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J Thorac Cardiovasc Surg 2004;127:1210-1212
© 2004 The American Association for Thoracic Surgery

Brief communication

Incomplete midline atrial chamber in a symptom-free adult: An enigma?

^a Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, London, United Kingdom
^b Department of Cardiology, John Radcliffe Hospital, Oxford, London, United Kingdom
^c National Heart and Lung Institute, Imperial College, London, United Kingdom

Received for publication October 17, 2003; accepted for publication October 31, 2003.

^* Address for reprints: Ravi Pillai, FRCS, Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, Level 01, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
ravi.pillai@nds.ox.ac.uk

The first 20% of the full text of this article appears below.

Pillai, Balacumaraswami, Ho, Ormerod

The incidence of atrial septal defect associated with anomalous pulmonary venous drainage is low. This case illustrates the presence of partial anomalous pulmonary venous drainage into a midline atrial chamber with no interatrial communication, a situation not previously described in patients with the usual atrial arrangement.

Clinical summary

An incidental heart murmur in a 24-year-old woman led to discovery of an atrial septal defect with an apparent partition on echocardiogram. Transesophageal echocardiography and magnetic resonance imaging showed left pulmonary venous drainage into the left atrium (LA) and right pulmonary venous drainage into a midline atrial chamber that communicated with the right atrium (RA) but was completely partitioned from the LA (Figures 1 and 2, A). There were no other cardiac anomalies or visceral malformations. Cardiac catheterization confirmed absence of an interatrial communication and normal pulmonary artery pressure. There was a step up in oxygen saturation in the mid RA (94%) from the superior vena cava and high RA (78%). The main pulmonary artery saturation was 92%, whereas the right upper and lower pulmonary veins accessed through the RA into the midline chamber were 98% saturated. The left pulmonary venous drainage into the LA was visualized on the levo phase of the left pulmonary angiogram (Figure 2, B).

View larger version (79K): [in this window] [in a new window]   Figure 1. Transesophageal echocardiogram showing midline . . . [Full Text of this Article]