Cor triatriatum and stroke

Area of Science:

• Cardiology
• Neurology
• Congenital Heart Disease

Background:

• Cor triatriatum sinistrum (CTS) is a rare congenital cardiac anomaly characterized by a fibromuscular membrane dividing the left atrium.
• CTS can lead to significant neurological complications, including stroke.

Observation:

• A 19-year-old female presented with a right middle cerebral artery (MCA) territory infarct.
• Diagnosis of CTS was confirmed via transthoracic echocardiography (TTE) showing a dividing membrane.
• The patient experienced recurrent strokes despite aspirin and later apixaban therapy.

Findings:

• This case represents the longest follow-up of a patient with CTS and stroke.
• It is the first reported instance of failure of both antiplatelet and anticoagulant therapies in managing CTS-related neurological events.
• The patient ultimately succumbed to hospital-acquired pneumonia following a third stroke.

Implications:

• This case underscores the potential for severe neurological morbidity in CTS.
• It challenges current treatment paradigms, suggesting limitations of standard antiplatelet and anticoagulant strategies in select CTS patients.
• Further research into optimal management of CTS to prevent thromboembolic events is warranted.