Dilatación idiopática de la aurícula derecha. Reporte de caso y revisión de la literatura / Idiopathic dilatation of the right atrium. Case report and literature review

Resumen La dilatación idiopática de la aurícula derecha (DIAD) es una malformación poco frecuente caracterizada por un crecimiento desproporcionado de la aurícula derecha en ausencia de una causa estructural o funcional que la justifique. Presentamos el caso de una paciente con DIAD con diagnóstico desde la etapa prenatal.

Abstract Idiopathic dilatation of the right atrium is a rare malformation characterized by disproportionate growth of the right atrium in the absence of a cause that justifies it. We present the case of a patient with idiopathic dilatation of the right atrium diagnosed since fetal life.

Cardiac Myxomas: A Single?Center Case Series of 145 Patients Over a 32?Year Period Study

Background:Myxomas are the most common primary cardiac tumors that develop mostly at the atrial chambers of the heart and represent 0,25% of all cardiac diseases. Methods: This is a retrospective study aiming to analyze epidemiological and intraoperative data from cardiac myxoma cases in the hospital of the last 32 years. The study population was 145 cardiac surgical patients and was divided into 4 certain 8?year periods. 87,6% of cases had the myxoma located at left atrium and 97,2% of all patients fully recovered. 4,1% of patients relapsed and underwent a redo operation. Results: Mean CPB time and mean ICU length of stay increased during the 8?year periods (p < 0,001, P < 0,001, P = 0,002 and P = 0,003 respectively). In-hospital length of stay decreased to 5 days in the most recent period (p < 0,001). Cases significantly increased to 54 in the last 8?year period (p = 0,009). Conclusion: Improvement on cardiac imaging and a better accessibility may drive patients to earlier and safer diagnosis of myxomas preventing any deterioration of their condition. Improvement on postoperative care can also reduce in-hospital length of stay. Surgical excision is the treatment of choice and guaranteed survival at 97,2% of patients.

Direct Anastomosis of Persistent Left Superior Vena Cava to Right Superior Vena Cava in a Pediatric Patient with Tetralogy of Fallot: an Alternative Technique

ABSTRACT The presence of persistent left superior vena cava to the left atrium connection without an innominate vein may give rise to technical challenges during intracardiac repair. In this report, the end-to-side anastomosis technique of the persistent left superior vena cava to the right superior vena cava is discussed in a patient with tetralogy of Fallot associated with persistent left superior vena cava draining directly into the left atrium. A successful end-to-side anastomosis between the persistent left superior vena cava and the right superior vena cava was performed and short-term anastomosis patency was documented via angiography.

Clinical Effects of Surgical Left Atrial Reduction and Concomitant Mitral Valve Replacement in Patients with Giant Left Atrium

ABSTRACT Introduction: A giant left atrium may cause respiratory dysfunction and hemodynamic disturbance postoperatively. This retrospective study aimed to evaluate clinical effects of surgical left atrial reduction in concomitant cardiac valves operations. Methods: One hundred and thirty-five patients with heart valve diseases and giant left atriums from January 2004 to July 2021 were enrolled into this research. They were divided into the folded group (n=63) and the unfolded group (n=72). Patients in the folded group had undergone cardiac valve operations concomitantly with left atrial reductions. The perioperative characteristics were compared between both groups, and subgroup analysis was performed. Results: There were five deaths in the folded group and 25 deaths in the unfolded group (P<0.001). Complications including pneumonia, sepsis, multiple organs dysfunction syndrome, low cardiac output syndrome, and the use of continuous renal replacement therapy were significantly fewer in the folded group. The receiver operating characteristic curve of left atrial max. diameter predicting mortality was significant (area under the curve=0.878, P=0.005), and the cutoff point was 96.5 mm. The stratified analysis for sex showed that more female patients died in the unfolded group. Logistic regression for mortality showed that the left atrium unfolded, left atrial max. diameter, cardiopulmonary bypass time, and mechanical ventilation time increased the risk of death. Conclusion: Surgical left atrial reduction concomitantly with valves replacement could decrease mortality and was safe and effective in giant left atrium patients.

Transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation for Budd-Chiari syndrome complicated with liver cancer: a case report with surgical video / 器官移植

Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis.

Trombo en tránsito entre la aurícula derecha y la vena cava inferior en un paciente con contraindicación absoluta para trombólisis / Thrombus in transit between the right atrium and the inferior vena cava in a patient with an absolute contraindication for thrombolysis

Resumen La tromboembolia venosa es una condición relativamente común que se identifica en los servicios de urgencias y que representa morbilidad y mortalidad significativas en la población. Su desenlace más grave es la tromboembolia pulmonar, la cual desencadena una serie de procesos fisiopatológicos que pueden terminar en paro cardiaco y en la muerte posterior del paciente. Un trombo en las cavidades cardiacas derechas o en la vena cava es poco detectable; esta condición se conoce en la literatura como trombo en tránsito, y su hallazgo se asocia con alta mortalidad hospitalaria. A continuación, se presenta el caso de un paciente de sexo femenino, de 64 años de edad, con antecedente de cáncer uterino activo, hospitalizada por trombosis venosa profunda y en quien se tomó un ecocardiograma transtorácico de control que mostró un trombo en tránsito de alta movilidad en el límite entre la aurícula derecha y la vena cava inferior.

Abstract Venous thromboembolism is a relatively common condition that is identified in the emergency services and represents significant morbidity and mortality in the population. Its most severe outcome is pulmonary thromboembolism, which triggers several pathophysiological processes that can end in cardiac arrest and subsequent death of the patient. A thrombus found in the right cavities or in the vena cava is an undetectable process, this condition is known like ongoing thrombus. The finding of thrombus in transit has been associated with high hospital mortality. We present the case of a 64-year-old female patient with a history of active uterine cancer, who was hospitalized for deep vein thrombosis and in whom a control transthoracic echocardiogram is taken, showing evidence of a highly mobile thrombus in transit between the right atrium and inferior vena cava compatible with ongoing thrombus at this level.

Survival outcomes of pneumonectomy with left atrial resection for non?small cell lung cancer

Background: Lung cancer invading left atrium is accepted as T4 tumor and surgical treatment in this situation is controversial. The aim of our study was to determine the prognostic factors of patients with surgically treated non-small cell lung cancer (NSCLC) invading left atrium. Methods: After the approval of local ethics committee, the study was conducted in Gazi University, Department of Thoracic Surgery (Ankara-Turkey). The records of the patients were obtained from the encrypted hospital management software. Sequential codes were given to the data of patients and it was transferred to the statistics program without their names and ID numbers. The data of patients were collected as follows: those who had extended pneumonectomy from the surgery reports were found, then their pathology reports were examined, and those who had atrial muscle tissue were included in the study. Selected cases included as follows: patients who were medically suitable for surgery, patients who could tolerate surgery in cardiology evaluation, patients who had adequate lung capacity for pneumonectomy. Data of patients were analyzed according to age, gender, lymph node invasion, complete resection, and operative mortality. Results: A total of 18 patients were included in the study. There were 16 (88.8%) men and 2 (12.2%) women. The mean age was 60.8 (range: 44 -76; Standard deviation: ± 1.8) years. Cardiopulmonary bypass was used in only one patient. The 30-day mortality was 5.5%. 1, 3, and 5-years overall survivals were 77%, 18.6%, and 9.3%, respectively. Mediastinal lymph node metastasis in N1 and N2 stations was detected 10 and 2, respectively. There was statistically significant correlation between recurrence and lymph node invasion status including N1 and N2 station (P = 0.04). Conclusion: Although surgery is controversial in patients with NSCLC invading left atrium, it can be performed in selected cases. Morbidity and morta

Comparative study the curative effect, ventricular remodeling and cardiac function of patients in different left atria size undergoing valve replacement with " X" ablation of posterior left atrium wall / 中华胸心血管外科杂志

