Real-time 3D TEE and stress echocardiography can guide the management of adult patients with incidentally discovered cor triatriatum by extrapolating cutoff values from mitral stenosis.
May guide deferral of surgery via stress echo in cor triatriatum; leaves open prospective validation of extrapolated cutoffs.
A 39-year-old female had cor triatriatum (CT) detected as an incidental finding on transthoracic echocardiography performed to evaluate chest pain. By conventional two- and real time three-dimensional transesophageal echocardiography, the CT membrane had a communicating orifice connecting the accessory and main left atrial chambers that measured 1.3 × 0.8 cm. The resting mean transmembrane gradient was 2 mm Hg. The postexercise mean transmembrane gradient and pulmonary artery pressure were 6 and 40 mm Hg. Extrapolating from cutoff values for postexercise gradients and pulmonary pressures in patients with mitral stenosis, we advised deferring surgery and close clinical and echocardiographic follow up.
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Willens et al. (2010) studied this question.
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