“Eustachian Valvectomy - An unexpected outcome of PFO closure” - A case report of unusual interaction of right atrial filaments with PFO closure device and review of the literature

Objectives

This is a case report describing technical challenges due to the presence of a right atrial filamentous structure during implantation of septal occluder in a patient with cryptogenic stroke and patent foramen ovale (PFO).

Background

The association of patent Foramen ovale (PFO) and cryptogenic ischemic stroke in young patients has been well described. Eustachian valve remnants (also variably and rather interchangeably referred to as Chiari network in the literature) are vestigial remnants of the sinus venosus and it is often associated with PFO and atrial septal aneurysm. Such filamentous structures can interfere during right heart procedures. Careful peri-procedural evaluation with transesophageal echocardiography (T.E.E) or Intracardiac echocardiography (I.C.E) can help identify and prevent inadvertent complications.

Conclusion

Peri-procedural intracardiac imaging is the cornerstone in identifying right atrial filamentous structures during right heart structural procedures, electrophysiology procedures etc. Such guidance and previously described “Pull-Push” technique can avoid undue complications.