Objective:To investigate the influence of left atrial size on the ablation efficacy, cardiac morphology and function after valve replacement combined with X-type radiofrequency ablation on posterior wall of left atrium.Methods:From January 2015 to December 2019, 416 patients with mitral valve disease complicated with atrial fibrillation were divided into two groups according to the size of left atrium(Anteroposterior diameter 60 mm). Valve replacement combined with " X" radiofrequency ablation on posterior wall of left atrium was performed. The clinical data were analyzed retrospectively.Results:Except for the AF types, gender, length of stay and postoperative complications, other clinical data, operative and perioperative indicators were better in small left atria group(SLA)than in large left atria group(LLA). The differences were statistically significant( P<0.05). Fractional shortening(FS), ejection fraction(EF) in SLA at any time point were higher than that in LLA, P<0.05. The sinus rhythm conversion rates, the change rate of LA anteroposterior diameter in SLA at postoperative time points were higher than that in LLA, P<0.05. There was no significant difference of cardiac troponin(cTn) and myoglobin(MYO) between the two groups in 6 months after operation, P>0.05. The B-type natriuretic peptide(BNP), cTn, MYO in the other time points were lower than that in LLA, P<0.05. Conclusion:Larger left atrium reduces the rate of sinus rhythm conversion and maintenance in patients undergoing valve replacement combined with fibrillation ablation. There were worse ventricular remodeling and cardiac function recovery. Preoperative evaluation of left atrial size is helpful for prognosis.

A Case of Redo Ascending Aortic Replacement for Anastomotic Pseudoaneurysm through Right Thoracotomy in a Patient with Severe Coagulation Disorder / 日本心臓血管外科学会雑誌

A 51-year-old man presented to our hospital with general fatigue and lower extremity edema due to right heart failure with severe coagulation disorder. He had undergone ascending aortic and total arch replacement for type A acute aortic dissection when he was 49 years old and had diagnosed with anastomotic pseudoaneurysm in the ascending aorta by computed tomography 1 year after the operation. Preoperative computed tomography showed an enlargement of the pseudoaneurysm. Since re-median sternotomy seemed to be high risk strategy for bleeding due to severe coagulation disorder, we decided to perform ascending aortic replacement through right thoracotomy. We opened the pseudoaneurysm and found an aorto-right atrium fistula. Redo ascending aortic replacement with direct closure of the fistula was successfully performed. The postoperative course was uneventful.

Stiff Left Atrium Syndrome After Atrial Fibrillation Ablation ­ A Diagnosis Not To Forget

Atrial fibrillation is the most prevalent arrhythmia in clinical practice and has different strategies for its control. Of these strategies, the percutaneous ablation of the pulmonary veins stands out, with robust results in relation to drug treatment. It is an invasive procedure and, therefore, not free from complications, which must be properly diagnosed and treated. Among the possible complications, there is stiff atrium syndrome, characterized by reduced atrial compliance caused by post-ablation fibrosis, which, in turn, leads to atrial filling dysfunction and the consequent increase in atrial and venous capillary pulmonary pressures. The case report demonstrates this infrequent but important complication, which presents good results for clinical treatment, in addition to the contribution of cardiac magnetic resonance in its diagnosis and in the assessment of arrhythmia recurrence rates.

Clinical value of left atrium-descending aorta distance measured on ultrasound images in the diagnosis of fetal total anomalous pulmonary venous connection / 中国基层医药

