Shah Bhushan, Uppal Abhimanyu, Kunal Shekhar, Prajapati Sudesh, Gupta Ankit
Cardiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Cardiology, Priyanka Hospital and Cardiac Center, Jaipur, IND.
Cureus. 2025 May 13;17(5):e84011. doi: 10.7759/cureus.84011. eCollection 2025 May.
Atrial septal defect (ASD) is a common congenital heart anomaly, often diagnosed with relative ease. However, the presence of additional structural abnormalities, such as cor triatriatum dexter (CTD) or a prominent eustachian valve, can create a triatrial appearance, complicating diagnosis and management. Accurate differentiation of these anomalies is essential to guide appropriate clinical decisions. We report the case of a 25-year-old male with exertional dyspnea and fatigue. Cardiovascular examination revealed a wide, fixed splitting of S2 and a systolic murmur. Transthoracic echocardiography (TTE) suggested an ostium secundum ASD (OS-ASD) with an abnormal membrane in the right atrium, raising suspicion for CTD. Further evaluation with transesophageal echocardiography (TEE) and cardiac computed tomography (CT) revealed an incomplete CTD (iCTD) rather than a true triatrial division. Cardiac catheterization confirmed an operable left-to-right shunt with mild pulmonary arterial hypertension. The patient underwent successful ASD closure and membrane excision. This case highlights the importance of multimodality imaging in distinguishing a triatrial appearance in ASD patients. Misdiagnosis of iCTD as CTD or a prominent eustachian valve can lead to inappropriate management decisions. Advanced imaging techniques, including three-dimensional TEE (3D TEE) and cardiac CT, are crucial for precise anatomical assessment and surgical planning, ensuring optimal patient outcomes.
房间隔缺损（ASD）是一种常见的先天性心脏异常，通常相对容易诊断。然而，额外结构异常的存在，如右房三房心（CTD）或显著的欧氏瓣，可造成三房心的表现，使诊断和处理复杂化。准确鉴别这些异常对于指导恰当的临床决策至关重要。我们报告一例25岁男性，有劳力性呼吸困难和疲劳症状。心血管检查发现S2固定宽分裂及收缩期杂音。经胸超声心动图（TTE）提示继发孔型房间隔缺损（OS-ASD）伴右房异常隔膜，怀疑为CTD。经食管超声心动图（TEE）和心脏计算机断层扫描（CT）进一步评估显示为不完全性CTD（iCTD）而非真正的三房心分隔。心导管检查证实存在可手术治疗的左向右分流及轻度肺动脉高压。患者成功接受了房间隔缺损封堵及隔膜切除术。本病例强调了多模态成像在鉴别房间隔缺损患者三房心表现中的重要性。将iCTD误诊为CTD或显著的欧氏瓣可导致不恰当的处理决策。先进的成像技术，包括三维经食管超声心动图（3D TEE）和心脏CT，对于精确的解剖评估和手术规划至关重要，可确保患者获得最佳预后。
