University Hospital of Wales, UK
Title: All that wheezes is not bronchial asthma
Biography: Afzal Abubakker Bapputty Haji
Objective: Although wheezing is a common manifestation of bronchial asthma, this symptom could also result from an underlying heart disease. We present a 3-year old with Cor-triatriatum who did not respond to previous treatment for bronchial asthma.
Methods: The child was investigated and its results and management were reviewed. A Medline search using the keywords was performed and results summarized.
Results: We report a 3-year-old, under treatment for bronchial asthma for 2 years with no relief to his cough and shortness of breath on exertion. His mother noted that he had a prominent cardiac chest impulse and further investigations revealed right axis deviation and RBBB pattern on his electrocardiogram. His echocardiogram revealed a membrane across the left atrium with a small restrictive orifice in its anterosuperior aspect. The pulmonary veins were draining into the left atrium above the membrane and the left atrial appendage was below the membrane. Pulmonary hypertension was also evident from a tricuspid regurgitation jet velocity of 4 m/s. The membrane was surgically resected with prompt relief to his symptoms and the pulmonary hypertension resolved.
Conclusion: We highlight the importance of considering a cardiac anomaly in children with bronchial asthma who do not respond to treatment. An electrocardiogram can give a valuable clue to this anomaly. The diagnosis is all the more important as the anomaly can be surgically corrected with complete resolution of symptoms and restoration of normal cardiac function.
Discussion: Cor-triatriatum is a rare anomaly (0.1% of congenital heart diseases), characterized by a fibro muscular membrane, dividing the left atrium into two chambers and offering variable obstruction to LV inflow. Literature review emphasized the importance of early diagnosis and that clinical manifestations generally depend on the degree of inflow obstruction. The resultant pulmonary hypertension and right heart failure can lead to symptoms that resemble bronchial asthma.