Acquired cor triatriatum after orthotopic cardiac transplantation

Oaks, Timothy E.; Rayburn, Barry K.; Brown, Marguerite; Kon, Neal D.

doi:10.1016/0003-4975(94)00577-x

Cited by 16 publications

(9 citation statements)

References 3 publications

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“…It has been reported, nonetheless, subsequent to the Fontan operation, orthotopic cardiac transplantation, or in the setting of complicated aortic valvar infective endocarditis in adults. The dividing partitions in these instances were produced by hypertrophied atrial tissue, suture lines, torsion of the atrial walls, or infolding of the redundant donor atrial tissue 16–21 …”

Section: Discussionmentioning

confidence: 99%

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Surgical management of divided atrial chambers

Sankhyan

Anderson

Chowdhury

et al. 2021

Journal of Cardiac Surgery

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Background and Aim The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We sought to address clinical presentations, potentially misdiagnosed cases, diagnostic modalities, surgical approaches, and outcomes of this “family” of uncommon lesions. Methods A total of 193 published investigations were synthesized. Diagnostic information was provided by clinical presentation, and multimodality imaging studies. Results Almost three‐quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra‐cardiac defects are present in between half and nine‐tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge todefinitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long‐term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed. Conclusions Resection of the dividing shelf allows the survivors to regain near normal dimensions with a low risk of recurrence. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.

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Section: Discussionmentioning

confidence: 99%

“…Acquired division can occur but is uncommon. We have discovered six case reports following orthotopic cardiac transplantation, an extracardiac Fontan operation, and complicated aortic valvar infective endocarditis 16–21 …”

Section: Introductionmentioning

confidence: 99%

Surgical management of divided atrial chambers

Sankhyan

Anderson

Chowdhury

et al. 2021

Journal of Cardiac Surgery

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show abstract

“…The dividing partitions in these instances were produced by hypertrophied atrial tissue, suture lines, torsion of the atrial walls, or infolding of the redundant donor atrial tissue. [16][17][18][19][20][21]…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Divided Atrial Chambers

Sankhyan

Anderson

Chowdhury

et al. 2021

Preprint

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The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We present a synthesis of 198 published investigations of this “family” of uncommon lesions. Almost three-quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra-cardiac defects are present in between half and nine-tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge to definitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long-term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.

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“…The acquired form is even more uncommon and has only been reported in sporadic case reports after orthotopic heart transplantation [2][3][4][5] or as a complication of infective endocarditis in adults [6]. These cases occurred secondary to hypertrophied atrial tissue [5], suture lines, or torsion of the atrium [3].…”

Section: Commentmentioning

confidence: 99%

Acquired Cor Triatriatum Sinister After the Fontan Operation and Successful Resection in a Child

Zaidi

Adhikari

El‐Zein

et al. 2017

The Annals of Thoracic Surgery

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Cor triatriatum sinister is a rare congenital lesion encountered in children. It consists of a fibromuscular membrane that separates the left atrium into two chambers resulting in a triatrial heart and often occurs with other structural cardiac anomalies. The acquired form is uncommon and has only been reported after orthotopic heart transplantation or as a complication of infective endocarditis in adults. These cases were mostly because of hypertrophied atrial tissue or suture lines and torsion of the atrium. We describe the first case of acquired cor triatriatum late after the Fontan procedure with successful surgical resection in a child.

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Acquired cor triatriatum after orthotopic cardiac transplantation

Cited by 16 publications

References 3 publications

Surgical management of divided atrial chambers

Surgical management of divided atrial chambers

Surgical Management of Divided Atrial Chambers

Acquired Cor Triatriatum Sinister After the Fontan Operation and Successful Resection in a Child

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