2014 [cited 2019 Aug 18];17:240-1. Available from: http://www.annals.in/text.asp?2014/17/3/240/135880


A 24-year-old male with a history of intravenous drug abuse presented with acute onset anomic aphasia that was highly suggestive of stroke. Transthoracic echocardiography (TTE) demonstrated large vegetation on the anterior leaflet of the mitral valve, with severe mitral regurgitation and pulmonary hypertension. The patient was scheduled for a mitral valve replacement. Intra-operative transesophageal echocardiography (TEE) demonstrated an echogenic membrane within the left atrium suggesting the presence of cor triatriatum sinistrum [CTS; [Figure 1] and [Figure 2], [Video 1].




No other structural heart abnormalities were present. All the four pulmonary vein openings were on the proximal left atrium, while the mitral valve and left atrial appendage were located in the distal left atrium. Resection of the left atrial appendage and the left atrial membrane along with mitral valve replacement were performed. The mitral regurgitation and pulmonary hypertension resolved after the surgery.
Figure 1: Mid-esophageal 4- chamber view obtained with transesophageal echocardiography (a). Left atrium is divided by a membrane and a large vegetation is seen on the anterior leafl et of the mitral valve. (b) Posteriorly directed mitral regurgitation jet observed with color flow Doppler (PLA - Proximal left atrium, dLA - Distal left atrium, MV - Mitral valve, LV - Left ventricle, RV - Right ventricle)

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Figure 2: 3-dimensional transesophageal echocardiographic image analyzed with multiplanar reformatting. Moving the green plane the membrane is seen partially dividing the left atrium into a proximal and distal portion

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Cor triatriatum sinistrum or left triatrial heart, is a rare congenital heart defect, reported in 0.4% of patients with congenital heart disease. [1] In CTS, the left atrium is completely or partially divided by a thin fibromuscular membrane. CTS is commonly diagnosed in childhood, but cases with incomplete or fenestrated membranes may remain asymptomatic throughout adulthood and manifest clinically until the membrane is calcified or mitral regurgitation is associated. Surgical excision of the membrane is usually indicated in symptomatic children and adults having significant intra-atrial obstruction or associated conditions.

This case illustrates CTS that presented as an incidental finding on a perioperative TEE examination. The CTS was of the nonobstructive type, due to a large orifice communicating the proximal and distal left atria [Figure 2] and [Figure 3], [Video 2]. Failure to recognize this abnormality in the preoperative TTE exam may be related to the limitation of this technique to visualize posteriorly localized structures. The patient did not present associated structural heart abnormalities despite the frequent association of CTS with other congenital abnormalities such as atrial septal defect and bicuspid aortic valve.
Figure 3: Full volume 3-dimensional transesophageal echocardiographic images of the membrane partially dividing the left atrium. (MV- mitral valve)

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   References Top

1.Jegier W, Gibbons JE, Wiglesworth FW. Cortriatriatum: Clinical, hemodynamic and pathological studies surgical correction in early life. Pediatrics 1963;31:255-67.  Back to cited text no. 1
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Correspondence Address:
Feroze Mahmood
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, CC470, Boston, MA, 02115
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.135880

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  [Figure 1], [Figure 2], [Figure 3]



 

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