Chen Ping-Hong, Liu Yi-Ching, Dai Zen-Kong, Chen I-Chen, Lo Shih-Hsing, Wu Jiunn-Ren, Wu Yen-Hsien, Hsu Jong-Hau
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Pediatrics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Front Cardiovasc Med. 2022 Feb 24;8:815312. doi: 10.3389/fcvm.2021.815312. eCollection 2021.
The cor triatiatum dexter is an embryologic remnant derived from the right atrium and totally separate from the right atrium. An incomplete cor triatiatum dexter (iCTD) means a partially obstructive remnant at the right atrium. It is usually formed by a remnant of the Eustachian valve (EV), Thebesian valve (ThV), or Chiari network (CN). This anatomic variant is usually asymptomatic but is often associated with other heart abnormalities including atrial septal defects (ASDs), and has the potential to hamper percutaneous heart procedures such as electrophysiological study or ASD closure. Herein, we report a rare complication, transient heart ischemia, in transcatheter closure of double ASDs in a 55-year-old woman with EV. This rare complication was thought to be caused by coronary sinus obstruction during device placement. The ischemic change was resolved spontaneously after we withdrew the device. For a second attempt, we adjusted the position of the device to avoid coronary sinus obstruction under transesophageal echocardiogram guidance and the device was smoothly deployed in a good position with a minimal residual shunt. This case suggests that anatomy details in percutaneous heart procedures are important, and this rare and dangerous complication, heart ischemia, should be identified immediately during the procedure.
右三房心是一种源于右心房的胚胎残余结构，与右心房完全分隔。不完全性右三房心（iCTD）指右心房处部分梗阻性的残余结构。它通常由欧氏瓣（EV）、心最小静脉瓣（ThV）或希阿里网（CN）的残余部分形成。这种解剖变异通常无症状，但常与包括房间隔缺损（ASD）在内的其他心脏异常相关，并且有可能妨碍诸如电生理研究或ASD封堵等经皮心脏操作。在此，我们报告了一例55岁患有欧氏瓣的女性在经导管封堵双ASD过程中出现的罕见并发症——短暂性心脏缺血。这种罕见并发症被认为是由于装置放置过程中冠状窦梗阻所致。在我们撤出装置后，缺血改变自行缓解。第二次尝试时，我们在经食管超声心动图引导下调整装置位置以避免冠状窦梗阻，装置顺利放置于良好位置，残余分流极小。该病例提示，经皮心脏操作中的解剖细节很重要，并且这种罕见且危险的并发症——心脏缺血，在操作过程中应立即识别。
