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Lang RM, Cameli M, Sade LE, Faletra FF, Fortuni F, Rossi A, Soulat-Dufour L. Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging 2022; 23:867-884. [PMID: 35079782 DOI: 10.1093/ehjci/jeac011] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.
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Affiliation(s)
- Roberto M Lang
- Heart and Vascular Center, University of Chicago, 5758 S Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Leila E Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Cardiology, University of Baskent, Ankara, Turkey
| | | | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Zurich, Switzerland
| | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, Pr Ariel Cohen, Sorbonne Université, INSERM, Unité de recherche sur les maladies cardiovasculaires, le métabolisme et la nutrition, ICAN, Paris F-75013, France
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Rojas-Díaz EL, Vásquez-Gómez OI, Amaya-Zuñiga WF. Chiari network diagnosis intraoperative based on echocardiography. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:542-544. [PMID: 34743906 DOI: 10.1016/j.redare.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/10/2020] [Indexed: 06/13/2023]
Abstract
We report a case of a Chiari network as a possible cause of intraoperative supraventricular tachycardia with potential cardiac flow obstruction and hemodynamic collapse. The intraoperative diagnostic analysis considered detects cardiac abnormalities associated to this congenital remnant and discard common intraoperative causes of hemodynamic alterations.
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Affiliation(s)
- E L Rojas-Díaz
- Servicio de Medicina Crítica y Cuidado Intensivo, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | - O I Vásquez-Gómez
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - W F Amaya-Zuñiga
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Universidad de los Andes, Universidad el Bosque, Bogotá, Colombia
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3
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Rojas-Díaz EL, Vásquez-Gómez OI, Amaya-Zuñiga WF. Chiari network diagnosis intraoperative based on echocardiography. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:S0034-9356(20)30258-9. [PMID: 33845991 DOI: 10.1016/j.redar.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 06/12/2023]
Abstract
We report a case of a Chiari network as a possible cause of intraoperative supraventricular tachycardia with potential cardiac flow obstruction and hemodynamic collapse. The intraoperative diagnostic analysis considered detects cardiac abnormalities associated to this congenital remnant and discard common intraoperative causes of hemodynamic alterations.
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Affiliation(s)
- E L Rojas-Díaz
- Servicio de Medicina Crítica y Cuidado Intensivo, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | - O I Vásquez-Gómez
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - W F Amaya-Zuñiga
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Universidad de los Andes, Universidad el Bosque, Bogotá, Colombia
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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: 0.5] [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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5
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Pagel PS, Telles-Hernandez L, Miller R, Hill GED, Almassi GH. Selective Partial Obstruction of Inferior Vena Cava Blood Flow During Diastole: Cor Triatriatum Dexter, Large Eustachian Valve, or Chiari Network? J Cardiothorac Vasc Anesth 2018; 33:575-578. [PMID: 30174263 DOI: 10.1053/j.jvca.2018.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Luis Telles-Hernandez
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Rebecca Miller
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Graham E D Hill
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Negi SL, Damodaran S, Thingnam S, Gourav KP, Aspari A. Transesophageal Echocardiography Guided Novel Technique for the Negotiation of Dual Stage Cavo-atrial Cannula into Inferior Vena Cava in a Patient with Large Eustachian Valve: A Case Report. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10034-1091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bennett JM, Nikolla I, Hernandez A. Deployment of a Sapien 3 Transcatheter Valve for Severe Tricuspid Insufficiency in a Patient With Non-obstructive Cor Triatriatum Dexter. J Cardiothorac Vasc Anesth 2017; 32:423-428. [PMID: 29203295 DOI: 10.1053/j.jvca.2017.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremy M Bennett
- Division of Cardiovascular Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
| | - Irida Nikolla
- Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Antonio Hernandez
- Division of Cardiovascular Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
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Raut MS, Maheshwari A, Shad S. Know the Guard of Coronary Sinus Before Cannulation. J Cardiothorac Vasc Anesth 2016; 30:e60-e61. [PMID: 27554228 DOI: 10.1053/j.jvca.2016.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Monish S Raut
