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Cor Triatriatum Treatment & Management

  • Author: Jamshid Shirani, MD; Chief Editor: Park W Willis IV, MD  more...
 
Updated: Dec 18, 2014
 

Medical Care

Medial care for symptomatic patients with cor triatriatum includes the following:

  • Stabilize hemodynamics by control of hypoxemia, fluid overload, and pulmonary congestion
  • Control ventricular rate in patients with atrial fibrillation
  • Anticoagulation prophylaxis against deep vein thrombosis and pulmonary embolism in those with right-sided heart failure
  • Full anticoagulation in those with atrial fibrillation

Obtain a surgical consultation.

Cor triatriatum dextrum

For cor triatriatum dextrum, observation alone is appropriate in asymptomatic patients. In others, control of fluid retention and rate-control of atrial arrhythmias may be required. Percutaneous technique of balloon septostomy of the accessory membrane has been reported.

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Surgical Care

Symptomatic patients with cor triatriatum who have significant gradient across the membrane benefit from surgical repair.[52] Surgical resection of the accessory membrane has been successful.[61, 62, 63, 64, 65, 66, 67, 68, 69]

Complete resection of the membrane and closure of the atrial septum with a pericardial patch is a common approach. Associated congenital defects need to be corrected at the same time.

A study by Saxena et al indicated that surgery for cor triatriatum results in satisfactory rates of early and long-term survival. The study involved 25 patients in whom the cor triatriatum membrane was excised using cardiopulmonary bypass, with 20 of these patients also undergoing concomitant surgical procedures. The 10-year survival rate, using the Kaplan-Meier estimate, was 83%; at a mean follow-up of 12.8 years, all patients had a New York Heart Association classification of I or II. The investigators found that patients in whom cor triatriatum coexists with complex congenital anomalies may be at greater risk for adverse outcomes.[70]

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Consultations

Obtain cardiology consultation for medical management and echocardiographic, hemodynamic, and angiographic evaluation.

Obtain a radiology consultation for advanced cardiac imaging with computerized tomography or cardiac magnetic resonance techniques.

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Diet and Activity

A low-salt diet is appropriate in those with significant fluid retention.

Bed rest is appropriate in symptomatic patients with pulmonary congestion or significant right-sided heart failure and pulmonary hypertension.

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Contributor Information and Disclosures
Author

Jamshid Shirani, MD Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, Director of Hypertrophic Cardiomyopathy Clinic, St Luke's University Health Network

Jamshid Shirani, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society of Echocardiography, Association of Subspecialty Professors, American College of Cardiology, American College of Physicians, American Heart Association

Disclosure: Nothing to disclose.

Coauthor(s)

Arun Kalyanasundaram, MD, MPH Interventional Cardiology Fellow, Department of Cardiology, Cleveland Clinic

Arun Kalyanasundaram, MD, MPH is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society of General Internal Medicine, Southern Medical Association, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Kamal K Pourmoghadam, MD Associate Professor, Department of Cardiothoracic Surgery, Jefferson Medical College; Director of Pediatric Cardiac Surgery, Department of Surgery, Janet Weis Children's Hospital, Geisinger Medical Center

Kamal K Pourmoghadam, MD is a member of the following medical societies: American College of Surgeons, Phi Beta Kappa, Sigma Xi, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Yuba R Acharya, MD Fellow, Department of Cardiology, St Luke's University Hospital, Bethlehem, Pennsylvania

Yuba R Acharya, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Frank M Sheridan, MD 

Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Park W Willis IV, MD Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine

Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography

Disclosure: Nothing to disclose.

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Cor triatriatum. Echocardiogram showing the proximal chamber (PC) and distal chamber (DC) of the left atrium; the right atrium (RA), left ventricle (LV), and right ventricle (RV) also are shown. Image courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Image courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Image courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Image courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Image courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Image courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. This film shows the classic pattern of pulmonary edema associated with pulmonary overcirculation and pulmonary venous obstruction. Patient has an anomalous pulmonary venous connection that was only obvious after a pulmonary artery shunt. The particular radiograph is not a patient with cor triatriatum, but appearance of prominent pulmonary vascularity is the same. Movie courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Movie courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Movie courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Movie courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Movie courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
Cor triatriatum. Movie courtesy of Guido Giordano, MD, Cardiovascular Department, Azienda Ospedaliera Cannizzaro, Catania, Italy.
 
 
 
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