CONGRESS ABSTRACT

37-year-old female patient came to our attention for episodes of chest pain, modifying with breathing, lasting for hours, always self-limiting, hoarseness, productive cough and hyperpyrexia, only partially responsive to paracetamol. On admission patient was symptomatic with intermittent chest pain, which worsened with coughing and inspiration, partially relieved by sitting in forward leaning position. Admission EKG and chest X-ray were both normal (Figures 1 and 2) ; urgent troponin T HS, performed on admission, was negative. Blood chemistry on admission: only weakly positive C reactive protein. Transthoracic echocardiogram showed no major alterations in segmental kinetics and preserved global systolic function (EF 55%). In left atrium there was a linear hyperechoic formation, compatible with a fibromuscular membrane, with transverse orientation, which incompletely separated upper and lower portion of left atrial chamber (Figure 3). No significant gradient between interatrial chambers; mild pericardial effusion. So echocardiographic imaging was consistent with cor triatriatum sinistrum (CTS) and mild pericardial inflammation. Moreover, since our young patient had a history of recurrent migraines from a very young age, not previously investigated, given this clinical setting, we decide to perform transoesophageal echocardiography in order to better explore the anatomy of left atrium and adjacent structures and to exclude presence of right-to-left atrial shunt. No interatrial shunt was found. Then, based on type of pain, positive inflammation indices and imaging findings (hyper-refraction of pericardial layer), a diagnosis of pericarditis was made. CTS can occur isolated or in association with other congenital heart diseases. The most widely used classification is Loeffler's one, which distinguishes three different groups: patients without membrane patency, with one or more small membrane patencies; with large membrane patencies. Presence and extent of patency is closely associated with the onset of symptoms. In adults, CTS is often an isolated finding. In previously asymptomatic adults with CTS clinical presentation may also be caused by fibrosis and calcification of the membrane, leading to obstruction, which can mimic mitral stenosis. Moreover anatomical conformation of left atrial chamber, together with increased incidence of mitral regurgitation with advancing age, may promote arrhythmogenesis thus contributing to the onset of atrial fibrillation.