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Al-Sabbagh MQ, Eswaradass P. The Covert Impact of Chiari Network and Eustachian Valves on Stroke: A Scoping Review and Meta-Analysis. Neurologist 2024; 29:188-193. [PMID: 37839085 DOI: 10.1097/nrl.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND The role of Chiari network (CN) and Eustachian valves (EVs) in cardioembolic strokes is still unclear. There is inconsistency in the literature regarding clinical approach to these lesions to reduce stroke risk. We aimed to describe clinical presentation, neuroimaging and cardioimaging features, as well as management approaches for CN and EV in stroke context. REVIEW SUMMARY A systemic search was carried out using PubMed and Web of Science following PRISMA guidelines, Supplemental Digital Content 1 ( http://links.lww.com/NRL/A123 ). We retrieved 4 case-control studies, 2 cross sectional studies as well 8 case reports, with a total of 883 patients with a mean age of 44.6 years (±13.8). The combined prevalence of EV/CN in stroke-related patent foramen ovale (PFO) patients was 50% (95% CI: 31-68). With isolated prevalence for EV and CN of 43% (95% CI: 25-63), 18% (95% CI: 12-25), respectively. Patients with history of stroke had higher prevalence of EV/CN compared with controls odds ratio=2.45 (95% CI: 1.2-5, P <0.01). All case-control and cross-sectional studies defined EV/CN by transesophageal echocardiography or intracardiac cardiography. In the 8 case reports, 7 cases were diagnosed by transesophageal echocardiography, while only 1 case was diagnosed postmortem. CONCLUSION EV/CN are relatively common findings in stroke patients with PFO. While it appears that presence of EV/CN with a PFO increases the risk of cardioembolic stroke, they remain underrecognized. EV/CN should be considered as high-risk PFO features. There is a scarcity of research emphasizing their role in clinical decision making, especially PFO closure and antithrombotic therapy choice.
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Ali H, Lupo P, Cristiano E, Nicolì L, Foresti S, De Ambroggi G, Anderson RH, De Lucia C, Turturiello D, Paganini EM, Bessi R, Farghaly AAA, Butera G, Cappato R. Chiari network for the interventional cardiologist: A hidden enemy at the heart gate - A systematic review of the literature. Int J Cardiol 2023; 375:23-28. [PMID: 36587656 DOI: 10.1016/j.ijcard.2022.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study aimed to collect and analyze the literature data regarding Chiari network (CN) and other right atrium (RA) remnants comprising the Eustachian and Thebesian valves (EV, ThV) as a potential entrapment site during different percutaneous cardiac procedures (PCP). METHODS AND RESULTS A systematic search was conducted using Pubmed and Embase databases following the PRISMA guidelines to obtain available data concerning PCP associated with entrapment of inserted materials within CN-EV-ThV. The final analysis included 41 patients who underwent PCP with reported material entrapment within these RA remnants. The PCP was atrial septal defect (ASD)/patent foramen ovale (PFO) closure, catheter ablation, and pacemaker/defibrillator implantation in 44%, 22%, and 17% of patients, respectively. The entrapped materials were ASD/PFO devices, multipolar electrophysiology catheters, passive-fixation pacing leads, and J-guidewires in about 30%, 20%, 15%, and 10% of patients, respectively. Intraprocedural transthoracic, transoesophageal and intracardiac echocardiography showed sensitivity to reveal these structures of 20%, ∼95%, and 100%, respectively. A percutaneous approach successfully managed 70% of patients, while cardiovascular surgery was required in 20% and three patients died (7.3%). CONCLUSIONS CN and other RA remnants may cause entrapment of various devices or catheters during PCP requiring right heart access. The percutaneous approach, guided by intraprocedural imaging, appears safe and effective in managing most patients. Prevention includes recognizing these anatomical structures at baseline cardiac imaging and intraprocedural precautions. Further studies are needed to analyze the actual incidence of this condition, its clinical impact and appropriate management.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Ernesto Cristiano
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Leoluca Nicolì
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Sara Foresti
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Carmine De Lucia
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Dario Turturiello
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Edoardo Maria Paganini
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Riccardo Bessi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Ahmad Abdelrady Abdelsalam Farghaly
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Cardiovascular Department, Assiut University, Assiut, Egypt
| | - Gianfranco Butera
- Department of Paediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambin Gesù Hospital and Research Institute, IRCCS, Rome, Italy; Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Chen PH, Liu YC, Dai ZK, Chen IC, Lo SH, Wu JR, Wu YH, Hsu JH. A Rare Complication During Transcatheter Closure of Double Atrial Septal Defects With Incomplete Cor Triatriatum Dexter: A Case Report. Front Cardiovasc Med 2022; 8:815312. [PMID: 35284495 PMCID: PMC8907262 DOI: 10.3389/fcvm.2021.815312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