Objective:To investigate the clinical value of ultrasonic measurement of left atrium-descending aorta distance in the diagnosis of fetal total anomalous pulmonary venous connection (TAPVC).Methods:Pregnant women who underwent fetal anatomy scans in the second trimester of pregnancy in Central Hospital of Panyu District between January 2018 and June 2019 were included in this study using prospective and case-control study methods. The GE Voluson E8 and Philips EPIQ 7 ultrasound machines were used to measure the left atrium-descending aorta distance in the four-chamber view of the fetal heart. Pulmonary vein was carefully examined. Fetuses with isolated TAPVC were included in the positive group. The pregnancy outcomes were followed up during all participants. 200 healthy fetuses were randomly selected and included in the control group. The correlation between left atrium-descending aorta distance in normal fetuses and gestational weeks was analyzed. The average value of left atrium-descending aorta distances was compared between positive and control groups.Results:A total of 2 156 pregnant women received fetal anatomy scans, with the completion rate of 100%. Among them, 1 786 pregnant women were successfully followed up and 370 were lost to follow up. Among the 1 786 pregnant women, four fetuses were diagnosed with isolated TAPVC, consisting of three fetuses with intracardiac type TAPVC and one fetus with supracardiac type TAPVC, as confirmed by prenatal ultrasound. The left atrium-descending aorta distance in 200 normal fetuses was weakly related to gestational weeks ( r2 = 0.35, P < 0.000 1). The mean left atrium-descending aorta distance in the positive group was significantly greater than that in the control group (5.4 mm vs. 2.1 mm). Conclusion:Ultrasonic measurement of left atrial posterior spatial distance is simple and it is hardly affected by gestational weeks. It is innovative to diagnose TAPVC through quantitative analysis. The widening of left atrium-descending aorta distance has a certain value in suggesting fetal TAPVC. The sample size is small in this study. Multi-center studies involving larger sample sizes are needed to further validate the clinical significance of widened left atrium-descending aorta distance.

Application value of 256-layer spiral CT left atrial pulmonary vein dual phase scanning imaging in radiofrequency ablation of nonvalvular atrial fibrillation / 中国医师进修杂志

Objective:To explore the application value of 256-layer spiral CT left atrial pulmonary vein dual phase scanning imaging (called simply CT dual phase scanning imaging) in radiofrequency ablation of nonvalvular atrial fibrillation.Methods:The clinical data of 74 patients with nonvalvular atrial fibrillation from October 2018 to September 2020 in Tiantan Hospital, Capital Medical University were retrospectively analyzed. All patients were examined by CT dual phase scanning imaging and transesophageal echocardiography (TEE). The result of TEE was as "gold standard", the value of CT dual phase scanning imaging in the diagnosis of left atrial pre-thrombotic state (PTS) and thrombus were assessed, and the variation of the pulmonary vein was observed.Results:CT dual phase scanning imaging in diagnosis of left atrial PTS had a sensitivity of 52.94% (9/17), a specificity of 92.45%(49/53), a negative predictive value of 85.96%(49/57), and a positive predictive value of 69.23%(9/13); it in diagnosis of left atrial thrombus had a sensitivity of 100.00% (4/4), a specificity of 90.74%(49/54), a negative predictive value of 100.00%(49/49), and a positive predictive value of 44.44%(4/9). The variation rate of the pulmonary vein was 21.62%(16/74).Conclusions:CT dual phase scanning imaging has relatively high values of sensitivity, specificity and negative predictive value in detecting left atrial PTS and thrombus. It can also evaluate the abnormal anatomical characteristics of the pulmonary vein, and find pulmonary vein variation. It provides a reliable basis for radiofrequency ablation of nonvalvular atrial fibrillation.

Combined general and cardiac surgery for the treatment of pediatric tumors with supradiaphragmatic inferior vena cava and right atrium tumor thrombus / 中华实用儿科临床杂志

