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Gozar L, Săsăran MO, Cosma MC, Toma D, Nan AG, Gozar H. Raghib Syndrome and Pulmonary Arterial Hypertension in a Pediatric Patient: Case Report and Literature Review. J Clin Med 2024; 13:3623. [PMID: 38930151 PMCID: PMC11204534 DOI: 10.3390/jcm13123623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Raghib syndrome is a rare malformation complex consisting of the drainage of the left superior vena cava (LSVC) into the left atrium, ostial atresia of the coronary sinus and an atrial septal defect (ASD). Case Report: This report aims to present the case of a child newly diagnosed with Raghib syndrome, complicated by pulmonary arterial hypertension, and to review previously published cases with the same diagnosis. A six-year-old female patient presented with signs and symptoms of heart failure (Ross III), reduced exercise tolerance and severe delay in stature and ponderal development. The imagistic work-up included echocardiography, followed by computer tomography (CT) and magnetic resonance imaging (MRI), through which a diagnosis of Raghib syndrome was established, complicated by pulmonary hypertension. As in other cases presented in the literature, MRI allowed for an accurate diagnosis, detecting the absent coronary sinus. The decision regarding the surgical closure of the ASD was made, with the patient having a favorable clinical evolution but with the persistence of elevated pulmonary artery pressure, for which Sildenafil therapy was instituted. Conclusions: The malformation complex consisting of an atrial septal defect, ostium atresia of the coronary sinus, uncovered coronary sinus, and persistent left superior vena cava, as identified through multiple imagistic investigations, was suggestive of the rare diagnosis of Raghib syndrome in this case. Among the limited number of cases of Raghib syndrome available in the literature, the present case is distinguished by the severity of the pulmonary artery hypertension at a very young age and in the absence of other concurrent cardiac malformations.
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Affiliation(s)
- Liliana Gozar
- Department of Pediatrics 3, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania; (L.G.); (D.T.)
- Pediatric Cardiology Clinic, Emergency Institute for Cardiovascular Diseases and Transplantation, Gheorghe Marinescu Street No. 50, 540136 Târgu Mureș, Romania;
| | - Maria Oana Săsăran
- Department of Pediatrics 3, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania; (L.G.); (D.T.)
| | - Marius Cătălin Cosma
- Pediatric Cardiology Clinic, Emergency Institute for Cardiovascular Diseases and Transplantation, Gheorghe Marinescu Street No. 50, 540136 Târgu Mureș, Romania;
| | - Daniela Toma
- Department of Pediatrics 3, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania; (L.G.); (D.T.)
- Pediatric Cardiology Clinic, Emergency Institute for Cardiovascular Diseases and Transplantation, Gheorghe Marinescu Street No. 50, 540136 Târgu Mureș, Romania;
| | - Andreea Georgiana Nan
- First Department of Psychiatry, Clinical County Hospital Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania;
| | - Horea Gozar
- Department of Pediatric Surgery, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Gheorghe Marinescu Street No. 38, 540136 Târgu Mureș, Romania;
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Sleiay M, Sleiay B, Batrash O, Alabdullah H, Alsmoudi H, AlBaroudi D, Almohamed A, Ali Abshi M, Takkem S. A 4-month-old male with Raghib syndrome: a rare case report from Syria. Ann Med Surg (Lond) 2024; 86:1687-1690. [PMID: 38463122 PMCID: PMC10923301 DOI: 10.1097/ms9.0000000000001693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/27/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Raghib syndrome is a rare congenital complication consisting of the termination of the left superior vena cava (LSVC) in the left atrium, an unroofed coronary sinus, and an atrial septal defect most often found in the posterior-inferior angle of the atrial septum. Both a right-to-left and a left-to-right intracardiac shunt exist. In most circumstances, they do not show any symptoms. Presentation of case The patient presented with a persistent left superior vena cava draining into the left atrium, an unroofed coronary sinus, and a secondary atrial septal defect (ASD). Transthoracic echocardiography was used to diagnose the condition, and surgery was applied as the primary treatment. Clinical discussion It was formerly believed that this complex was exclusive to Raghib syndrome; however, cases have been found in which the interatrial connection is the aperture of the unroofed coronary sinus in patients with a normal atrial septum. Conclusion Extracardiac treatment for this illness reduces the load on the left atrial suture and may stop further arrhythmias. There is no possibility of pulmonary vein flow restriction when there are no atrial tunnels.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Saleh Takkem
- Department of Cardiology, Alwatani Hospital, Hama, Syria
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Sankhyan LK, Anderson RH, Chowdhury UK, George N, Pradeep D, Vaswani P, Pandey NN, Arvind B. Surgical management of divided atrial chambers. J Card Surg 2021; 36:4267-4279. [PMID: 34392568 DOI: 10.1111/jocs.15896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM The morphological variations when one, or both, of the atrial chambers is subdivided, are many and varied. We sought to address clinical presentations, potentially misdiagnosed cases, diagnostic modalities, surgical approaches, and outcomes of this "family" of uncommon lesions. METHODS A total of 193 published investigations were synthesized. Diagnostic information was provided by clinical presentation, and multimodality imaging studies. RESULTS Almost three-quarters of patients with divided atrial chambers present during infancy with severe pulmonary hypertension and cardiac failure. Associated cardiac and extra-cardiac defects are present