Clinical vignette
Anatomical features of congenital right atrial diverticulum on 3D-transoesophageal echocardiography
Carlo Pisacane1*, Marco Pascotto1, Giuseppe Caianiello2, Raffaele Calabrò1
1Division of Pediatric Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy; 2Pediatric Cardiac Surgery, Second University of Naples, Monaldi Hospital, Naples, Italy
*Corresponding author. E-mail address: pisacane@aliceposta.it
A 9-year-old female was referred to our institution with a history of palpitations at rest. She had no comorbidities or history of cardiovascular disease. Previous electrocardiograms (ECGs) and 24 h Holter monitoring failed to record any arrhythmias. The physical examination revealed a blood pressure of 100/60 mmHg, pulse of 85 b.p.m., and normal findings on auscultation. The 12-lead ECG was normal for age and sex. A transthoracic echocardiogram revealed an abnormal chamber connected to the lateral wall of the right atrium consistent with a large congenital right atrial aneurysm/diverticulum. A transoesophageal echocardiogram was then performed (Panel A) along with 3D off-line reconstruction. Multiplane 3D views showed a large diverticulum connected to the free wall of the right atrium with a 1×1.5 cm orifice (Panel B–E) with several trabeculae consistent with septation within the diverticulum (Panel D). The patient was referred for surgery owing to the increased risk of supraventricular arrhythmias and thrombus formation. Surgical exploration confirmed all the echocardiographic findings (Panel F). Excision of the diverticulum and direct suture of the connecting orifice was then performed. The patient was discharged 7 days after surgery and remains asymptomatic at 6-month follow-up.
This case illustrates how improvements in both transthoracic and transoesophageal real-time 3D echo are likely to be useful for presurgical and intraoperative evaluation of cardiac anatomy.
Panel A. Transoesophageal echo at 0° mid-oesophageal plane. The transducer is slightly rotated rightward to enhance the visualization of the right cardiac chambers. A large diverticulum is seen lateral to the right atrium and extending inferiorly towards the right ventricle. D: diverticulum; TV: tricuspid valve; RA: right atrium; RV: right ventricle.
Panels B and C. 3D-echo reconstructions from the right atrium (view from a virtual atriotomy). The diverticulum is connected to the lateral wall of the right atrium. The orifice (small arrows) connecting to the right atrium to the diverticulum is well defined. D: diverticulum; TV: tricuspid valve; RA: right atrium.
Panel D. 3D-echo reconstruction in a longitudinal plane. The large diverticulum with multiple trabeculae (arrowheads) is connected to the lateral wall of the right atrium. D: diverticulum; TV: tricuspid valve; RA: right atrium; RV: right ventricle.
Panel E. 3D-echo reconstruction en-face from the diverticulum (view from a virtual diverticulotomy). Notice the orifice (1 cm×1.5 cm) connecting the diverticulum (demarcation by arrowheads) to the lateral wall of the right atrium.
Panel F. Surgical images of the large diverticulum confirming the 3D-echo findings. The orifice (1 cm×1.5 cm) is directly connected to the lateral wall of the right atrium. A large trabecula is seen within the diverticulum.
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