Objective:To investigate the feasibility and efficacy of combined general and cardiac surgery in the treatment of pediatric tumors with supradiaphragmatic inferior vena cava (IVC) and right atrium (RA) tumor thrombus.Methods:Retrospective analysis was performed on the clinical treatment of 8 pediatric tumor patients with supradiaphragmatic IVC and RA tumor thrombus treated by combined general and cardiac surgery in Children′s Hospital, Capital Institute of Pediatrics from June 2015 to May 2019.The operation was performed through a combined thoracoabdominal median incision.Cardiac surgeon opened the pericardium for cardiopulmonary bypass (CPB). Subsequently, general surgeon resected the primary abdominal tumor, cut open the subphrenic IVC, removed the subphrenic tumor thrombus, and made an attempt to remove the supradiaphragmatic tumor thrombus through the same incision of IVC.If the tumor thrombus cannot be completely removed through this incision, cardiac surgeon shall tighten the prefabricated pulmonary artery blocking band, establish CPB, and remove the supradiaphragmatic tumor thrombus in IVC or open RA to remove the atrial tumor thrombus.Results:In the 8 cases, there was hepatoblastoma in 4 cases, nephroblastoma in 3 cases, and adrenocortical carcinoma in 1 case.Among them, there was RA tumor thrombus in 4 cases, which was removed by right atrial thrombectomy under CPB; tumor thrombus in supradiaphragmatic IVC in 1 case, which was removed under CPB; subphrenic IVC in 3 cases, which was completely removed without the adoption of CPB.Among those 8 cases, 7 cases had complete resection of the tumor thrombus and 1 case had residual iliac vein tumor thrombus, and none of them developed pulmonary embolism.All the 8 cases underwent regular postoperative chemotherapy, and median follow-up time was 22.5 months (10-57 months), with 6 survived cases, 1 case died, and 1 case losing follow-up.Conclusions:Combined general and cardiac surgery can allow complete resection of the primary tumor and supradiaphragmatic and right a trial tumor thrombus in a single operation with reduced pain in patients, which could not only improve the rate of complete tumor resection but also reduce the risk of pulmonary embolism, thereby making the previously painful and risky surgery safer, more effective and more humane.

Transcriptional co-activator p300 participates in atrial fibrosis induced by high hydrostatic pressure by regulating TGF-β/Smad3 signaling pathway / 中国药理学通报

Aim To investigate the role and potential mechanism of transcriptional co-activator p300 in atrial fibrosis caused by high hydrostatic pressure. Methods The left atrial appendage tissues of humans in three groups of sinus rhythm, atrial fibrillation (AF), hypertension and AF were collected. The expressions of p300 protein and TGF-β/Smad3 signaling pathway and fibrotic factors as type I/III collagen Alphal chain (Col-lAl/Col-3Al), matrix metalloproteinase 2/9 (MMP-2/9) were tested by Western blot. Mouse atrial appendage fibroblasts were cultured under hydrostatic pressures of 0, 20 and 40 mmHg. The fibroblasts cultured under 40 mmHg pressure were treated with curcumin and p300 interference RNA. Western blot was used to test changes in the expression of p300 and the above fibrosis indicators. CCK-8 method was used to test changes of cell proliferation. Results The expressions of p300 and TGF-β/Smad3 signaling pathway proteins and fibrotic factors in AF group and hypertension combined with AF group were significantly higher than those in sinus rhythm group (P < 0. 05). 40 mmHg high hydrostatic pressure stimulation in vitro could increase the expression of p300 and fibrotic factors in fibroblasts (P < 0. 0 5) and enhance the proliferation ability (P < 0. 05). Both curcumin and p300 interfering RNA could reverse the increased expression of p300 and fibrotic factors (P < 0. 05) and decrease cell proliferation (P < 0. 05) induced by hydrostatic pressure. Conclusions High hydrostatic pressure can induce atrial fibrosis, which involves the participation of p300 in this process by regulating the TGF-β/Smad3 signaling pathway.

Aorto-Left Atrial Fistula after Aortic Valve Replacement : a Rare Complication / 日本心臓血管外科学会雑誌

A 60-year-old man underwent aortic valve replacement for aortic valve regurgitation, tricuspid valve annuloplasty, and coronary artery bypass grafting. Postoperative echocardiography revealed shunted flow from the noncoronary sinus of Valsalva into the left atrium. The pathogenesis of this complication is considered to be uncertain ; however, it might be due to some kind of intraoperative injury. Three weeks after the initial surgery, we reoperated to repair the aorto-left atrial fistula. According to the intraoperative findings, small slits were found on the left atrial surface close to the posteromedial side of the mitral valve and the noncoronary sinus of Valsalva. The fistula was closed with transmural mattress sutures. Post-operative echocardiography showed no shunt flow. Although an aorto-left atrial fistula is a rare complication after aortic valve replacement, reoperation might be mandatory if the shunt flow is considerable. Surgeons should keep in mind the possibility of intraoperative injury to surrounding structures when performing aortic valve replacement.

