Query: cor triatriatum dexter

title: Atrial fibrillation cryoablation in cor triatriatum dexter.
abstract: A 62 year old male patient with symptomatic paroxysmal atrial fibrillation (AF) was scheduled for cryoablation. A preprocedural transthoracic echocardiogram was performed and demonstrated a membranous structure dividing the right atrium into two parts. Intravenous injection of agitated saline mixed with air (bubble study) from the left arm revealed blood flow from the superior vena cava to the right ventricle opacifying one of the two chambers. A diagnosis of cor triatriatum dextrum was confirmed by magnetic resonance imaging (Figure 1A) Due to this malformation, the transseptal puncture was guided intraprocedurally by transoesophageal echocardiogram. During the transseptal puncture, the wire and the long transseptal sheath/dilator were advanced from the inferior vena cava to the superior vena cava without difficulty. Access to the left atrium was achieved and pulmonary vein isolation was performed without complications  The patient remains free of AF recurrences during the last 18 months. Cor triatriatum dexter is a rare cardiac abnormality characterized by subdivision of the right atrium into two chambers, usually an anterior or distal chamber, communicating with the tricuspid valve and the coronary sinus and a posterior or proximal chamber including the fossa ovalis and receiving blood flow from the superior and inferior vena cava. Cor triatriatum dexter is caused by the persistence of the right valve of the sinus venosus. Normally, between the 6th and 8th week of embryogenesis, the right sinus valve separates the right atrium into two chambers. On the 12th week, the valve regresses into the crista terminalis, the eustachian valve, and the thebesian valve. Failure of the normal regression of this valve can lead to subdivision of the right atrium into two chambers, varying from partial partition by the presence of a prominent eustachian valve to complete right atrial division. Cor triatriatum dextrum can occur as an isolated anomaly or can be associated with other complex right sided cardiac defects, such as abnormalities of the tricuspid valve, atresia or pulmonary artery stenosis, and Ebstein's anomaly. Moreover, cor triatriatum dexter has varying clinical manifestations, depending on the degree of flow obstruction produced by the fibromuscular membrane, which is usually fenestrated. When the partition is incomplete, it can be asymptomatic and might be detected incidentally by echocardiographic examination or other imaging diagnostic test. In our case, the right atrium was divided into two components by a persisting right sinus valve, leading the blood flow from the inferior vena cava to the posterior component, while the superior vena cava drained to the distal component.

title: Cor Triatriatum Dexter: A Case Report in a 70 Year Old Male
abstract: Cor triatriatum dexter (CTD) is a rare congenital heart disease resulting from persistence of the right valve of the sinus venosus. The persistent valve forms a membrane that divides the right atrium into a proximal and a distal chamber. This disorder exhibits varying clinical manifestations depending on the degree of partitioning or septation of the right atrium. In asymptomatic patients, the disease may be discovered during surgical procedures, diagnostic testing such as echocardiography, or hemodynamic monitoring. Severe septation abnormalities may cause right sided heart failure and elevated central venous pressures due to obstruction of the tricuspid valve, right ventricular outflow tract, or inferior vena cava. Here we report a case of CTD in a patient presenting with symptoms of dyspnea and fatigue, followed by a short discussion of the embryology and clinical implications of this congenital disease, as well as current advances in management.  Cases.

title: PLATYPNEA ORTHODEOXIA SYNDROME IN A PATIENT WITH COR TRIATRIATUM DEXTER AND PATENT FORAMEN OVALE: A CASE REPORT
abstract: Platypnea orthodeoxia syndrome (POS) is a clinical phenomenon of dyspnea and hypoxemia in upright posture which is relieved in the supine position. It is seen in patients with defects in the atrial septum, other intra cardiac or intrapulmonary shunts. Cor triatriatum dexter (CTD) is a rare

title: Cor Triatriatum Dexter: A Case Report in a 70 Year Old Male
abstract: Cor triatriatum dexter (CTD) is a rare congenital heart disease resulting from persistence of the right valve of the sinus venosus. The persistent valve forms a membrane that divides the right atrium into a proximal and a distal chamber. This disorder exhibits varying clinical manifestations depending on the degree of partitioning or septation of the right atrium. In asymptomatic patients, the disease may be discovered during surgical procedures, diagnostic testing such as echocardiography, or hemodynamic monitoring. Severe septation abnormalities may cause right sided heart failure and elevated central venous pressures due to obstruction of the tricuspid valve, right ventricular outflow tract, or inferior vena cava. Here we report a case of CTD in a patient presenting with symptoms of dyspnea and fatigue, followed by a short discussion of the embryology and clinical implications of this congenital disease, as well as current advances in management.

title: Balloon dilation of a perforated cor triatriatum dexter in a Springer Spaniel: anaesthetic management
abstract: A four month old male Springer Spaniel presented for investigation of ascites of three weeks' duration. On transthoracic echocardiogram, cor triatriatum dexter was diagnosed with associated right sided congestive heart failure. Medical therapy consisting of furosemide, spironolactone and benazepril was initiated. On the day of surgery, the dog was premedicated with methadone 0.2 mg/kg intravenously, and general anaesthesia was induced with midazolam 0.2 mg/kg intravenously and propofol 25 mg. Anaesthesia was maintained with isoflurane in oxygen. Concurrently, constant rate infusions of fentanyl 0.2 0.3 ug/kg/minute and lidocaine 50 ug/kg/minute were administered. Ventricular premature complexes and ventricular tachycardia developed during the placement of the catheter and during the first balloon dilation. Antiarrhythmic therapy with lidocaine 2 mg/kg was required. At the end of the procedure, acepromazine 5 ug/kg intravenous and buprenorphine 20 ug/kg intravenous were administered. Recovery from general anaesthesia was uneventful.