The cor triatiatum dexter is an embryologic remnant derived from the right atrium and totally separate from the right atrium. An incomplete cor triatiatum dexter (iCTD) means a partially obstructive remnant at the right atrium. It is usually formed by a remnant of the Eustachian valve (EV), Thebesian valve (ThV), or Chiari network (CN). This anatomic variant is usually asymptomatic but is often associated with other heart abnormalities including atrial septal defects (ASDs), and has the potential to hamper percutaneous heart procedures such as electrophysiological study or ASD closure. Herein, we report a rare complication, transient heart ischemia, in transcatheter closure of double ASDs in a 55-year-old woman with EV. This rare complication was thought to be caused by coronary sinus obstruction during device placement. The ischemic change was resolved spontaneously after we withdrew the device. For a second attempt, we adjusted the position of the device to avoid coronary sinus obstruction under transesophageal echocardiogram guidance and the device was smoothly deployed in a good position with a minimal residual shunt. This case suggests that anatomy details in percutaneous heart procedures are important, and this rare and dangerous complication, heart ischemia, should be identified immediately during the procedure.
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Affiliation(s)
- Ping-Hong Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hsing Lo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Yen-Hsien Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- *Correspondence: Yen-Hsien Wu
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Jong-Hau Hsu
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Thrombus straddling a patent foramen ovale: Also a myocardial infarction matter? Int J Cardiol 2021; 340:24-25. [PMID: 34375708 DOI: 10.1016/j.ijcard.2021.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022]
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Onorato EM. Large eustachian valve fostering paradoxical thromboembolism: passive bystander or serial partner in crime? World J Cardiol 2021; 13:204-210. [PMID: 34367504 PMCID: PMC8326156 DOI: 10.4330/wjc.v13.i7.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/06/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023] Open
Abstract
Catheter-based closure of patent foramen ovale (PFO) is more effective than medical therapy in the prevention of recurrent stroke[1]. It is likely that a proportion of patients evaluated for potential transcatheter PFO closure has actually different anatomical variants particularly common in the right atrium such as eustachian valve, Chiari network, Thebesian valve and Crista Terminalis. Notably, the eustachian valve may represent an increased risk factor for left circulation thromboembolism beyond that associated with PFO size and shunting. Such patients may benefit the most from percutaneous closure procedure.
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Affiliation(s)
- Eustaquio Maria Onorato
- Invasive Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan 20138, Italy
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6
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Bruce L, Gunston G, Myburgh A, Keet K, Augoustides JG, Pulton DA, Thalappillil R, Rong LQ, Garner C, Fernando RJ. The Anatomy of the Eustachian Valve-Navigating the Implications for Right-Sided Surgical and Transcatheter Cardiac Interventions. J Cardiothorac Vasc Anesth 2020; 35:1215-1224. [PMID: 33455884 DOI: 10.1053/j.jvca.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Louren Bruce
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Geney Gunston
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Adriaan Myburgh
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Kerri Keet
- Division of Clinical Anatomy, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Danielle A Pulton
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Chandrika Garner
- Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston Salem, NC
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston Salem, NC
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Acar B, Ozeke O, Tak BT, Akdi A, Ekizler FA, Kafes H, Ocak K, Golbasi Z, Tufekcioglu O, Ilkay E. The importance of recognizing the prominent Eustachian valve in the evaluation of atrial septal defects before percutaneous or surgical closure. Indian Heart J 2017. [PMID: 28648433 PMCID: PMC5485441 DOI: 10.1016/j.ihj.2017.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Since some echocardiographic features play an important role in the assessment of the defect and safety of the procedure, the salient features of the anatomical variations seen in adults undergoing transcatheter device closure should be well known to prevent inadvertent adverse effect or complications. It has been reported that the valve of the inferior vena cava, Eustachian valve, could be mistaken as the atrial septum thus ending in a wrong diagnosis and causing inadvertent surgical or percutaneous closure of an Eustachian valve to interatrial septum. We present a concise article that brings out a practical issue encountered during device closure of atrial septal defects.
