TY  - CHAP
M1  - Book, Section
TI  - Cor Triatriatum
A1  - Crupi, Giancarlo
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyCor  triatriatum  is  an  uncommon  congenital  cardiac  anomaly  in  which  either  the  left  (cor  triatriatum  sinister)  or  right  (cor  triatriatum  dexter)  atrium  is  divided  into  two  chambers  by  a  membrane.  Subdivided  left  atrium  represents  the  most  frequent  anatomic  variant  of  this  lesion,  and  accounts  from  0.1  to  0.4  percent  of  all  congenital  heart  defects.MorphologyThe  pulmonary  veins  enter  a  proximal  chamber  (common  pulmonary  venous  chamber)  separated  by  a  fibromuscular  membrane  from  a  distal  chamber  where  the  left  atrial  appendage  and  the  mitral  valve  are  found.  The  proximal  and  distal  chambers  may  communicate  through  one  or  more  openings  within  the  dividing  membrane,  and  an  atrial  septal  defect  (ASD)  is  usually  present.PathophysiologyIn  the  absence  of  associated  cardiac  lesions,  the  pathophysiology  of  subdivided  left  atrium  depends  on  the  resulting  obstruction  to  pulmonary  blood  flow.  Pulmonary  overcirculation  is  present  when  left-to-right  shunting  occurs  through  an  ASD  between  common  pulmonary  venous  chamber  and  right  atrium.Clinical  featuresThe  clinical  presentation  in  infancy  is  similar  to  that  of  total  anomalous  pulmonary  venous  connection,  with  low  cardiac  output,  pallor,  tachypnea,  poor  peripheral  pulses,  and  failure  to  thrive.  Death  may  occur  within  the  first  year  of  life  in  75  percent  of  untreated  patients  with  significant  obstruction.  Children  and  young  adults  present  with  signs  of  pulmonary  venous  hypertension  of  various  importance.DiagnosisDiagnosis  is  usually  established  by  transthoracic  and  transesophageal  echocardiography,  although  magnetic  resonance  imaging  (MRI)  can  be  used  in  selected  cases.  Cardiac  catheterization  may  be  indicated  in  the  presence  of  associated  cardiac  lesions.TreatmentResection  of  the  membrane  through  a  right  atrial  approach  is  recommended  in  infants,  whereas  a  left  atrial  approach  through  the  common  pulmonary  venous  chamber  may  be  used  in  older  children  and  adults  and  in  the  presence  of  associated  anomalies.  Percutaneous  catheter  disruption  of  the  membrane  may  represent  an  alternative  to  surgery  in  selected  cases  of  subdivided  right  atrium.  Outcomes  are  dependent  on  the  preoperative  clinical  condition.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104598097
ER  -