in between half and nine-tenths of cases. Acquired division of the left atrium has been reported after the Fontan operation, orthotopic cardiac transplantation, and complicated aortic valvar infective endocarditis. Surgery under cardiopulmonary bypass remains the definitive treatment. Balloon dilation may be considered in anatomically compatible variants in the setting of cardiac failure and pregnancy as a bridge todefinitive treatment. Overall, mortality has been cited between nil to 29%. Presentation during infancy, associated congenital anomalies, pulmonary hypertension, and surgery in the previous era, have been the reported causes of death. The operative survivors have long-term favourable outcomes, with near normal cardiac dimensions and low risk of recurrence. While asymptomatic patients with division of the right atrium do not need treatment, surgical resection of the dividing partition under cardiopulmonary bypass is recommended in symptomatic patients with complex anatomy, the spinnaker malformation, or associated cardiac anomalies. Balloon dilation may be considered in uncomplicated patients with less obstructive lesions. Hybrid intervention and endoscopic robotic correction also have been performed. CONCLUSIONS Resection of the dividing shelf allows the survivors to regain near normal dimensions with a low risk of recurrence. We submit that an increased appreciation of the anatomic background to division of the atrial chambers will contribute to improved surgical management.
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Affiliation(s)
- Lakshmi K Sankhyan
- Cardiothoracic Centre, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ujjwal K Chowdhury
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niwin George
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Doniparthi Pradeep
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Vaswani
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Kumar B, Kodliwadmath A, Upadhyay AN, Singh A, Darbari A, Nanda N. Cor triatriatum with supramitral ring: "cor tetratriatum", associated with Raghib syndrome with Eisenmenger syndrome: multimodality imaging approach in this exceedingly rare case report. Egypt Heart J 2021; 73:66. [PMID: 34273027 PMCID: PMC8286211 DOI: 10.1186/s43044-021-00183-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cor triatriatum and supramitral ring are congenital anomalies which result in formation of three chambers of atria. To the best of our knowledge, simultaneous presence of both entities in the same patient resulting in the formation of four chambers of atria has not been described in the literature. Here, we report a case of simultaneous presence of cor triatriatum and supramitral ring associated with Raghib syndrome and Eisenmenger syndrome. Case presentation We report the case of a middle-aged gentleman, who presented to us with features of atrial septal defect with Eisenmenger syndrome. Multimodality imaging confirmed the simultaneous presence of supramital ring and cor triatriatum resulting in “cor tetratriatum” along with Raghib syndrome. Presence of Eisenmenger syndrome compelled us to offer medical therapy for the patient. Conclusion This is the first case report describing the simultaneous presence of supramitral ring and cor triatriatum resulting in a new entity—“cor tetratriatum”. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00183-4.
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Affiliation(s)
- Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Virbhadra road, Rishikesh, Uttarakhand, 249203, India.,Department of Cardiology, PGIMER, Dr Ram Manohar Lohia Hospital, Delhi, India
| | - Ashwin Kodliwadmath
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Virbhadra road, Rishikesh, Uttarakhand, 249203, India.
| | | | - Anupam Singh
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Anshuman Darbari
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - N Nanda
- Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Cor triatriatum with Raghib complex in partial atrioventricular septal defect and common atrium: a rare combination. Gen Thorac Cardiovasc Surg 2019; 68:641-643. [PMID: 31250204 DOI: 10.1007/s11748-019-01159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
Persistent left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect (Raghib complex) is an uncommon anomaly of systemic venous drainage. We present a unique case of simultaneous presentation of cor triatriatum and persistent left superior vena cava draining into the left atrium in an adult female with partial AV canal and common atrium. Complex intra-atrial baffling including a procedure to redirect flow from a proximal atrial chamber was successful.
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Ak K, Hamidov A, Ileri C, Tigen K, Isbir S, Arsan S. Correction of cortriatriatum sinister with classical Raghib's complex using an extracardiac conduit. J Card Surg 2017; 32:729-731. [PMID: 29205510 DOI: 10.1111/jocs.13240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a 32-year-old patient with cortriatriatum sinister with Raghib's complex (a left persistent superior vena cava draining into the left atrium with an absent coronary sinus and an atrial septal defect [ASD]) who underwent successful surgical correction with excision of the cortriatriatum, closure of the ASD, and establishing the drainage of the persistent left superior vena cava to the right atrium via interposition of an extracardiac 13-mm ringed polytetrafluoroethylene conduit.
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Affiliation(s)
- Koray Ak
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Anar Hamidov
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ciğdem Ileri
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kursat Tigen
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Selim Isbir
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Sinan Arsan
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
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