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Affiliation(s)
- Burak Acar
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ozcan Ozeke
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
| | - Bahar Tekin Tak
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ahmet Akdi
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Firdevs Aysenur Ekizler
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Habibe Kafes
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Kadir Ocak
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Omac Tufekcioglu
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Erdogan Ilkay
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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Abstract
Patent foramen ovale (PFO) is considered a risk factor for serious clinical syndromes, the most important of which is cryptogenic stroke in the setting of paradoxic embolism. The safety and feasibility of transcatheter PFO closure have been addressed in several studies; this procedure is performed worldwide with excellent results. Variations in the atrial septal configuration and PFO are frequent and have an impact on the technical aspects and success in transcatheter PFO closure. To minimize the rate of complications of percutaneous closure of PFO, patients must be carefully selected on the basis of morphology and location of the interatrial defect.
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Affiliation(s)
- Eustaquio Onorato
- Clinica Montevergine, Via M. Malzoni, 83013 Mercogliano (Av), Italy; Humanitas Gavazzeni, Bergamo, Italy.
| | - Francesco Casilli
- Emodinamica e Radiologia Cardiovascolare, Policlinico San Donato, Piazza Edmondo Malan-20097 San Donato Milanese, Milano, Italy
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9
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Taniguchi M, Akagi T. Real-time imaging for transcatheter closure of atrial septal defects. Interv Cardiol 2011. [DOI: 10.2217/ica.11.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jeong IS, Ahn BH, Kim SJ, Oh SG, Oh BS, Kim SH. Mid- to Long-term Results of Surgical Treatment of ASD in Patients over 60 Years Old. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2011; 44:137-41. [PMID: 22263140 PMCID: PMC3249289 DOI: 10.5090/kjtcs.2011.44.2.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/27/2010] [Accepted: 11/15/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older. MATERIALS AND METHODS We reviewed the clinical course of 57 patients (mean age: 63.54±5.59 years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was 6.8±4.5 years. RESULTS One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B. CONCLUSION Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.
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Affiliation(s)
- In-Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Korea
| | - Byoung-Hee Ahn
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Korea
| | - Soon-Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Korea
| | - Sang-Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Korea
| | - Bong-Suk Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Korea
| | - Sang-Hyung Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Korea
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Goel SS, Tuzcu EM, Shishehbor MH, de Oliveira EI, Borek PP, Krasuski RA, Rodriguez LL, Kapadia SR. Morphology of the patent foramen ovale in asymptomatic versus symptomatic (stroke or transient ischemic attack) patients. Am J Cardiol 2009; 103:124-9. [PMID: 19101242 DOI: 10.1016/j.amjcard.2008.08.036] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 08/19/2008] [Accepted: 08/19/2008] [Indexed: 12/14/2022]
Abstract
The clinical implications of patent foramen ovale (PFO) morphology are still debated. Quantitative analysis by transesophageal echocardiography (TEE) is helpful in characterizing PFO morphology. The aim of this study was to determine whether there were differences in the anatomy of PFOs on TEE in patients with and without recurrent cryptogenic stroke or transient ischemic attack. The results of TEE in 58 patients who had PFO closure for cryptogenic cerebrovascular accident (CVA) were compared with those in 58 consecutive asymptomatic patients with PFOs found incidentally on TEE. The data were analyzed for differences in PFO size (maximum separation of the septum primum and septum secundum), tunnel length (maximum overlap of the septum primum and septum secundum), the presence of atrial septal aneurysm (>11 mm mobility), the severity of shunting (mild, 3 to 9 microbubbles; moderate, 10 to 30 microbubbles; severe, >30 microbubbles), the prominence of the Eustachian valve; and the presence of Chiari's network. Patients with CVAs had larger PFOs (3.9 +/- 1.6 vs 2.9 +/- 1.4 mm, p <0.001), longer tunnels (14 +/- 6 vs 12 +/- 6 mm, p = 0.05), and a greater frequency of atrial septal aneurysm (45% vs 21%, p <0.005) compared with controls. They also had a greater proportion of large (>or=4 mm) PFOs (46% vs 17%, p <0.001), long (>or=1 cm) tunnels (78% vs 55%, p <0.01), and severe shunting (16% vs 5%, p <0.06). The frequencies of prominent Eustachian valves and Chiari's network were not significantly different. In conclusion, PFOs in patients with cryptogenic CVAs are larger, have longer tunnels, and are more frequently associated with atrial septal aneurysms. This information should be considered when evaluating patients with cryptogenic CVAs.
