Transesophageal imaging of cor triatriatum sinistrum

Excerpt

A 55-yr-old asymptomatic patient (who consented to this report) presented for cardiac surgical treatment of a stenotic bicuspid aortic valve and dilated ascending aorta that had been identified by transthoracic echocardiography (TTE) and computed tomography (CT) imaging. Intraoperative transesophageal echocardiography (TEE) revealed an additional anomaly in the left atrium not previously reported. A TEE mid-esophageal five-chamber view (panel A) with additional views at 72° (panel B) showed a clear relation of the anomaly to the left atrial appendage and pulmonary veins. A membrane extending from the coumadin ridge to the intra-atrial septum separated the left atrium into two chambers finalizing the diagnosis of cor triatriatum sinistrum. After discussion with the cardiac surgeon, the decision was made to excise the membrane, as it could potentially lead to (further) stenosis of the membrane or increased thrombosis/stroke risk if left untreated. Partial resection of the left atrial membrane showed multiple fenestrations (panel C). The TEE examination at the end of surgery showed some remnants of the membrane (panel D).

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