Coexistence of coronary cameral fistulae and cor triatriatum sinister in an elderly patient

Abstract

Coronary cameral fistulae are unusual congenital or acquired anomalous communications between an epicardial coronary artery and a cardiac chamber. There are no reported cases of the association of coronary cameral fistulae and cor triatriatum, a rare congenital cardiac anomaly in which a fibromuscular membrane divides the left atrium into two chambers. We report the case of an 82-year-old man presenting with recurrent anterior chest pain. Echocardiographic examination identified non-obstructive cor triatriatum, mitral valve prolapse resulting in significant mitral regurgitation, dilated coronary arteries, and established the entry site of coronary artery fistulae at the apex of the left ventricle (Figure 1). Coronary angiography confirmed the existence of a plexiform fistula between the left anterior descending coronary artery and the left ventricle. Tetrofosmine scintigraphy revealed the presence of stressinduced ischaemia in the apex. To our knowledge, we report the oldest person with coronary cameral fistulae presenting with angina only at this stage, and the interesting case of the coexistence of two, although unconnected, congenital conditions in an elderly patient. In addition, this report highlights the important role of transthoracic and transoesophageal echocardiography to the characterization of these unusual anomalies, and the complementary information offered by three-dimensional transthoracic echocardiography.

Adult Cor Triatriatum Presenting as Cardioembolic Stroke

“…Management of cor triatriatum depends on the degree of obstruction between the LA chambers (17). Surgical resection of the accessory membrane is indicated in symptomatic patients with obstructive cor triatriatum (17 …”

“…Surgical resection of the accessory membrane is indicated in symptomatic patients with obstructive cor triatriatum (17 …”

Cor Triatriatum Sinister diagnosed in adult life with three dimensional transesophageal echocardiography

“…The embryologic etiology remains debated, it may result from incomplete incorporation of the common pulmonary vein into the left atrium [1,4,6], abnormal overgrowth of septum primum[1,4], entrapment of the common pulmonary vein by the left horn of the sinus venosus preventing its incorporation into the left atrium [1], or persistence of a left-sided superior vena cava which may impinge on the left atrium, resulting in the formation of an abnormal membrane [4]. …”

“…Color flow mapping usually demonstrates increases in velocity and turbulent flow, suggesting obstruction that can be assessed by continuous wave Doppler through the membrane [4,10]. Transesophageal echocardiography is superior to transthoracic imaging to diagnose cor triatriatum, providing better imaging of the left atria, left atria appendage, morphology of the dividing membrane and the degree of obstruction [6]. Three D echocardiography is a more recent diagnostic tool providing additional information, able to demonstrate the entire membrane, the size, the location and the number of openings in the dividing membrane [6,10].…”

“…Transesophageal echocardiography is superior to transthoracic imaging to diagnose cor triatriatum, providing better imaging of the left atria, left atria appendage, morphology of the dividing membrane and the degree of obstruction [6]. Three D echocardiography is a more recent diagnostic tool providing additional information, able to demonstrate the entire membrane, the size, the location and the number of openings in the dividing membrane [6,10]. In our patient 2 D TTE was abnormal but could not fully assess the diagnosis, which was finally confirmed on TEE3 D echocardiography.…”