SH: Multidisciplinary collaboration between Baptist Health Heart & Vascular Care and Nicklaus Children’s Hospital enables minimally invasive treatment of late-presenting cor triatriatum

Carlos Perez noticed something was terribly wrong when his field of vision began to narrow. At 73 years-old, the father, grandfather and longtime car-repair shop owner in South Miami, started feeling an irregular, heavy heartbeat.

These sudden episodes of atrial fibrillation, commonly known as AFib, forced him to visit the emergency room. He assumed the irregular rhythm was a standard age-related issue. Instead, physicians uncovered a very rare congenital heart condition that Mr. Perez had unknowingly lived with his entire life.

He had effectively a five-chambered heart – instead of the normal four chambers. The official medical term for this condition is “cor triatriatum.”

It is a rare congenital defect where a thin membrane divides one of the upper chambers of the heart into two separate compartments. This effectively creates a third atrium. Finding this condition in a man in his seventies is extremely rare, but such occurrences are expected to increase along with the size of the elderly population.

Because of the congenital nature of his condition, this surprising diagnosis led to a first collaboration between Baptist Health Heart & Vascular Care and the Nicklaus Children’s Hospital Heart Institute.

The discovery surprised even the medical staff at Baptist Health. Mr. Perez noted this in the examination room when his echocardiogram results appeared on the screen. "They started doing the echocardiogram, and all of a sudden two more doctors come in the room. And then five medical students — and they said: ‘Well … we read about it, but we've never seen one.’ "

Discovering a Lifelong Medical Mystery

Most people diagnosed with congenital heart defects find out during infancy or early childhood. Mr. Perez lived a full, active life without any symptoms for more than seven decades. He graduated from the University of Florida College of Law, practiced law, and eventually opened an auto repair shop next to South Miami Hospital, running it for 40 years. He raised three children and now enjoys spending time with his six grandchildren.

His heart condition remained “hidden” because the dividing membrane in his heart was unobstructive for most of his life. Blood could still flow through. However, as he aged, the tissue became calcified and narrow. His heart had to work harder to pump blood, which eventually triggered the AFib episodes.

"In September, I had another episode, and I think this time they did a few more tests, and the doctors reminded me that I have a five-chambered heart," Mr. Perez recalled. "Apparently, under normal conditions at rest, it wasn't giving me a problem. But if I strained to any extent or overheated or whatever, it would start interfering with the blood flow and causing the problems. So, they did a number of tests and the doctors here at Baptist Health recommended the surgical procedure."

Tom C. Nguyen, M.D., FACS, FACC, chief medical executive of Baptist Health Heart & Vascular Care, director of Minimally Invasive Surgery, and Barry T. Katzen Endowed Chair at Miami Cardiac & Vascular Institute, explained the mechanics of the condition using a simple housing analogy.

“He had almost five chambers. An example would be that you have a master bedroom, but suddenly someone puts a wall through it," said Dr. Nguyen, who is also professor and chair of the Department of Cardiovascular Sciences at Florida International University Herbert Wertheim College of Medicine.

"Now, it’s not one room, but two rooms. To get from one part to the other, you have to go through a little door. Sometimes that door is really big and it’s not an issue. But sometimes it’s so small that people can’t get through. That’s what happened with our patient.”

Because the "door" in Carlos's heart became too narrow, blood could not easily travel across the left atrium to the rest of the body. Without intervention, his heart would eventually fail.

To provide Mr. Perez with the best possible outcome, medical professionals from two leading institutions joined forces. Dr. Nguyen and Makoto Hashimoto, M.D., cardiac surgeon at Baptist Health Miami Cardiac & Vascular Institute, and professor and director of robotic cardiac surgery at Florida International University Herbert Wertheim College of Medicine, teamed up with David Kalfa, M.D., chief of Cardiovascular Surgery, co-director of the Nicklaus Children's Hospital Heart Institute, and professor of surgery and pediatrics at Florida International University Herbert Wertheim College of Medicine.

“Diagnosing a congenital heart defect depends on its severity,” explains Dr. Kalfa. “For the most severe malformations, many of these are actually diagnosed before birth, during the prenatal life. For less severe malformations, they can be diagnosed after birth — a few years or even a few decades later.”

Dr. Hashimoto explains that robotic heart surgery, such as the procedure undergone by Mr. Perez, offers critical advantages of minimal invasiveness.

“We can do many types of procedures through a small incision and the wound healing is better than the conventional heart surgery,” explains Dr. Hashimoto.”The biggest advantage of robotic surgery is doing a very precise operation. We can do really clean surgery to treat the heart.” 

More than 140 robotic cardiac surgeries have been performed at Baptist Health Miami Cardiac & Vascular Institute since the program’s launch in January 2025. 

First Cardiac Collaboration with Nicklaus Children’s Hospital Heart Institute

Treating a 73-year-old patient with a pediatric heart condition requires a unique blend of expertise. Pediatric cardiologists understand the anatomy of congenital defects extensively, while adult cardiothoracic surgeons specialize in operating on older bodies that may have calcified tissues and other age-related factors.

“Because this congenital heart condition is so rare, Dr. Kalfa gave us valuable insights before and during the surgery,” said Dr. Hashimoto.