Função de reserva do átrio esquerdo na avaliação da função diastólica indeterminada / Left atrial reserve function in assessing indeterminate diastolic function

Fundamento: A elevação das pressões de enchimento secundária à disfunção diastólica do ventrículo esquerdo ocupa papel central na fisiopatologia da insuficiência cardíaca. Mesmo assim, as diretrizes internacionais falham em detectar a disfunção diastólica em uma parte dos casos. Objetivo: Avaliar a função de reserva do átrio esquerdo, estimada pelo strain longitudinal de pico do átrio esquerdo, nos casos de função diastólica indeterminada. Método: Estudo observacional com indivíduos em ritmo sinusal e fração de ejeção do ventrículo esquerdo preservada, submetidos ao ecocardiograma e divididos em três grupos conforme a análise conjunta da relação E/e´ e do volume de átrio esquerdo indexado: Grupo 1, se pressões de enchimento normais; Grupo 2, se pressões de enchimento elevadas e Grupo 3, se pressões de enchimento indeterminadas. Speckle tracking bidimensional foi empregado para medir o strain longitudinal de pico do átrio esquerdo. Análise de variância, teste t Student e curva receptor-operador (ROC) foram empregados na análise estatística. Resultado: Foram incluídos 58 pacientes, com 61 ± 14 anos, sendo 57% mulheres, com fração de ejeção do ventrículo esquerdo de 62 ± 7%. Os Grupos 2 e 3 tiveram strain longitudinal de pico do átrio esquerdo menor que o Grupo 1 (20 ± 5% versus 22 ± 6% versus 30 ± 8%, respectivamente, p=0,004), mas não diferiram entre si (p=0,93). O strain longitudinal de pico do átrio esquerdo foi preditor de pressões de enchimento elevadas (p=0,026, área sob a curva=0,80), obtendo-se sensibilidade de 60% e especificidade de 80% com valor de corte ≤ 20%. Conclusão: A função de reserva do átrio esquerdo dos indivíduos com função diastólica indeterminada é similar à dos indivíduos com disfunção diastólica avançada, conferindo ao strain longitudinal de pico do átrio esquerdo o potencial de auxiliar na reclassificação da função diastólica indeterminada.(AU)

Background: Elevation of left ventricular filling pressures secondary to diastolic dysfunction plays a central role in the pathophysiology of heart failure. However, international guidelines still fail to diagnose diastolic dysfunction in some cases. Objective: To evaluate left atrial reservoir function in indeterminate diastolic function Method: Observational study with individuals in sinus rhythm and preserved left ventricular ejection fraction, submitted to echocardiogram and divided into three groups according to the combined analysis of E/e´ ratio and indexed left atrium volume: Group 1, if normal left ventricular filling pressures; Group 2, if increased left ventricular filling pressures and Group 3, if indeterminate left ventricular filling pressures. Twodimensional speckle tracking was used to measure peak left atrial strain (LAS). Analysis of variance, Student's t test and receiver-operator curve (ROC) were used in the statistical analysis. Results: We included 58 patients who had 61 ± 14 years old, 57% of whom were women, and had average left ventricular ejection fraction 62 ± 7%. Groups 2 and 3 had lower LAS than Group 1 (20 ± 5% versus 22 ± 6% versus 30 ± 8%, respectively, p = 0.004), but did not differ between them (p = 0.93). LAS was a good predictor of elevated left ventricular filling pressures (p = 0.026; area under the curve = 0.80), obtaining sensitivity of 60% and specificity of 80% with a cut-off value ≤ 20%. Conclusion: The findings suggest that the left atrial reservoir function of individuals with indeterminate diastolic function is similar to that of individuals with advanced diastolic dysfunction, rendering LAS the potential to support the reclassification of indeterminate diastolic function.(AU)

