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Cor Triatriatum Surgery in the Pediatric Patient Workup

  • Author: David L Morales, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
 
Updated: Feb 06, 2015
 

Imaging Studies

The most common imaging study used to identify cor triatriatum is echocardiography. The diagnosis can be strongly suspected by using M-mode echocardiography and confirmed using 2-dimensional echocardiography (see the images below).

Relevant intracardiac anatomy. The pulmonary veins empty into a chamber, which then empties into the right atrium. The proximal and distal left atrium is divided by a membranous wall. The right atrium then communicates to the right ventricle via the tricuspid valve and to the left atrium via a secundum atrial septal defect.
Color flow imaging confirms flow from the pulmonary veins into the proximal left atrial chamber, exiting directly into the right atrium. Flow is shown crossing the atrial septum via an atrial septal defect and entering the left atrium. No flow is seen coursing between the proximal and distal chambers in the left atrium.
Color flow imaging confirms flow from the pulmonary veins into the proximal left atrial chamber, exiting directly into the right atrium. Flow is shown crossing the atrial septum via an atrial septal defect and entering the left atrium. No flow is seen coursing between the proximal and distal chambers in the left atrium.

CT scanning and MRI has been valuable in confirming the diagnosis and, more importantly, understanding the connection and drainage of the pulmonary and systemic veins.[26] These connections can often be quite difficult to delineate with echocardiography but are often easily seen in this type of imaging. Regardless of imaging, the careful inspection of the anatomy at the time of repair is always essential, especially in these patients in whom the location of venous connections can be quite anomalous.

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Other Tests

Cardiac catheterization and cineangiographic studies are no longer considered necessary unless the presence of major associated cardiac anomalies is suspected. However, further evidence may be obtained from selective cineangiographic studies and pressure measurements in the common pulmonary venous chamber and the left atrium.

For a study of virtual cardioscopy, see Chen SJ. Virtual cardioscopy in cor triatria. J Pediatr. Jun 2007;150(6):659.[26]

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Contributor Information and Disclosures
Author

David L Morales, MD Associate Professor of Surgery, Michael E DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine; Surgical Director, Hospital Wide ECMO Program, Director, Cardiac Mechanical Circulatory Support Team, Director, Clinical and Industrial Research, Division of Congenital Heart Surgery, Director, North American Berlin Heart VAD Training and Reference Center, Texas Children’s Hospital; Cardiovascular Surgeon, Texas Heart Institute, St Luke’s Episcopal Hospital

David L Morales, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, Association for Academic Surgery, International Society for Heart and Lung Transplantation, Society of Thoracic Surgeons, Texas Pediatric Society, Michael E DeBakey International Surgical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Muhammad Shoaib Khan, MD Research Associate, Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John Myers, MD Director, Pediatric and Congenital Cardiovascular Surgery, Departments of Surgery and Pediatrics, Professor, Penn State Children's Hospital, Milton S Hershey Medical Center

John Myers, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, Congenital Heart Surgeons Society, Pennsylvania Medical Society, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Mary C Mancini, MD, PhD, MMM Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Society of Thoracic Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Daniel S Schwartz, MD, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

Daniel S Schwartz, MD, FACS is a member of the following medical societies: Society of Thoracic Surgeons, Western Thoracic Surgical Association, American College of Chest Physicians, American College of Surgeons

Disclosure: Nothing to disclose.

References
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Relevant intracardiac anatomy. The pulmonary veins empty into a chamber, which then empties into the right atrium. The proximal and distal left atrium is divided by a membranous wall. The right atrium then communicates to the right ventricle via the tricuspid valve and to the left atrium via a secundum atrial septal defect.
Color flow imaging confirms flow from the pulmonary veins into the proximal left atrial chamber, exiting directly into the right atrium. Flow is shown crossing the atrial septum via an atrial septal defect and entering the left atrium. No flow is seen coursing between the proximal and distal chambers in the left atrium.
Color flow imaging confirms flow from the pulmonary veins into the proximal left atrial chamber, exiting directly into the right atrium. Flow is shown crossing the atrial septum via an atrial septal defect and entering the left atrium. No flow is seen coursing between the proximal and distal chambers in the left atrium.
 
 
 
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