This marked the first collaboration of its kind between Baptist Health and Nicklaus Children’s.

“The process of him finding out, I think, is where the magic happens," Dr. Nguyen said. "It's a collaboration between Nicklaus Children’s, where this is a condition that usually happens in children, and our hospital, where we're very comfortable operating on 70-year-olds and 80-year-olds.”

Bringing together specialists from different disciplines ensures a comprehensive approach to complex medical puzzles. Dr. Nguyen emphasized that this partnership allows them to treat conditions that develop during youth — but only cause severe issues during adulthood.

“We know what we're really good at, and we know there are things that other groups might be better at or other specialists might have a different perspective," Dr. Nguyen added. "By bringing different people to the table with their respective expertise, it ultimately leads to the best patient care.”

The Precision of Robotic Heart Surgery

When facing heart surgery, many patients picture a long, painful procedure involving a cracked sternum and months of difficult rehabilitation. The surgical team wanted to spare Mr. Perez from that traditional approach. Because Baptist Health runs one of the largest robotic heart surgery programs in the country, they knew they could offer a minimally invasive alternative.

“This easily could have been done the traditional way by cracking the chest and going through the front of the sternum," Dr. Nguyen said. "But we wanted to make sure that Mr. Perez could get the fastest recovery, the smallest incision, to get back to doing the things he enjoys, like traveling."

On January 7, at Baptist Health South Miami hospital, the team used an advanced robotic surgical system to repair his heart. Instead of opening his chest, surgeons made tiny incisions on his side. They inserted miniature robotic arms and a high-definition camera to access the heart. The surgeons controlled these precise instruments from a console in the operating room.

“The biggest benefit of using the robot is the accuracy or preciseness,” explains Dr. Hashimoto. “It's because we can see the magnified clear field of view during the surgery. And we can use a very precise instrument during the surgery, and it makes us do a very precise and accurate operation.”

Mr. Perez: ‘It's Still Science Fiction to Me’

"They go in from the side, and it's still science fiction to me. But four miniature robot arms go in there; a camera goes in there; another gizmo goes in there," Mr. Perez said. "I mean, obviously I didn’t feel a thing."

He also expressed amazement at the imaging technology used to map his heart before and during the procedure. "I was surprised at what they can do. I mean, I saw the blood flow diagrams. They did it with contrast, and I’m looking at a live video of blood flowing through, which is like, wow. How do they do this?"

During the operation, the surgical team achieved three major goals simultaneously. They successfully removed the obstructive membrane dividing his atrium. They performed cryogenic ablations—using extreme cold to destroy the tissue causing his irregular heartbeats. Finally, they placed a specialized clip to help regulate his heart function.

"They got rid of the membrane, they did the ablations — cryogenic ablations — and they put in a clip," Mr. Perez noted. "So, three things in one deal. I have not experienced any more AFib."

A Smooth Recovery and Return to Normalcy

Because the surgery was minimally invasive, Mr. Perez experienced a remarkably fast recovery for a 73-year-old undergoing major heart repair. He spent only six days in the hospital before returning home.

While the first few days required some careful movements, he quickly regained his strength. "I woke up a little tight and, you know, hug your pillow before you cough, you know," Mr. Perez joked. "But I would say recovery went very well."

Today, Mr. Perez reports feeling normal again. His energy levels have improved significantly, and the terrifying symptoms of his AFib have completely vanished. He no longer experiences the narrow vision or the heavy, irregular heartbeats that initially sent him to the emergency room.

He recently put his repaired heart to the test during a family trip.

"Week ago, I went to Houston to see my cousins and did the strong walking tour of the missions in the Alamo and all that," he shared. "Felt great. I mean, never had any problems."

Beyond traveling, Mr. Perez looks forward to spending more time with his grandchildren and getting back to his favorite hobby: restoring classic BMWs. He credits the medical team's dedication and innovative spirit for his renewed lease on life.

"I’m very grateful for their work and their interest in the field," Mr. Perez said. "I mean, I think they have to do it out of an internal drive, curiosity, and a desire to explore the boundaries."

Setting a New Standard of Care

This surgery represents a milestone in cardiac care. It proves that advanced robotics can safely correct rare, complex congenital defects even in older adults. Furthermore, it highlights the vital value of cross-institutional medical teamwork.

“As a medical executive for Baptist Health Heart & Vascular Care, it's really special for me personally because we're at a point where all the stars are aligning," Dr. Nguyen reflected. "We're collaborating with a world-class children's hospital, Nicklaus Children’s, partnering with our world-class center, and doing things that no other program does across the country, like robotic heart surgery on adult congenital heart patients.”

Dr. Nguyen hopes this successful case is just the first of many collaborative efforts between the two hospitals, paving the way for more adults with congenital heart defects to receive cutting-edge, minimally invasive care.

Dr. Kalfa, of Nicklaus Children’s Hospital agrees and points out that there are more adults like Mr. Perez with treated congenital heart defects than children because of increased advances in pediatric heart surgery.

“Now, in the United States, the number of adults with congenital heart malformations is actually larger than the number of children,” Dr. Kalfa said. “That’s because over the last two or three decades, there has been such major progress — in terms of techniques, survival and outcomes after pediatric open-heart surgery — that all these children now are able to thrive into adulthood with repaired malformations.”