An unusual case of cor triatriatum sinister presenting as pulmonary oedema during labor

Anesthesia and cor triatriatum

“…[19] As with other stenotic valvular lesions, the CT patients with restrictive membrane poorly tolerate dysrhythmias that diminish diastolic filling time (tachycardia, atrial fibrillation). [20][21][22][23] Other conditions can contribute to cardiac decompensation in patients with CT, specifically hyperdynamic circulatory states which may overburden the blood flow capacity across accessory atrial membrane. In their study Bisinov et al [12] have reported a man with severe burns who remained hypotensive despite massive fluid resuscitation which did not improve until the aperture of his right intra-atrial membrane was percutaneously dilated to allow for unrestricted blood flow.…”

Isolated cor triatriatum sinistrum and pregnancy: case report and review of the literature

“…The clinical course in our patient differed from reports that provide evidence that pregnancy may trigger the initial onset of cardiac symptoms in women with pre-pregnancy asymptomatic CTS (Table). 1,7,[17][18][19] To evaluate the experience with cor triatriatum during pregnancy, we performed a MEDLINE database search from January 1, 1946, to July 1, 2012 with the following MeSH terms: cor triatriatum, pregnancy, pregnancy complications, pregnancy outcome, pregnancy high-risk, labor, obstetric labor, labor onset, labor stage first, labor stage second, labor stage third, and delivery obstetric. The following keywords were used: cor triatriatum, triatriatum, polyatria$, triatria$, subdivided left atria/atrium, pregnan$, gravid$, labor, and delivery.…”

“…It is noteworthy that our patient remained asymptomatic despite pregnancyinduced changes in cardiovascular dynamics, as evidenced by the increase in the diastolic pressure gradient from 6.5 mmHg before pregnancy to 13.0 mmHg during late pregnancy, reflecting increased intravascular volume load. Our literature search identified ten parturients with cor triatriatum, 1,2,12,[16][17][18][19]23,25,28 and review of the bibliography of these articles revealed three additional cases (Table). [29][30][31] Six of these 13 women were first diagnosed with CTS during pregnancy; 1,12,19,23,29,30 four of them presented during the early postpartum period; 2,16,18,31 one was diagnosed with CTS at the age of 17 yr (presenting sign was transient atrial fibrillation), but she was asymptomatic until severe symptoms developed during her first pregnancy at the age of 41 yr; 25 one was diagnosed with a ''nonspecified cardiac defect'' at the age of 18 yr, was asymptomatic throughout life, but underwent further cardiac evaluation during an uneventful pregnancy; 28 and one was diagnosed in childhood with a ''hole in the heart'' but had no further workup until she became symptomatic during her first pregnancy.…”

“…1,16,17 For example, late pregnancy is associated with increased intravascular volume and heart rate, and this physiologic change can convert the clinical presentation of CTS from asymptomatic to symptomatic. 1,7,[17][18][19] We describe a woman with an asymptomatic isolated type of CTS who had an uncomplicated vaginal delivery with epidural analgesia. We also review the literature relating to pregnancy in patients with cor triatriatum.…”

Severe right heart failure and pulmonary hypertension because of cor triatriatum sinister in a 54year-old patient

“…One explanation for mitral regurgitation is the occurrence of myxomatous degeneration [6]. On the other hand, some adult patients may be symptomatic during high output states, like pregnancy [7]. Improvement in diagnostic cardiac imaging in clinical practise has probably decreased the number of late diagnosis.…”