- Departments of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Maheshwari
- Departments of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Sujay Shad
- Departments of Cardiac Surgery, Dharam Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
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Raut MS, Maheshwari A, Joshi S. Knowing the Thebesian Valve by the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2016; 30:e20. [DOI: 10.1053/j.jvca.2015.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Indexed: 11/11/2022]
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Yoshimura M, Toriumi T. Guidewire Entrapment in the Chiari Network. J Cardiothorac Vasc Anesth 2016; 30:e24-5. [DOI: 10.1053/j.jvca.2015.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Indexed: 11/11/2022]
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Klimek-Piotrowska W, Hołda MK, Koziej M, Strona M. Anatomical barriers in the right atrium to the coronary sinus cannulation. PeerJ 2016; 3:e1548. [PMID: 26823994 PMCID: PMC4731008 DOI: 10.7717/peerj.1548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background. The coronary venous system is an increasingly frequent target of minimally invasive cardiac procedures. The purpose of this paper is to assess the anatomical barriers in the right atrium to coronary sinus cannulation. Methods. We examined the anatomy of the right atrium, coronary sinus ostium, inferior and superior vena cava ostia in 110 randomly selected autopsied human hearts of both sexes (27% females; mean age 49.2 ± 17.5 years). Results. The Eustachian valve was present in 79 cases (71.8%) with mean height =4.9 ± 2.6 mm. The valve was perforated in 11 cases (13.9%). It is typically too small to hinder the coronary sinus catheterization, but in some cases (about 2%) a significantly protruding valve may be an obstacle. Chiari’s network (4.6%) is not a barrier to catheter entry into the right atrium but may significantly impede further catheter manipulations inside the heart venous system. A typical Thebesian valve leaves enough space for the passage of the standard catheter to the coronary sinus. Discussion. Detailed anatomy of various anatomical structures within the right atrium that could play a potential role in coronary sinus cannulation is discussed.
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Affiliation(s)
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University , Cracow , Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University , Cracow , Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University , Cracow , Poland
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Kesner KL, Chaney MA, Ota T. Coronary Sinus Ostial Atresia with Unroofed Coronary Sinus Precluding Retrograde Cardioplegia. Anesth Analg 2015; 121:879-881. [PMID: 26378700 DOI: 10.1213/ane.0000000000000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kimberly L Kesner
- From the Department of Anesthesia, Rush University Medical Center, Chicago, Illinois; and Department of Anesthesia & Critical Care, University of Chicago Medical Center, Chicago, Illinois
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13
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Obstructive Thebesian valve: anatomical study and implications for invasive cardiologic procedures. Anat Sci Int 2013; 89:85-94. [DOI: 10.1007/s12565-013-0203-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
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Kuroda M, Takahashi T, Mita N, Kagaya S, Miyoshi S, Saito S. Difficult cannulation of the coronary sinus due to a large Thebesian valve. Anesth Analg 2013; 116:563-6. [PMID: 23400976 DOI: 10.1213/ane.0b013e31827bc77e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Masataka Kuroda
- Department of Anesthesiology Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Japan.
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Islam AKMM, Sayami LA, Zaman S. Chiari network: A case report and brief overview. J Saudi Heart Assoc 2013; 25:225-9. [PMID: 24174864 DOI: 10.1016/j.jsha.2012.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 12/09/2012] [Accepted: 12/28/2012] [Indexed: 02/08/2023] Open
Abstract
The Chiari network is mobile, net-like structures occasionally seen in right atrium near the opening of inferior vena cava and coronary sinus. This is usually of no clinical significance and is often diagnosed incidentally. However, sometimes it may cause diagnostic confusion with right atrial pathologies, and may favour thromboembolism by causing flow obstruction. It may be associated with infective endocarditis, arrhythmias, and migraine. Sometimes, it acts as a physical barrier during invasive procedures. The Chiari network has also been described to protect from pulmonary embolism by acting as an inferior vena cava filter due to its sieve-like effect at the cavo-atrial junction. Here, the Chiari network has been described in a case of Ebstein anomaly of tricuspid valve which produced diagnostic confusion during echocardiography. A brief overview has also been presented.
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