E-page Original Images: Two-and three-dimensional echocardiographic views of a prominent Chiari network prolapsing into right ventricle

A 20-year-old male patient with no medical history was admitted to our cardiology clinic for atypical chest pain. Physical examination was normal. Heart rate and blood pressure were 90bpm and 120/85 mmHg respectively. Electrocardiography (ECG) showed sinus rhythm with a normal axis. The chest X-ray was unremarkable. Two-dimensional (2D) and real-time 3-dimensional (3D) transthoracic echocardiography (TTE) revealed a very mobile (characterized by whip-like motion), thin, filamentous structure in the right atrium (Chiari network) prolapsing into right ventricle through the tricuspid orifice during diastole (Fig.1, 2, Video 1-5. See corresponding video/movie images at www.anakarder.com). Other echocardiographic findings were normal. After injection of agitated saline into an upper extremity vein was not detected right-to-left shunt by transthoracic contrast echocardiography. Therefore, we recommended echocardiographic follow-up to the patient.