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Arenas Ramírez J, Fernandez Castro C, Otero Chouza M, Duplá Parugues B, Montes Sanchez R. Persistent and redundant eustachian valve simulating atrial tumor: prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:704-7. [PMID: 17523156 DOI: 10.1002/uog.3992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The eustachian valve, or valve of the inferior vena cava, is an embryogenic derivative of the right valve of the sinus venosus. Although it generally disappears during fetal life, its persistence may simulate symptoms of cardiac disease, particularly those associated with atrial tumors. We describe a case of prenatal diagnosis of a persistent, large and prominent eustachian valve with redundant tissue attached to the junction of the inferior vena cava and the right atrium. The neonate was asymptomatic and was healthy at 7 months of age at the time of writing. This is the first time that this finding has been diagnosed prenatally.
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Affiliation(s)
- J Arenas Ramírez
- Hospital Cabueñes, Obstetricia y Ginecología, Gijón, Asturias, Spain.
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Rigatelli G. Patent foramen ovale: the evident paradox between the apparently simple treatment and the really complex pathophysiology. J Cardiovasc Med (Hagerstown) 2007; 8:300-4. [PMID: 17413311 DOI: 10.2459/01.jcm.0000263497.99157.77] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The simplicity and high safety profile of the new generation family of devices, and in particular of the last generation of occluder device, has given impetus to the diffusion of patent foramen ovale (PFO) transcatheter closure, which appears to be very simple and safe. Paradoxically, the pathophysiology of PFO is all but simple and the fact that many details of PFO-mediated syndromes are not yet fully understood is taken as proof of improper PFO closure by skeptics. However, on careful in-depth analysis of this apparently straightforward operation, many potential problems can be found at different stages; from a technical point of view, nickel toxicity, the possibility of thrombus formation, presence of residual shunt, malpositioning, and erosions are still active and real problems, whereas the pathophysiology of right-to-left shunt, role of coagulation abnormalities, significance of atrial septal aneurysm and other sources of shunt remain unresolved issues. Multidisciplinary task forces with PFO-related syndromes surveillance programs and highly-skilled interventional cardiologists are likely to increase the effectiveness and safety of PFO management.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Department of Emergency-Urgency Medicine, Rovigo General Hospital, Rovigo, Italy.
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14
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Rigatelli G, Rigateli G, Cardaioli P, Braggion G, Aggio S, Giordan M, Magro B, Nascimben A, Favaro A, Roncon L, Rincon L. Transesophageal Echocardiography and Intracardiac Echocardiography Differently Predict Potential Technical Challenges or Failures of Interatrial Shunts Catheter-Based Closure. J Interv Cardiol 2007; 20:77-81. [PMID: 17300409 DOI: 10.1111/j.1540-8183.2007.00219.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We sought to prospectively assess the role of transesophageal (TEE) and intracardiac echocardiography (ICE) in detecting potential technical difficulties or failures in patients submitted to interatrial shunts percutaneous closure. We prospectively enrolled 46 consecutive patients (mean age 35+/-28, 8 years, 30 female) referred to our center for catheter-based closure of interatrial shunts. All patients were screened with TEE before the intervention. Patients who met the inclusion criteria underwent ICE study before the closure attempt (40 patients). TEE detected potential technical difficulties in 22.5% (9/40) patients, whereas ICE detected technical difficulties in 32.5% (13/40 patients). In patients with positive TEE/ICE the procedural success (92.4% versus 100% and, P = ns) and follow-up failure rate (7.7% versus 0%, P = ns) were similar to patients with negative TEE/ICE, whereas the fluoroscopy time (7 +/- 1.2 versus 5 +/- 0.7 minutes, P < 0.03), the procedural time (41 +/- 4.1 versus 30 +/- 8.2 minutes, P +/- 0.03), and technical difficulties rate (23.1% versus 0%, P = 0.013) were higher. Differences between ICE and TEE in the evaluation of rims, measurement of ASD or fossa ovalis, and detection of venous valve and embryonic septal membrane remnants impacted on technical challenges and on procedural and fluoroscopy times but did not influence the success rate and follow-up failure rate.
