The Prevalence of Eustachian Valve on Transoesophageal Echo Examination

Abstract

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.

Comparison of residual shunt rate and complications across 6 different closure devices for patent foramen ovale

“…A large PFO with an atrial septal aneurysm, lipomatous septum secundum, prominent Eustachian valve, Chiari network, and other associated congenital malformations introduce technical difficulties at the time of the procedure and device deployment that may hinder effective closure . In this study, the highest frequency of residual shunting was noted with some of the larger non‐self‐centered devices (8/11 [73%] 30 mm Helex devices and 2/6 [33%] 35 mm Amplatzer PFO devices vs. 0/6 [0%] 35 mm Amplatzer Cribriform device, p = .009).…”

“…PFO closure is currently FDA-approved for prevention of recurrent stroke in patients without an alternative etiology for their initial [17][18][19] In this study, the highest frequency of residual shunting was noted with some of the larger non-self-centered devices ( In the RESPECT study, shunt resolution after placement of the Amplatzer PFO device was significantly higher than that observed in our study (458/462 [99%] in RESPECT vs. 28/33 [85%] in this study). 12 This large difference may be due to the protocol of RESPECT using TEE, which is less sensitive compared to TCD in the evaluation of shunts, and sample size.…”

Eustachian valve infective endocarditis

“…Eustachian valve is an embryological remnant of sinus venosus, in fetal circulation it deviates blood from the inferior vena cava to the left atrium through foramen ovale. Eustachian valve endocarditis is an uncommon presentation as only 4% of the adult population were found to have a persisting eustachian valve on transoesophageal echocardiogram (TEE) 1. Moreover in adults, the eustachian valve is non-functional hence the shear stress on the eustachian valve is much lower than the other valves.…”

Transesophageal contrast echocardiography is not always the gold standard method in the identification of a patent foramen ovale: A clinical case

“…[3] Its accurancy is close to that of cTEE, which is considered, among diagnostic strategies in cryptogenic stroke, the gold standard in detecting a large right-to-left shunt,[1456] particularly if associated with an atrial septal aneurysm. [7]…”