Cor triatriatum sinistrum in a pregnant woman.

Cor triatriatum sinistrum is a congenital cardiac malformation in which left atrium is divided into 2 parts by a perforated fibromuscular membrane, it can mimic signs and symptoms of mitral valve (MV) stenosis or occasionally without any symptoms and discovered as an accidental finding.

CLINICAL FEATURE

A 31‐year‐old primigravida woman, 21‐week pregnant, was referred to the clinic because of a murmur; she was symptom free. Her blood pressure and pulse rate were 110/70 and 80 regular beat per minute, respectively. In physical examination, a II/VI diastolic murmur accentuated in mitral foci was detected, and other results were unremarkable. Electrocardiogram was normal, as shown in Figure 1. Transthoracic echocardiography (TTE) revealed a perforated membrane within left atrium (LA) which divides it into 2 parts (Figure 2); upper part gets pulmonary veins blood and lower chamber communicates with LA appendage and MV. Chamber dimensions and left ventricular systolic function were normal. Color Doppler survey showed a flow between 2 separated part with mean gradient of 3 mm Hg and peak gradient 7 mm Hg; in pulse Doppler imaging, mild TR with pulmonary artery systolic pressure 25 was detected. In bimonthly follow‐up, no specific changes were observed in TTE findings and her signs and symptoms, as well.

Figure 1

ECG shows no significant changes

Figure 2

Transthoracic echocardiography. Right: Turbulent flow across the perforated fibromuscular membrane. Left: Nonsignificant gradient between 2 separated parts of left atrium

The vaginal delivery in this case was not contraindicated, so her pregnancy terminated by vaginal delivery without any complication.

Transthoracic echocardiography after delivery and its findings were the same as initial results.

DISCUSSION

Cor triatriatum, a congenital malformations of the heart, was first described by WS Church in 1868.1 Cor triatriatum dextrum is rarer than Cor triatriatum sinistrum.2 In Cor triatriatum sinistrum, a membrane divides the LA into 2 chamber, proximal and distal.3 Clinical manifestations present in infancy, and some cases remain asymptomatic until adulthood or geriatric period; also its signs can mimic those of mitral stenosis.2, 4, 5

Echocardiography is the first imaging modality for cor triatriatum diagnosis.6 It helps physician to differentiate cor triatriatum from mitral stenosis, pulmonary vein stenosis, and acute coronary syndrome7; as in our case, TTE revealed cor triatriatum sinistrum. Management in symptomatic patients includes management of volume overload, pulmonary edema, and control of ventricular response in patients with atrial fibrillation (AF) rhythm, also anticoagulant therapy in AF and right‐sided heart failure. Surgical excision of the membrane is definite treatment in symptomatic patients.8, 9 Patients with membrane fenestration more than 1 cm in diameter are usually asymptomatic.10, 11 In asymptomatic patients, as our case, with no significant obstruction, conservative management is advised.10

The patient was followed bimonthly by TTE and remained asymptomatic during the pregnancy length; she had been terminated by natural vaginal delivery without cardiac or obstetric complications.

ACKNOWLEDGMENT

The author has acknowledged from Department of Cardiology, Kermanshah University of Medical Sciences, Kermanshah, Iran.

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTION

Zh. T. is corresponding author; diagnosed and followed the patient and conceived of the case report, and took full responsibility for the contents of this manuscript.