Floating thrombi on the Eustachian valve as a complication of venous thromboembolic disease

Barriales, Vicente; Tamargo, J; Aguado, Marcos Garcı́a; Martı́n, Marı́a; Rondán, Juan; Segovia, Eduardo; Morı́s, César

doi:10.1016/s0167-5273(03)00153-0

Cited by 14 publications

(10 citation statements)

References 5 publications

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“…The thrombus may originate in situ or may result from adhesion of embolic material from a distant source (2,3). In either case, there is significant risk of embolization.…”

Section: Discussionmentioning

confidence: 99%

Thrombus on the eustachian valve leading to recurrent pulmonary embolism: A rare problem requiring aggressive management

Jyotsna

Alla

Misra

et al. 2009

Canadian Journal of Cardiology

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T he eustachian valve is an embryological remnant of the inferior vena cava (IVC) valve. It is usually absent or inconspicuous and has no known function in the normal adult. However, on rare occasions, a persistent eustachian valve may be associated with thrombus, infective endocarditis or tumour. Herein, we report a case of recurrent pulmonary embolism from an adherent thrombus on a prominent eustachian valve. Case presentationA 52-year-old man presented to a peripheral hospital with acute dyspnea. Computed tomography scanning revealed pulmonary embolism with a nonocclusive clot in the main pulmonary artery. A transthoracic echocardiogram (TTE) also demonstrated the thrombus in the main pulmonary artery but revealed no evidence of right ventricular dysfunction. Doppler ultrasonography revealed acute thrombosis of the left femoral vein extending into the left iliac vein and distal IVC, which was confirmed by radionuclide venography. The patient was hemodynamically stable but had mild hypoxia that was easily corrected with minimal supplemental oxygen. Despite the absence of hypotension, respiratory failure or right ventricular dysfunction, the patient was thrombolyzed with streptokinase, presumably due to the high clot burden. He received a bolus of 250,000 units followed by 100,000 units/h infusion for 24 h and was subsequently started on heparin and warfarin. The patient had marked improvement with the above therapy and, within one week, was ambulating comfortably without supplemental oxygen. Complete blood count and the metabolic panel were normal, and evaluation for inherited and acquired thrombophilic states (proteins C and S, antithrombin III, factor V Leiden, and antiphospholipid antibody) was unremarkable. Approximately 10 days after onset of his initial symptoms, the patient developed recurrent shortness of breath and progressively became hypoxic. A repeat TTE showed complete resolution of thrombus in the main pulmonary artery, mild pulmonary arterial hypertension and normal right ventricular function. The patient was then transferred to Nizam's Institute of Medical Sciences (Hyderabad, India) for further workup and management.Evaluation at Nizam's Institute of Medical Sciences revealed an unchanged chest x-ray and absence of new infiltrates on a computed tomography scan. Repeat Doppler examination revealed resolution of the left femoral vein, left iliac vein and IVC thrombi. This was confirmed by conventional venogram (Figure 1). A subsequent transesophageal echocardiogram (TEE) revealed a small freely mobile mass at the IVC-right atrium (IVC-RA) junction (Figure 2 and Video). The primary diagnostic consideration at this point was a residual adherent thrombus on the eustachian valve. Therapeutic alternatives included repeat systemic thrombolysis, local The eustachian valve is an embryological remnant of the inferior vena cava valve that is absent or inconspicuous in the adult. Even when prominent, it is considered to be a benign finding. The present report describes a patient with deep venous thrombosis...

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“…The thrombus may originate in situ or may result from adhesion of embolic material from a distant source (2,3). In either case, there is significant risk of embolization.…”

Section: Discussionmentioning

confidence: 99%

Thrombus on the eustachian valve leading to recurrent pulmonary embolism: A rare problem requiring aggressive management

Jyotsna

Alla

Misra

et al. 2009

Canadian Journal of Cardiology

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“…2,8 The two major etiologies of right heart thrombus are embolic (due to propagation of a deep vein thrombosis, DVT) or in situ (due to stagnant blood flow, as seen in cardiomyopathy and in arrhythmia, such as in atrial fibrillation). However, there are case reports documenting right heart thrombus secondary to pacemaker wires 9 , central venous catheters 10 , hemodialysis catheters 11 , and embryological remnants 12 , as a complication of ablation 13 , formed during cardiac arrest with cardiopulmonary resuscitation 14 , and after carbon monoxide poisoning 15 . With regard to our patient, it is likely that the FRHT development was multifactorial.…”

Section: Discussionmentioning

confidence: 99%

Complete resolution of right atrial free-floating thrombus after warfarin therapy in chemotherapy-induced cardiomyopathy: a case report

Mappiare

Pratiwi

Muzakkir

2009

JKKI

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“…In some situations, however, it may be clinically significant. Complications associated with a large EV include obstruction of the inferior vena cava 5 , thrombosis 6,7 and possibly subsequent pulmonary embolism 6 . Infective endocarditis 8,9 is a major issue; the involvement of persistent EV in infective endocarditis is often described in drug abusers.…”

Section: Marek E Sovova E Kocianovamentioning

confidence: 99%

The Prevalence of Eustachian Valve on Transoesophageal Echo Examination

Marek¹,

Sovová²,

Kociánová³

2011

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. The Eustachian valve (EV) is an embryonic structure redirecting the blood flow from the inferior vena cava through the foramen ovale. It may persist in adults as a floating membrane in the right atrium. A large EV can be associated with thrombosis, embolization, bacterial endocarditis, etc. The prevalence of EV in the normal population is unknown.Aim. to assess the prevalence and size of EV in unselected patients examined by transoesophageal echo. Methods. 1100 consecutive patients were examined for various reasons by a single operator and interpreter. Routine check was made for the presence of EV in the right atrium. Only patients with a mobile EV and not with a simple rigid rim were counted. Three measurements of the EV length at the level of the aortic valve (i.e. 90°) were made off-line and the longest distance considered. If the EV was not visualized and recorded as a straight line because of its chaotic movement, the picture of the valve was segmented into several separated valve portions and the sum taken as the true length.Results. 46 patients (24 males) with EV were identified out of total 1100 pts examined. The average length of the EV was 23.6 ± 9.7 mm (7-47 mm, median 23 mm).Conclusions. The finding of a persisting Eustachian valve on transoesophageal echo examination is not rare. The prevalence was similar in men and in women. Bearing in mind the possible complications associated with a large valve, we recommend that a proper description of persistent EV is included in routine transoesophageal echo reports.

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Floating thrombi on the Eustachian valve as a complication of venous thromboembolic disease

Cited by 14 publications

References 5 publications

Thrombus on the eustachian valve leading to recurrent pulmonary embolism: A rare problem requiring aggressive management

Thrombus on the eustachian valve leading to recurrent pulmonary embolism: A rare problem requiring aggressive management

Complete resolution of right atrial free-floating thrombus after warfarin therapy in chemotherapy-induced cardiomyopathy: a case report

The Prevalence of Eustachian Valve on Transoesophageal Echo Examination

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