Cor Triatriatum Surgery in the Pediatric Patient Workup

Updated: Dec 18, 2020
  • Author: David L S Morales, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Workup

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 two-dimensional echocardiography (see the images below).

Cor Triatriatum Surgery in the Pediatric Patient. 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.
Cor Triatriatum Surgery in the Pediatric Patient. 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.
Cor Triatriatum Surgery in the Pediatric Patient. 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.

Computed tomography (CT) scanning and magnetic resonance imaging (MRI) has been valuable in confirming the diagnosis and, more importantly, understanding the connection and drainage of the pulmonary and systemic veins. [32] 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.

Cor triatriatum on CT angiography shows a septum dividing the left atrium, with the proximal chamber receiving blood flow from the pulmonary veins. [33]

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Other Tests

Cardiac catheterization and cineangiographic studies are no longer considered necessary for cor triatriatum 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. [32]

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