Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of left atrial inflow obstruction, including exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. History significant for recurrent pulmonary congestion or failure to thrive in pediatric cases. Absence of cyanosis noted. Symptoms exacerbated by physical exertion, consistent with restrictive physiology secondary to accessory atrial membrane.
Clinical Examination Findings
Cardiovascular exam reveals a prominent pulmonary component of the second heart sound (P2) indicating pulmonary hypertension. A diastolic murmur may be audible at the apex, mimicking mitral stenosis. Signs of right-sided heart failure, including jugular venous distension, hepatomegaly, and peripheral edema, may be present in advanced cases. Lung auscultation demonstrates bilateral basal crackles.
Treatment Protocol
Surgical resection of the accessory atrial membrane is the definitive treatment. Pre-operative management includes diuretics for pulmonary congestion and management of associated congenital anomalies. Post-operative care focuses on monitoring for residual obstruction, arrhythmias, or mitral valve dysfunction. Long-term follow-up with serial echocardiography is required to assess for membrane recurrence or stenosis.