Kobayashi A, Niitsuya M, Muramatu J, Kikawada R, Masuda T
Department of Internal Medicine, School of Medicine Kitasato University, Sagamihara.
J Cardiol. 1989 Sep;19(3):961-9.
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.
