Cor triatriatum is a congenital heart defect that results in one of the atria being divided into two chambers. When it affects the right atrium, it is termed “cor triatriatum dexter.” When it affects the left, it is termed “cor triatriatrum sinister.”
The division is made of a fibromuscular membrane or band, and its degree of completeness and permeability varies; hence, this condition can be anything from an incidental finding with no haemodynamic significance to the patient, to a cause of severe obstruction to inflow (mimicking mitral stenosis).
The below image shows an apical 5 chamber view in a patient with cor triatriatum sinister. Notice how the left atrium is divided into two.
Cor triatriatum sinister is very rare, but not unheard of, in feline patients. There are hardly any reports in the literature of this condition in dogs.
Check out a few clips from Sherif Elsherif’s amazing scan of a 10 year old Micro Maltese at City Veterinary Clinic in Abu Dhabi, which looks highly suspicious for cor triatriatum sinister.
Cor triatriatrum sinister can be isolated, or found in conjunction with other abnormalities such as an atrial septal defect (as above), anomalous pulmonary venous drainage, and mitral regurgitation.
Even when the obstruction is mild, over time, the obstruction to left atrial flow increases pressures inside the left atrium, which feeds through to the pulmonary veins, resulting in pulmonary venous hypertension. If the patient has an atrial septal defect (ASD) as well, then onset of elevated right heart pressures is accelerated due to the left to right shunting of blood. It may be that it is the pulmonary hypertension that is the initial reason for the referral and for your echo examination.
If your cor triatriatum patient already has significantly elevated right heart pressures when you first scan them, be mindful of the fact that left and right heart pressures may have equalised, making a shunt difficult to detect with colour Doppler. In such cases, you will need to rely on your B-mode imaging skills.
We would love to spend the day with you on Thursday the 12th of September 2024 in Bromley, Southeast London.
Bromley is 18 minutes by train from central London (London Victoria Station), 90 minutes by train (55 minutes by car) from Gatwick Airport, and 120 minutes by train from Heathrow Airport. If you are travelling from abroad, we will gladly help you find a local hotel, and pick you up on the morning of the course.
The focus of the day is maximising hands-on scanning time. As such, places are very limited to ensure that you get plenty of 1:1 expert mentoring.
You can book your place here.
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