title: Cor Triatriatum Dexter and Patent Foramen Ovale Discovered Following Cardioembolic Stroke
abstract: Cor Triatriatum (CT) is a seldom reported cardiac anomaly defined by the presence of an abnormal septation within the right or left atrium. Cor triatriatum usually remain asymptomatic until late adulthood, but depending on the severity of septation and location within the atrium the manifestations can vary in presentation. We present a case of cardioembolic cerebrovascular accident in a patient with cor triatriatum dexter and a patent foramen ovale. To our knowledge, no existing case report describes a cerebrovascular accident in a patient affected by right atrial cor triatriatum dexter.

title: Imperforate cor triatriatum dexter with patent foramen ovale and pulmonic stenosis in three dogs: Diagnostic findings and attempted surgical correction.
abstract: Three canines were identified with aberrant drainage of the caudal vena cava to the left atrium, consistent with imperforate cor triatriatum dexter, and concurrent patent foramen ovale. All three had concurrent significant pulmonic stenosis with varying degrees of hypoplasia of the right ventricular outflow tract. Echocardiography, positive contrast studies, and angiography confirmed the diagnosis. Surgical redirection of the caudal vena cava bloodflow to the right atrium was attempted unsuccessfully in two symptomatic patients. The third patient was asymptomatic, and correction was not attempted. Possible embryologic causes and possible approaches in future cases are discussed.

title: Commentary: Cor triatriatum dexter: A tale of 2 horns
abstract: An important component of the primitive heart tube is the sinus venosus with its 2 horns. The left horn obliterates leaving 2 remnants: the oblique vein of left atrium (of Marshall) and the coronary sinus, whereas the right horn is what constitutes the major part of the right atrium (RA) (smooth part) and is separated by the sinoatrial orifice from the primitive atrium. Two venous valves guard this sinoatrial orifice, the right and left venous valves. The right valve regresses between the ninth and 15th week, leaving the Eustachian and Thebesian valves of the inferior vena cava (IVC) and the coronary sinus, respectively. It is the persistence of the right venous valve that results in partitioning the RA into 2 separate chambers and creates what is known as cor triatriatum dexter (CTD) to differentiate it from its counterpart on the left side. This is among the rarest cardiac malformation, and very limited number of cases have been reported on so far. Kalangos and colleagues reviewed the literature for CTD and identified only 13 cases in addition to their report. However, the majority of CTD cases may not require surgical intervention, so the true incidence may not be known with certainty but is estimated to be<0.01% The term CTD should be used only to describe anomalous septation of the RA in which the membrane is welldeveloped enough to interfere with a normal venous return within the RA. Other misleading abnormalities include dilated coronary sinus with prominent Thebesian valve, prominent Eustachian valve, and persistent Chiari network; however, an important defining feature is the presence of atrial septal attachment for a true CTD.

title: Commentary: Cor triatriatum dexter: Persistent tissue causing protean issues!
abstract: Cor triatriatum dexter is a rare congenital cardiac anomaly caused by the abnormal persistence of embryonic tissue guarding the primitive sinoatrial orifice. The pathophysiology is determined by a number of factors that come into interplay, including the size of the sinoatrial orifice, the presence of atrial communication, and the degree of tricuspid valve obstruction. The manifestations are indeed variable, with clinical presentation ranging from abdominal distension and cyanosis to incidental findings during correction of other cardiac malformations. The chronicity of this lesion only adds to its protean character as illustrated in this case report. Tricuspid regurgitation is an unusual manifestation of cor triatriatum dexter and probably related to repetitive trauma and consequent deformation of the tricuspid valve leaflets from the bulging membrane. Although the authors have done a commendable job of collating the various case reports on this rare congenital heart defect from literature, the disease is under reported and not as exotic as this study suggests. Most cases are asymptomatic and others coexist as part of other complex congenital heart defects. The study also raises an important question regarding the risks of conservative management in a largely asymptomatic child with well documented membrane in the right atrium. The risks to the tricuspid valve tissue should not be ignored and the surgical correction of the defect can become complicated.

title: Cor triatriatum dexter in children: Literature review and case report
abstract: From Iaso Children's Hospital, Athens, Greece; and Heart Institute Ministry of Health of Ukraine, Kiev, Ukraine.  The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.  Aug 8, 2020; revisions received Aug 8, 2020; accepted for publication Aug 11, 2020; available ahead of print Aug 15, 2020. Address for reprints: Afksendiyos Kalangos, MD, Clinic for Pediatric and Congenital Heart Surgery, Iaso Children's Hospital, Kifisias Ave 37 39, 15123 Marousi, Athens, Greece (E mail: a.kalangos@gmail.com) JTCVS Techniques 2020;4:254 8 2666 2507   Intraoperative photograph of cor triatriatum dexter through right atriotomy.