Dhanjal, Tarvinder S.

Kakar, Puneet

Srivastava, Samir

Watson, Timothy

English

Via Medica Journals

IMAGES IN CARDIOLOGYCardiology Journal2007, Vol. 14, No. 5, pp. 508–509Copyright © 2007 Via MedicaISSN 1897–5593508 www.cardiologyjournal.orgAddress for correspondence: Dr. Timothy WatsonCity Hospital, Birmingham, United Kingdom B18 7QHTel: +44(0) 121 507 5080, fax: +44(0) 121 507 5774e-mail: timothy.watson@swbh.nhs.ukEustachian valve remnantTimothy Watson, Puneet Kakar, Samir Srivastava and Tarvinder S. DhanjalUniversity Department of Medicine, City Hospital, Birmingham, United KingdomThe eustachian valve exists in the superiorportion of the inferior vena cava (IVC) during fetallife [1, 2]. The valve directs blood from the IVC to-wards the foramen ovale and away from the tricus-pid valve, thereby bypassing the (still immature)pulmonary circulation. Postnatally, following clo-sure of the foramen ovale, the eustachian valve hasno specific function and therefore tends to regressand is usually absent by adulthood.A eustachian valve remnant, if present, is usu-ally noted by the presence of a thin ridge ora crescenteric fold of endocardium arising from theanterior rim of the IVC orifice. The lateral horn ofthe crescent tends to meet the lower end of the cristaterminalis, while the medial horn joins the thebesianvalve, a semicircular valvular fold at the orifice of thecoronary sinus. Alternatively, the remnant mayappear as a mobile, elongated structure projectingseveral centimeters into the right atrial cavity.Here we show transesophageal images ofa large valve remnant in a young adult male. Theremnant has no pathophysiologic effects and needsno intervention. Such a large eustachian valveshould be differentiated from a Chiari network rem-nant and cor triatriatum dexter, since the latter re-quires surgical correction. It is also important toexclude right atrial tumors, thrombi or vegetations,each of which may also require treatment.Figure 1. Bicaval trans-oesophageal view showing the Eustachian valve remnant (EV). Additional structures markedare left atrium (LA), right atrium (RA), and intra-atrial septum (IAS).509Timothy Watson et al., Eustachian valve remnantwww.cardiologyjournal.orgPersistent eustachian valves without other sig-nificant structural heart disease usually require notreatment. Endocarditis and thrombus formationover the eustachian valve are extremely rare com-plications [3–6], and therefore antibiotic prophylaxisis not always necessary.References1. D’Cruz IA. Echocardiographic anatomy: understand-ing normal and abnormal echocardiograms. 1st ed.Appleton & Lange, Stamford (CT) 1996: 114–115.2. Otto CM (ed.) The practice of clinical echocardiogra-phy. 1st ed. W.B. Saunders, Philadelphia 1997: 668.3. Bowers J, Krimsky W, Gradon JD. The pitfalls oftransthoracic echocardiography. A case of eustachi-an valve endocarditis. Tex Heart Inst J, 2001; 28:57–59.4. Palakodeti V, Keen WD Jr., Rickman LS, Blanchard DG.Eustachian valve endocarditis: detection with multi-plane transesophageal echocardiography. Clin Cardiol,1997; 20: 579–580.5. Punzo F, Guarini P, De Michele M et al. Eustachianvalve endocarditis in an elderly woman. Echocardio-graphy 1999; 16: 259–261.6. Jolly N, Kaul UA, Khalilullah M. Right atrial throm-bus over eustachian valve — successful lysis withstreptokinase. Int J Cardiol, 1991; 30: 354–356.

Eustachian valve remnant

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Eustachian valve remnant

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