Title of article :
When an Elongated Eustachian Valve Resembled a Chimney
Author/Authors :
Yaminisharif, Ahmad Department of Cardiology - Tehran Heart Center - Tehran University of Medical Sciences - North Karegar Street - Tehran, Iran , Hosseinsabet, Ali Department of Cardiology - Tehran Heart Center - Tehran University of Medical Sciences - North Karegar Street - Tehran, Iran
Abstract :
A 65-year-old woman presented to our outpatient
arrhythmia clinic with a complaint of palpitation. She
had a history of surgical atrial septal defect closure many
years earlier. Electrocardiography showed atrial flutter. She
had consumed warfarin for several months. We decided to
ablate this arrhythmia. Transthoracic echocardiography
demonstrated a normal left ventricular size, mild left
ventricular systolic dysfunction (ejection fraction=45%),
right ventricular enlargement with mild systolic dysfunction,
mild left and severe right atrial enlargement with severe
tricuspid regurgitation, and an estimated systolic pulmonary
pressure of 35 mmHg. Additionally, an elongated Eustachian
valve (21 mm) was noted in the subcostal view (Figure 1). In
the electrophysiology laboratory, no electrical activity was
recorded when the ablating catheter was moved from the
inferior vena cava up to the mid right atrium. Consequently,
we injected a contrast medium into the inferior vena cava–
right atrium in order to better visualize the inferior vena
cava and the right atrial anatomy in the anterior-posterior
projection. A volcano-like inferior vena cava was illustrated,
extending to the mid right atrium because of the elongated
Eustachian valve (Figure 2). Electrophysiology study
revealed isthmus-dependent lower loop atrial flutter, which
was successfully ablated.
Keywords :
Elongated Eustachian Valve Resembled , Chimney
Journal title :
The Journal of Tehran University Heart Center (JTHC)