Eastern Cardiothoracic Surgical Society

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Mitral Valve Repair in Patient with Cor Triatriatum Sinister
Patrick G. Chan, Ernest G. Chan, Pyongsoo D. Yoon.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

OBJECTIVE: To report a rare case of mitral valve repair (MVRep) in a patient with cor triatriatum.
METHODS: We present a 69-year-old female with severe mitral regurgitation (MR) and an abnormal wall dividing the left atrium (LA).
RESULTS: A 69-year-old female presented with progressive dyspnea on exertion. She had a transesophageal echocardiogram which showed an ejection fraction of 60-65%, thickened and tethered MV leaflets with moderate MR, pulmonary hypertension and atria consistent with cor triatriatum. Cardiac MRI confirmed the diagnosis with a membrane that extends from the ridge of Marshall to the interatrial septum and moderate MR between A2/P2. The patient underwent a MVRep with ring annuloplasty and repair/resection of cor triatriatum sinister. There was a large septum dividing the LA into two, with pulmonary veins draining into one LA and MV in the second LA (Figure 1, arrow points to septum). The wall of tissue was excised via a left atriotomy, leaving a single LA cavity and the MV was repaired. Immediate postoperative transthoracic echocardiography showed a MVRep with no perivalvular leak and a single LA. She was discharged on post-operative day 5 and her follow-up outpatient transthoracic echocardiogram showed an intact repair and no MR.
CONCLUSIONS: Cor triatriatum sinister is a rare congenital defect that is generally diagnosed in childhood. Diagnosis in adults is rare. Therefore, there are limited reports of concomitant cor triatriatum sinister repair and mitral valve surgery, which is safe and feasible as shown in this case report.


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