Virtual Cardioscopy in Cor Triatria

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Generalized cyanosis developed 1 day after birth in a 3-year-old female infant. With echocardiography, tricuspid atresia, hypoplastic right ventricle, transposition of the great artery, pulmonary atresia, ventricular and atrial septal defect, and persistent left superior vena cava were demonstrated. An emergency modified Blalock-Taussig shunt was performed at 10 days of age, with partial patency achieved. Bilateral bi-directional Glenn shunt was then performed at 16 months, with mild stenosis observed at the junctions of the anastomosis. Mild dyspnea had been noted when she walked fast for the preceding year. The suspicion of pulmonary venous obstruction was raised with follow-up echocardiography and angiography. A small connection between a pulmonary venous confluence and the left atrium was identified with contrast-enhanced cardiac computed tomography, with an associated cor triatria diagnosed (Figure). Virtual cardioscopy viewing from both the left atrium and pulmonary venous confluence (right and left frames, respectively) delineated this restrictive interconnecting ostium (Videos 1 and 2, available at www.jpeds.com). The patient underwent surgical enlargement of this ostium and the Fontan procedure.

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  Virtual cardioscopy viewing from both the left atrium and pulmonary venous confluence (right and left frames, respectively) clearly delineated the restrictive interconnecting ostium of this cor triatria. Diagrams in the right lower corners of each frame represent the angle of the viewpoint of this endoscope; diagram in the middle upper portion represents the corresponding computed tomography. LA, Left atrium; LV, left ventricle; PVC, pulmonary venous conference; RA, right atrium; RV, right ventricle.

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