congenital heart defects / diseases contribute substantially to morbidity and mortality in childhood , especially in the third - world countries where facilities for management are often deficient.1 about 35,000 infants ( 1 out of every 125 ) are born with heart defects every year in the united states.2 the incidence in the tropics is not expected to differ from the 8 - 10 per 1000 live - births documented in the developed world.3 the defect may be so slight that the baby may be asymptomatic for many years after birth , or so severe that it is life threatening .
heart defects are the leading cause of birth defect - related deaths.4 however ; the use of echocardiography has improved description of congenital heart diseases and their early diagnosis.5 this , has led to dramatic increases in survival of children with serious heart defects .
cor triatriatum is a rare congenital cardiac anomaly , in which a fibromuscular membrane divides the atrium in two . it was first reported in 1868.6 cor triatriatum , a heart with 3 atria ( triatrial heart ) , is a congenital anomaly in which the left atrium ( cor triatriatum sinistrum ) or right atrium ( cor triatriatum dextrum ) is divided into 2 parts by a fold of tissue , a membrane , or a fibromuscular band.7 however , variable types of subtotal cor triatriatum are also noted , with only the right or left pulmonary veins draining into the upper chamber.8 cor triatriatum represents 0.1% of all congenital cardiac malformations and may be associated with other cardiac defects in as many as 50% of cases .
examples of associated cardiac defects include atrial septal defect , persistent left superior vena cava with an unroofed coronary sinus , partial anomalous pulmonary venous connection , ventricular septal defect and more complex cardiac lesions such as tetralogy of fallot , atrioventricular canal and double outlet right ventricle .
associated bicuspid pulmonary valve , aortic valve atresia and heterotaxy have also been described.9 congenital pulmonary vein stenosis is a very rare association with cor triatriatum.10 the morbidity and mortality of cor triatriatum sinistrum is high in those who are symptomatic in infancy .
this is due to the severely restrictive opening in the accessory membrane and the association with major cyanotic or acyanotic congenital heart lesions .
significant sequel is unusual with cor triatriatum dextrum as it is not commonly associated with life - threatening symptoms or major congenital cardiac defects .
a female baby seen on the second day of life was delivered by a 25-year - old primiparous youth corper .
the mother attended antenatal clinic in federal medical centre owerri from the 16 week of gestation .
however , during the 8 week of pregnancy , the mother had threatened abortion for which some drugs were given ( injections and tablets names unknown ) at a hospital in lagos
. she also had some liquid herbal preparation at 8 months of gestation ; other drugs she took were essentially haematinics .
she gave birth to a 3.6-kg baby girl who cried immediately after , and breastfeeding commenced .
the child was transferred to the special care baby unit from the postnatal ward on account of history of fever on day 2 of life .
examination revealed a full - term newborn , febrile ( 38.1 ) with a respiratory rate of 100 cycles per minute , acyanotic , heart rate of 110 beats / min heart
however , the child completed a course of antibiotics ( ampicillin  sulbactam and gentacin ) and , with clinical improvement , was discharged home . at follow - up at the 2 week of life ,
the child weighed 3.5 kg , heart rate was 130 beat / min and a grade 3 pansystolic murmur was heard , following which a chest radiograph and electrocardiograph ( ecg ) was requested . at 1 month of life , a review of ecg showed : heart rate : 128 beats / min , t-18 , which suggested supraventricular arrhythmia , abnormal right superior axis deviation .
murmur was still grade 3/6 , pansystolic maximal at the left - lower sternal edge .
echocardiograph was subsequently requested and the result showed that a 2d echocardiogram was done [ figure 1 ] with the following results : echocardiogram showing the distal chamber ( x ) and the left atrium ; the right atrium ( ra ) , left ventricle ( lv ) , and right ventricle ( rv ) separate left atrium with dividing membranous running in the direction of long axis of left atrium close to the lateral wall .
mitral valve draining the larger , more medial chamber , normal atrio - ventriculo - arterial connection .
high velocity turbulent flow in the main artery noted ( pa vmax = 335 cm / s pg = 45 mm ) .
secundum atrial septal defect [ figure 1 ] the child is presently being followed - up regularly . during her last visit , at 7 months of age
, she weighed 9.6 kg , length was 73 cm , occipito - frontal circumference was 47 cm and mid - upper - arm circumference was 15 cm ( all within normal for age ) .
cardiovascular examination revealed a child with heart rate of 120 beats / min , apex beat located at the 4 left intercostals space , with a grade 3/6 systolic murmur heard loudest at the upper left sternal edge .
the respiratory rate was 42 cycles / min and no organs palpably enlarged on digestive system examination .
this was the first case of a five - chambered heart seen and managed in the federal medical centre owerri .
the case demonstrates the need for comprehensive evaluation of patients and provision of cardiac investigative facilities ( x - ray , ecg and echocardiograph machines ) in health facilities . in our patient , it was an incidental finding at a routine follow - up clinic .
subsequent investigative evaluations led to the confirmation of the diagnosis of a five - chambered heart in a child who has remained asymptomatic .
the dearth of facilities in our hospital is obvious here , where the patient had to be referred to the university of nigeria teaching hospital enugu for echocardiograph .
clinical manifestations are often delayed due to the presence of a large opening ; and include an asymptomatic murmur .
finding is mostly incidental on routine cardiac imaging ; it therefore highlights the need for exhaustive evaluation and management because such conditions , although rare , can still be found here . in conclusion
, we reported a case of an asymptomatic congenital - heart defect a five - chambered heart - cor triatriatum , an extremely rare condition .
 five - chambered heart is extremely rare in children . 
 we report a case of asymptomatic five chamber heart detected in infancy . 
 the patient is 2-day - old and managed in a special care baby unit ( scbu ) for neonatal sepsis . during routine follow - up at the age of 1 month 
 , she was found to have an asymptomatic murmur . 
 echocardiograph reported five - chambered heart , concluding that it is cor triatriatum , supravalvular pulmonary stenosis and secundum atrial septal defect . 
 the child is still been followed - up and is still asymptomatic at 7 months . 
 five - chambered heart , although rare , can occur even if asymptomatic . 