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.

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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.

View Media Gallery

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]

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]

Treatment & Management

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Media Gallery

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.

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Author

David L S Morales, MD Professor of Pediatrics and Surgery, University of Cincinnati College of Medicine; Clark-Helmsworth Chair and Director of Congenital Heart Surgery, Heart Institute; Director of Quality and Outcomes, Department of Surgery, Cincinnati Children’s Hospital Medical Center

David L S 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, Michael E DeBakey International Surgical Society, Society of Thoracic Surgeons, Texas Pediatric Society

Disclosure: Nothing to disclose.

Coauthor(s)

Karthik Thangappan, MD Resident Physician in General Surgery, Department of Surgery, University of Cincinnati Medical Center; Research Fellow in Congenital Heart Surgery, Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center

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

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, Phi Beta Kappa, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

M Shoaib Khan, MD Resident Physician, Department of Family Medicine, University of Oklahoma at Tulsa College of Medicine

Disclosure: Nothing to disclose.

Sections Cor Triatriatum Surgery in the Pediatric Patient
Overview
Workup
Treatment
Media Gallery
References

Cor Triatriatum Surgery in the Pediatric Patient Workup

Imaging Studies

Other Tests

References

Tables

Contributor Information and Disclosures

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