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Trans-septal cardiac catheterisation
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Other important structures related to the fossa ovalis include the aortic knuckle (torus aorticus), which lies antero-superiorly, and the coronary sinus, which lies antero-inferiorly (Figure 30.1a). The Eustachian valve, which lies on the anterior rim of the inferior vena cava (IVC), helps direct pre-natal blood flow from the IVC towards the foramen ovale and away from the right ventricle. It may remain prominent into adult life. Its size and shape are variable, with some persisting as mobile structures that project into the RA.
Cardiac masses
Published in Andrew R. Houghton, MAKING SENSE of Echocardiography, 2013
The Eustachian valve is a membranous embryological remnant – its role in fetal life is to direct oxygenated blood towards the foramen ovale and away from the tricuspid valve. In adult life it is usually seen as a thin flap at the junction of the inferior vena cava with the RA. The size and mobility of the Eustachian valve is very variable between individuals, but this represents normal variation.
Fetal Circulation
Published in Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod, The Primary FRCA Structured Oral Examination Study Guide 1, 2017
Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod
How is preferential oxygenation to the major organs achieved?The pO2 in the umbilical vein is only ~4.7 kPa, representing saturations of 80–90%, and so the fetus is hypoxaemic when compared to the mother.Blood arriving in the right atrium from the inferior vena cava has saturations of ~60%, as it is composed of blood from the umbilical vein, mixed with deoxygenated blood returning from the body.The blood returning to the RA from the superior vena cava is even more deoxygenated, with sats of ~25%, because of the relatively high oxygen extraction of the brain. Clearly, it is sensible for this blood to be returned to the placental bed for re-oxygenation via as direct a route as possible, and certainly not to be re-introduced to the cerebral circulation. This is achieved by a structure called the Eustachian valve, a tissue flap found at the junction of the inferior vena cava and right atrium. It causes preferential ‘streaming’ of the more highly oxygenated inferior vena cava blood straight across the foramen ovale, to the left atrium to be expelled in to the aorta and therefore supply the brain. The less oxygenated blood of the superior vena cava ‘falls’ into the right ventricle to be distributed to the lungs and through the ductus arteriosus. This blood rejoins the aorta at a point distal to the origin of the carotids, therefore ensuring that the brain and heart are supplied with the most oxygen-rich blood.
High-Detailed evaluation of the right atrial anatomy by three-dimensional rotational angiography during ablation procedures for atrioventricular nodal reentrant tachycardia and atrial flutter
Published in Scandinavian Cardiovascular Journal, 2018
Christophe Garweg, Stijn De Buck, Bert Vandenberk, Rik Willems, Joris Ector
The CTI is a critical component of the AFl circuit. The ablation line is most commonly traced along the inferior isthmus located between the IVC and the posterior annulus of the tricuspid valve. However, a complete bi-directional block may be difficult to achieve because of the presence of a Eustachian valve creating a pouch-like recess difficult to access with the ablation catheter. Although autopsy series, conventional 2D angiography, and CT reveal the variant anatomy of the Eustachian valve, 3D transesophageal echocardiography, intracardiac echocardiography and 3DRA probably provide the most comprehensive anatomical views to assist the movement of the ablation catheter [8–11]. Our results confirm considerable individual variations of CTI morphology and size as previously reported [10,12]. 3DRA provided clear representation of the Eustachian valve anatomy as shown in Figure 1, Panel D.
Patent foramen ovale closure for secondary prevention of cryptogenic stroke
Published in Expert Review of Cardiovascular Therapy, 2021
Dhaval Kolte, Igor F. Palacios
The presence of a prominent Eustachian valve (EV) has been proposed as responsible for re-directing blood flow toward the septum, potentially allowing emboli to travel through the inter-atrial septum into the left atrium. Schuchlenz et al. [9] compared patients that had cryptogenic strokes with healthy volunteers. The authors found a significant higher incidence of PFO and Eustachian valve by TEE in those patients with cryptogenic stroke.
Eustachian valve endocarditis
Published in Baylor University Medical Center Proceedings, 2019
Jerry Fan, Phuong Tram N. Le, Billy Don Jones
The Eustachian valve is a “remnant of the valve of the right sinus venosus, also known as the valve of the inferior vena cava,” which rarely persists into adulthood.2–5 Eustachian valve endocarditis usually manifests in intravenous drug abusers or those with implanted medical devices or indwelling central venous catheters. Staphylococcus aureus is the causative organism in approximately 53% of cases.1–6