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Affiliation(s)
- Gianluca Rigatelli
- Rovigo General Hospital, Interventional Cardiology Unit, 18 Legnago, Verona, Italy.
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15
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Abstract
We report a patient with a snake-shaped, mobile mass in the right atrium. The mass was determined to be an elongated Eustachian valve which was a persistent part of the embryologic valve of the sinus venosus.
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Affiliation(s)
- Okan Gulel
- Department of Cardiology, Faculty of Medicine, 19 Mayis University, Samsun, Turkey
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Butera G, Montinaro A, Carminati M. The “pull–push” technique to deal with a redundant eustachian valve interfering with placement of a PFO occluder. Catheter Cardiovasc Interv 2006; 68:961-4. [PMID: 17086524 DOI: 10.1002/ccd.20903] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the role of a new technique to deal with a redundant Eustachian valve (EV) interfering with placement of a patent foramen ovale (PFO) occluder. BACKGROUND The EV is a remnant of the embryonic valve of the sinus venosus. In rare occasions, it is large and redundant and it may interfere with catheters and devices used in cardiac catheterization. METHODS We have developed a new technique to control the EV in order to avoid interferences with the device for closure of atrial septal defects and PFO's. This technique is called "pull-push" technique and consists in pulling down on the inferior vena cava the redundant EV by using a 6 Fr pigtail catheter while a second operator pushes the right atrial disc out of the long sheath. RESULTS Here, we report on two patients with a patent foramen ovale, in whom the EV prevented the right atrial disc of an Amplatzer PFO occluder to be completely flat against the interatrial septum. Finally, we used this technique in one more patient to avoid any interference of a very redundant EV during placement of a Starflex device. CONCLUSIONS In conclusion. the so called "pull-push" technique is an alternative and easy technique to control the EV in order to avoid interferences with the device for closure of atrial septal defects and PFO's
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Affiliation(s)
- Gianfranco Butera
- Pediatric Cardiology, Istituto Policlinico San Donato, San Donato Milanese, Italy.
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Muench A, Boccalandro F, Ellis K, Smalling RW. Approaches to correct device malposition in percutaneous PFO closure: Anatomical and technical implications. Catheter Cardiovasc Interv 2005; 64:338-44. [PMID: 15736258 DOI: 10.1002/ccd.20253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe three patients with initial failure of transcatheter patent foramen ovale closure. Two patients had residual defects successfully closed during the initial session, and one patient had a persistent shunt, which was corrected at a later time. Anatomical and technical considerations and the role of intracardiac ultrasound are discussed.
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Affiliation(s)
- Andreas Muench
- Division of Cardiology, University of Texas, Houston Medical School, Houston, TX 77030, USA
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Carlson KM, Johnston TA, Jones TK, Grifka RG. Amplatzer septal occluder closure of secundum atrial septal defects in the presence of persistent left superior vena cava to coronary sinus. Pediatr Cardiol 2004; 25:686-9. [PMID: 15054553 DOI: 10.1007/s00246-003-0658-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Secundum atrial septal defects (ASDs) are routinely closed using transcatheter devices. In patients with left superior vena cava (LSVC) draining to the coronary sinus (CS), the device must not obstruct CS drainage. We report five cases of successful ASD device closure without obstructing flow from the LSVC or dilated CS.
