Management of Maternal Cor Triatriatum During Pregnancy

BACKGROUND: Cor triatriatum is a rare congenital cardiac abnormality, usually diagnosed in childhood. We describe the first case of atrial fibrillation secondary to maternal cor triatriatum diagnosed during the first trimester of pregnancy and its successful management until postpartum (MEDLINE [1966 to 2003] and Embase [1988 to 2003], using MeSH terms for "cor triatriatum" and "pregnancy"). CASE: A 31-year-old gravida 1 complained of progressive dyspnea on exertion and palpitations, which occurred at the end of the first trimester of the pregnancy. Atrial fibrillation was observed on electrocardiogram. A transesophageal echocardiography examination revealed a cor triatriatum that was responsible for the arrhythmia. beta-adrenergic blocking agents and digitalis glycosides were used to control supraventricular arrhythmia, while low-molecular-weight heparin was administered to prevent thromboembolic events. Low-molecular-weight heparin was discontinued at 37 weeks of gestation, and subcutaneous unfractionated heparin was administered instead. Pregnancy continued a normal course until full-term vaginal delivery with epidural anesthesia and close hemodynamic monitoring. CONCLUSION: A standard treatment for atrial fibrillation could be effective in preventing maternal hemodynamic complications secondary to cor triatriatum during pregnancy. Moreover, this case illustrates the American consensus in neuraxial anesthesia and anticoagulation, which supports the opinion that there is a limited risk associated with the use of epidural and spinal anesthesia in the presence of subcutaneous heparin treatment.