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[Echocardiographic study of a cardiac murmur in cor triatriatum: a case report]
A Kobayashi1, M Niitsuya, J Muramatu
1Department of Internal Medicine, School of Medicine Kitasato University, Sagamihara.
Insights
Cor triatriatum, a rare heart condition, was diagnosed in an elderly patient. Doppler and contrast echocardiography revealed the mechanism behind his complex cardiac murmur.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Cor triatriatum is a rare congenital heart anomaly characterized by an accessory intra-atrial septum.
- This case report details a 63-year-old male with a history of cardiomegaly and valvular disease presenting with hematemesis.
Observation:
- A complex cardiac murmur, described as regurgitant and continuous, was noted on phonocardiogram.
- Two-dimensional echocardiography identified an abnormal left atrial septum, dividing the chamber.
- Color Doppler and contrast echocardiography visualized turbulent flow and its origin.
Findings:
- The abnormal septum in the left atrium caused a continuous turbulent flow towards the mitral orifice.
- Doppler and contrast echocardiography successfully elucidated the mechanism of the patient's cardiac murmur.
- The findings suggest the murmur associated with cor triatriatum may not be persistent but continuous.
Implications:
- This case highlights the utility of advanced echocardiographic techniques in diagnosing rare cardiac conditions.
- Understanding the mechanism of murmurs in cor triatriatum can improve diagnostic accuracy.
- Early and accurate diagnosis of cor triatriatum is crucial for appropriate patient management.
Abstract:
This is a report of an aged patient with cor triatriatum in whom the mechanism of his cardiac murmur was elucidated by Doppler and contrast echocardiography. This 63-year-old man was followed up for cardiomegaly detected at 40 years of age, and he had been treated for a cardiac murmur due to valvular disease during the previous 10 years. He was admitted to our hospital for the evaluation of incidental hematemesis. A phonocardiogram recorded over the apex showed a regurgitant murmur from early to mid-systole, followed by a continuous murmur lasting up to mid-diastole. Two-dimensional echocardiogram revealed an abnormal septum in the left atrium dividing the atrium into two chambers and showing bulging in late systole through diastole. In the lower chamber, color Doppler echocardiography disclosed continuous turbulent flow originating from the bulge directing the mitral orifice. Contrast medum coursing toward the mitral orifice was demonstrated during contrast echocardiography and left ventriculography, which coincided with the turbulent signal on the Doppler echocardiogram. The description of the cardiac murmur of cor triatriatum suggests that it is not persistent. Conceivably, it is a continuous murmur, whose mechanism can be elucidated by Doppler and contrast echocardiography.