Diagnóstico prenatal de dilatación idiopática de la aurícula derecha. Reporte de un caso / Prenatal diagnosis of idiopathic dilatation of the right atrium. A case report

La dilatación idiopática de la aurícula derecha es una entidad poco frecuente. Estimar la verdadera incidencia es dificultoso dado que muchos pacientes son asintomáticos y los síntomas reportados, tanto en niños como en adultos, presentan un amplio espectro de manifestaciones clínicas. Pocos pacientes con diagnóstico prenatal fueron publicados.Se presenta un caso de diagnóstico prenatal de dilatación auricular derecha con un seguimiento de 3 años y 8 meses. El paciente se encuentra asintomático, sin evidencia de trombosis auricular, medicado con ácido acetilsalicílico desde su nacimiento. El seguimiento se realizó con ecocardiogramas regulares; sin embargo, la confirmación diagnóstica fue a través de la resonancia magnética nuclear cardíaca.La importancia del reporte radica en describir una enfermedad rara, potencialmente grave, y cómo el diagnóstico prenatal permite tomar conductas anticipadas, como el monitoreo cardíaco, para la detección de arritmias y el inicio temprano de profilaxis primaria antitrombótic

Idiopathic dilatation of the right atrium is a rare condition. The real incidence of the disease is difficult to estimate since most patients are asymptomatic, although a wide spectrum of symptoms have been reported in children and adults. In the literature, prenatal diagnosis has been reported in few cases.We report a case of prenatally diagnosed right atrial dilation with a 3 years and 8 months follow up. The patient is on acetylsalicylic acid since birth and remained asymptomatic without any atrial thrombosis. We performed regular transthoracic echocardiograms during follow up, however was a cardiac magnetic resonance imaging the method for achieving diagnostic confirmation.The aim of this case report is to describe a rare, potentially serious disease and how prenatal diagnosis allows anticipated actions such as monitoring for cardiac arrhythmia detection and early starting of primary thrombosis prophylaxis.

Cor triatriatum sinister, una anomalía clásica pero un tanto olvidada: A propósito de un caso / Cor triatriatum sinister, a classic but somewhat forgotten anomaly: Apropos of a case

RESUMEN Un corazón con tres aurículas, que sumaba cinco cámaras en total, fue un hecho que sorprendió a la medicina hace ya más de un siglo. Este raro defecto cardíaco congénito tiene muy baja incidencia, lo cual hace que sea muy poco conocido por las jóvenes generaciones de médicos dedicados a las enfermedades cardiovasculares. El cor triatriatum sinister generalmente se diagnostica en la temprana infancia y es considerado una causa congénita de estenosis mitral. La conducta quirúrgica es de elección para poder liberar el obstáculo al adecuado flujo sanguíneo a través de la aurícula izquierda. Se presenta el caso de un adulto joven con síntomas típicos de estenosis mitral, sin aparentes elementos claves al examen físico y con un ecocardiograma que evidencia esta anomalía, apenas vista y publicada en nuestro medio en pacientes adultos.

ABSTRACT A heart with three atria, totaling five chambers in all, was a fact that surprised medicine more than a century ago. This rare congenital heart defect has a very low incidence, which makes it very little known to the young generations of doctors dedicated to cardiovascular diseases. The cor triatriatum sinister is usually diagnosed in early childhood, and it is considered a congenital cause of mitral stenosis. Surgical approach is the choice to release the obstacle in order to adequate blood flow through the left atrium. We present the case of a young adult with typical symptoms of mitral stenosis, without apparent key elements on the physical examination and that the echocardiogram showed this anomaly, hardly seen and published in our field in adult patients.