The prevalence of eustachian valve on transoesophageal echo examination

Persistent Eustachian Valve Causing Abdominal and Pelvic Venous System Dilation in a 44-Year-Old Male: A Case Report

This case report presents a rare incidence of a persistent Eustachian valve (EV) causing notable venous dilation in the abdominal and pelvic regions of a 44-year-old healthy male. Initially presenting with left flank pain, diagnostic evaluations identified a 4.8-mm calculus in the distal left ureterovesical junction. Incidentally, imaging also revealed unexplained venous distensions, subsequently attributed to a prominent EV obstructing the inferior vena cava (IVC). The EV, an embryological structure in fetal circulation that helps divert blood from the IVC to the left atrium via the foramen ovale, typically regresses postnatally. Its persistence into adulthood is uncommon and often does not necessitate intervention. However, a persistent EV is often associated with other cardiac findings, especially a patent foramen ovale (PFO) of an atrial septal defect (ASD). There were some reports demonstrating that persistent EV may play a role in an increased risk of paradoxical cerebral embolism in such cases. Therefore, the case underscores the importance of considering such embryological remnants in the differential diagnoses of unexplained venous distension and cryptogenic stroke. It also highlighted the need for a personalized approach to management, especially during the preparation phase before interventional procedures, such as an ASD closure, to minimize the risks during the operation. Furthermore, it also contributed to a broader understanding of the clinical implications of persistent embryological structures and emphasized the value of meticulous diagnostic processes in identifying the underlying causes of observed anomalies.

Large eustachian valve fostering paradoxical thromboembolism: passive bystander or serial partner in crime?

Catheter-based closure of patent foramen ovale (PFO) is more effective than medical therapy in the prevention of recurrent stroke[1]. It is likely that a proportion of patients evaluated for potential transcatheter PFO closure has actually different anatomical variants particularly common in the right atrium such as eustachian valve, Chiari network, Thebesian valve and Crista Terminalis. Notably, the eustachian valve may represent an increased risk factor for left circulation thromboembolism beyond that associated with PFO size and shunting. Such patients may benefit the most from percutaneous closure procedure.

Paradoxical Platypnea-Orthodeoxia Syndrome Induced by Patent Foramen Ovale and Highly Tortuous Descending Thoracic Aorta: A Case Report

Perioperative hypoxemia is common in patients with aortic dissection. Platypnea-orthodeoxia syndrome (POS), in which hypoxemia in the upright position improves with relocating to a recumbent position, can be a rare cause of hypoxemia. This syndrome is more likely to occur in patients with an intracardiac shunt and aortic malformation. Hypoxemic symptoms present in our patient were paradoxical to those of common POS due to the highly tortuous descending thoracic aorta (DTA) and Eustachian valve. Therefore, establishing the diagnosis was difficult. POS should be suspected when patients with high tortuosity and curvature of DTA show hypoxemia.

Case of eustachian valve endocarditis and the importance of synergistic antibiotic therapy

A 46-year-old woman with a history of end-stage renal disease on chronic haemodialysis presented with 1 week of fever, chills, altered mental status and hand pain. She was febrile and ill-appearing on presentation with a pulse rate of 102 beats per minute. She had a tunnelled dialysis catheter in her right neck. Hand examination demonstrated a swollen, erythematous and tender wrist. Cardiovascular examination demonstrated no murmurs. CT of the hand showed abscesses involving the left forearm. Blood and abscess cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Transesophageal echocardiography (TEE) showed a 1.0×1.0 cm mobile vegetation involving the eustachian valve (EV), confirming EV endocarditis. She remained bacteraemic for 18 days despite being on vancomycin with appropriate blood levels. Vancomycin was switched to daptomycin and ceftaroline, which cleared her cultures. Repeat TEE showed improved vegetation size. Our case highlights the rarity and management of EV endocarditis and the importance of synergy for treatment of persistent MRSA bacteraemia.

Thoracic Osteomyelitis and Eustachian Valve Endocarditis: A Case Report and Literature Review

Infective endocarditis and vertebral osteomyelitis are rare infections, most commonly caused by methicillin-sensitive Staphylococcus aureus (MSSA). The eustachian valve is an embryological remnant of the inferior vena cava that has the potential to harbor a nidus leading to infective endocarditis. Eustachian valve endocarditis has been documented in the literature on less than 50 occasions and has yet to be documented in the presence of concomitant vertebral osteomyelitis. In this case, we present a 43-year-old male presenting with vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Persistent bacteremia prompted the identification of vegetative growth on a eustachian valve remnant. This case helps mend the gap in the literature by documenting the treatment considerations in a patient with eustachian valve endocarditis in the presence of osteomyelitis caused by MRSA.

Eustachian valve infective endocarditis

A 40-year-old woman presented with postoperative fever. Echocardiography revealed a large pedunculated cauliflower right atrial mass of heterogeneous echogenicity attached to the eustachian valve measuring about 2×3 cm. She underwent surgical excision, gross and microscopical examination were consistent with eustachian valve infective endocarditis.

Transesophageal Contrast Echocardiography is Not Always the Gold Standard Method in the Identification of a Patent Foramen Ovale: A Clinical Case

In the embryo, Eustachian valve is a crescent-shaped membrane extending from the lower margin of the inferior vena cava and the ostium of the coronary sinus into the right atrium toward fossa ovalis and tricuspid valve. At birth, after the functional closure of the foramen ovale, the Eustachian valve loses its function, reducing to an embryo remnant. According to growing evidence, a persistent Eustachian valve is a frequent finding in patients with a patent foramen ovale (PFO). By directing the blood from the inferior cava to the interatrial septum, it may prevent the spontaneous closure of PFO after birth and indirectly predispose to paradoxical embolism. Transesophageal contrast enhanced echocardiography (cTEE) is considered the gold standard to diagnose a PFO in postnatal life, but its accuracy maybe is not so high in the presence of a persistent Eustachian valve. In these cases, color Doppler TEE is more sensitive and simplifies the diagnostic process, reducing the duration of TEE and improving the patient compliance.