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Ischemic stroke associated with cor triatriatum sinistrum

CASE STUDY, January 2015, VOL III ISSUE I, ISSN 2042-4884
10.5083/ejcm.20424884.130 , Cite or Link Using DOI
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Célia Machado MSc MD, Ana Filipa Santos MSc MD, Filipa Sousa MD, João Ramalho Fontes, M.D.1 António Costeira Pereira MD, Carla Ferreira MD, João Pinho MD

ABSTRACT

Cor triatriatum sinistrum is a rare congenital cardiac anomaly which may be asymptomatic, especially when it is not associated with additional cardiac defects or restricted pulmonary venous return. We present the case of a young ischemic stroke patient, in whom after detailed etiological investigation, a rare congenital cardiac anomaly was found. Very few adult patients with cor triatriatum sinistrum and ischemic stroke are reported in the literature, and we discuss the importance of transesophageal echocardiogram and the underlying pathophysiologic mechanisms. We recommend anticoagulation as secondary prevention therapy in adult patients with ischemic stroke associated with cor triatriatum sinistrum and no congestive heart failure syndrome.

INTRODUCTION

Cor triatriatum sinistrum (CTS) is a rare congenital condition characterised by a fibromuscular membrane that divides the left atrium (LA) in two chambers. In patients with no or a lesser degree of obstruction, the diagnosis is made in adulthood and is usually a coincidence. In these patients, the LA suffers mechanical and electrical remodelling and the risk of degeneration into arrhythmogenesis and thrombogenesis should not be overlooked. Atrial fibrillation (AF) and stroke may be the first clinical manifestations. We report a case of an ischemic stroke in young adult, in which CTS was diagnosed during the follow-up.