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Affiliation(s)
- K M Carlson
- Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC 19345-C, Houston, TX 77030, USA
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Earing MG, Cabalka AK, Seward JB, Bruce CJ, Reeder GS, Hagler DJ. Intracardiac echocardiographic guidance during transcatheter device closure of atrial septal defect and patent foramen ovale. Mayo Clin Proc 2004; 79:24-34. [PMID: 14708945 DOI: 10.4065/79.1.24] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe our experience with intracardiac echocardiographic (ICE) guidance during transcatheter device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) and to describe a detailed stepwise approach for performing ICE examinations. PATIENTS AND METHODS We reviewed the ICE results of all patients who underwent transcatheter device closure of ASD/PFO at the Mayo Clinic in Rochester, Minn, between October 2000 and November 2002. Conscious sedation was used, and all ICE studies were performed using a diagnostic ultrasound catheter. RESULTS Ninety-four patients (47 male; median age, 51 years [range, 17-81 years]) underwent ICE during transcatheter device closure of ASD/PFO. Total procedure time was 128 minutes (range, 27-320 minutes). ICE identified a previously unrecognized anatomical diagnosis in 32 of 94 patients. An additional ASD or PFO was found in 16 patients; a redundant atrial septum or an atrial septal aneurysm was found in 12 patients. There were few ICE complications (4%): 3 patients developed atrial fibrillation, and 1 developed supraventricular tachycardia; of these 4, 2 resolved spontaneously, and 2 required cardioversion with no recurrence. CONCLUSION ICE provides anatomical detail of ASD/PFO and cardiac structures facilitating congenital cardiac interventional procedures. ICE eliminates major drawbacks related to the use of transesophageal echocardiographic guidance for transcatheter device closure of ASD/PFO, specifically problems related to airway management. Finally, ICE gives the interventional cardiologist the ability to control all aspects of imaging without relying on additional echocardiographic support. We believe that ICE should be considered the preferred imaging technique for guidance of transcatheter device closure of ASD/PFO in adults and larger pediatric patients.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Atrial Fibrillation/etiology
- Balloon Occlusion/adverse effects
- Balloon Occlusion/methods
- Echocardiography, Doppler, Color
- Echocardiography, Doppler, Pulsed
- Echocardiography, Transesophageal/adverse effects
- Echocardiography, Transesophageal/methods
- Female
- Heart Aneurysm/diagnostic imaging
- Heart Aneurysm/therapy
- Heart Atria/diagnostic imaging
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/therapy
- Humans
- Male
- Middle Aged
- Tachycardia, Supraventricular/etiology
- Treatment Outcome
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Affiliation(s)
- Michael G Earing
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Khositseth A, Cabalka AK, Sweeney JP, Fortuin FD, Reeder GS, Connolly HM, Hagler DJ. Transcatheter Amplatzer device closure of atrial septal defect and patent foramen ovale in patients with presumed paradoxical embolism. Mayo Clin Proc 2004; 79:35-41. [PMID: 14708946 DOI: 10.4065/79.1.35] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review our experience with, and profile the safety and efficacy of, the Amplatzer PFO (patent foramen ovale) occluder (APO) and Amplatzer septal occluder (ASO) used to close PFO and/or atrial septal defect (ASD) in patients with paradoxical embolism (PE). PATIENTS AND METHODS Between April 1998 and November 2002, 103 patients at the Mayo Clinic in Rochester, Minn, and Scottsdale, Ariz, mean age 52.4 years, with presumed PE (transient ischemic attack [n=22], stroke [n=77], or peripheral emboli [n=4]) underwent transcatheter device closure of PFO (n=81), ASD (n=12), and ASD/PFO (n=10) with 106 devices (APO [n=22] or ASO [n=84]). RESULTS All devices deployed successfully, and no patients died. Procedural complications included atrial fibrillation (n=2), vessel injury (n=3), profound sinus node dysfunction (n=1), and device embolization with successful retrieval (n=1). At 3 months, 7 of 95 monitored patients had trivial residual shunt; at 12 months, 2 of 28 monitored patients had trivial residual shunt. Three patients had recurrent events--2 transient ischemic attacks and 1 retinal artery occlusion--at a mean +/- SD follow-up of 8.3 +/- 8.1 months (range, 1-34 months). None of these 3 patients had residual shunt or evidence of intracardiac thrombus. The average annual recurrence of all events was 3.6% at 23 months. The overall mean +/- SD freedom from recurrence of all events was 98.9% +/- 1.2% and 83.8% +/- 10.2% at 12 and 29 months of follow-up, respectively. CONCLUSIONS Transcatheter device closure of PFO and/or ASD with use of APO/ASO in patients with presumed PE is effective and safe. Recurrent events may occur in the absence of a residual shunt.
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Affiliation(s)
- Anant Khositseth
- Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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