Okuyama Yusuke, Tamura Atsushi, Ueda Kohei, Matsuoka Shunzo, Nakagawa Yoshihisa
Department of Cardiovascular Medicine, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima-cho, Uji, Kyoto Prefecture, 611-0041, Japan.
Department of Clinical Engineering, Uji-Tokushukai Medical Center, Uji, Kyoto Prefecture, 611-0041, Japan.
Eur Heart J Case Rep. 2024 Sep 10;8(9):ytae490. doi: 10.1093/ehjcr/ytae490. eCollection 2024 Sep.
Cor triatriatum sinister (CTS) is a rare congenital heart defect sometimes complicated with atrial fibrillation (AF). Catheter ablation (CA) relieves the AF-associated symptoms, but CA for AF with CTS has been reported rarely. Because CTS can be associated with other congenital heart disease, detailed preoperative assessment is important.
An 80-year-old man was referred to our institution for shortness of breath that had persisted for 2 months when he was first diagnosed with AF. Transthoracic echocardiography revealed an enlarged left atrium (LA) divided into two chambers by a membrane. Transoesophageal echocardiography showed the membrane extending from the fossa ovalis (FO) to the Coumadin ridge, with the accessory (dorsal) chamber (AC) in closer proximity to the FO. Computed tomography showed that all pulmonary veins (PVs) flowed into the AC, with no PV anomalies. No other heart anomaly was identified, with no thrombus in the LA. With these findings, PV isolation (PVI) with CA was considered safe. Transseptal puncture was performed with intracardiac echocardiography for precise catheterization of the AC. Pulmonary vein isolation was performed successfully. The patient was discharged 4 days after the procedure, without any complications. His symptoms improved post-procedure, and sinus rhythm was maintained without antiarrhythmic drug therapy during the 18-month follow-up.
Cor triatriatum sinister is a rare anomaly that accounts for 0.1% of all congenital heart diseases. Cor triatriatum sinister sometimes complicated with symptomatic AF. Detailed preoperative anatomical assessment with multiple imaging modalities helped us achieve safe and effective CA for a patient with AF and CTS, even in an octogenarian.
左房三房心（CTS）是一种罕见的先天性心脏缺陷，有时会并发心房颤动（AF）。导管消融（CA）可缓解与房颤相关的症状，但关于CTS合并房颤的CA治疗报道较少。由于CTS可能与其他先天性心脏病相关，详细的术前评估很重要。
一名80岁男性因气短持续2个月首次被诊断为房颤而转诊至我院。经胸超声心动图显示左心房（LA）扩大，被一层膜分隔为两个腔室。经食管超声心动图显示该膜从卵圆窝（FO）延伸至华法林嵴，附属（背侧）腔室（AC）更靠近FO。计算机断层扫描显示所有肺静脉（PVs）均流入AC，无PV异常。未发现其他心脏异常，LA内无血栓。基于这些发现，认为CA联合肺静脉隔离（PVI）是安全的。在心脏内超声引导下进行经房间隔穿刺，以精确导管插入AC。成功进行了肺静脉隔离。术后4天患者出院，无任何并发症。术后症状改善，在18个月的随访期间无需抗心律失常药物治疗即可维持窦性心律。
左房三房心是一种罕见的先天性心脏病，占所有先天性心脏病的0.1%。左房三房心有时会并发有症状的房颤。即使对于一名八旬老人，通过多种影像学检查进行详细的术前解剖评估，也有助于我们对AF合并CTS患者实施安全有效的CA治疗。
