scholarly journals Anatomical Study of Chiari Network and the Remnant of Left Venous Valve in the Interior of Right Atrium

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
D. Devi Jansirani ◽  
S. Shiva Deep ◽  
S. Anandaraja
Keyword(s):  
Coronary Sinus ◽  
Right Atrium ◽  
Vena Cava ◽  
Clinical Manifestations ◽  
Anatomical Study ◽  
Right Atrial ◽  
Venous Valve ◽  
Membranous Structure ◽  
Chiari Network ◽  
The Right

Chiari network occurs due to incomplete resorption of right valve of sinus venosus. It is often noticed as fenestrated membranous structure or reticular network like structure in the valve of inferior vena cava and coronary sinus. The remnant of left venous valve is observed as trabeculae over the fossa ovalis. The incidence of Chiari network and the remnant of left venous valve were studied in 80 cadaveric hearts utilized for teaching the undergraduates. The right atrium was opened anterior to sulcus terminalis and the interior was examined for the presence of these embryological remnants. The incidence of Chiari network and left venous valve in the present study is 3.75% and 7.5%, respectively. Chiari network was observed as a fenestrated membranous structure in 2 specimens and a reticular network in 1 specimen, with variable extension to coronary sinus opening and right atrial wall. The remnant of left venous valve was observed as multiple fine strands in 3 specimens and trabecular structure in 3 specimens. These structures may create diagnostic confusion, difficulty in interventional procedures, and complications like thromboembolic events. Hence, the knowledge about the incidence, morphology, and clinical manifestations of these rare embryological remnants is mandatory.

scholarly journals Chiari Network in Right Atrium of Heart

2017 ◽  
Vol 15 (2) ◽  
pp. 75-77
Author(s):  
Raj Kumar Thapa ◽  
Kanchan KC ◽  
Rishi Khatri ◽  
Devendra Khatri
Keyword(s):  
Clinical Significance ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Paradoxical Embolism ◽  
Right Atrial ◽  
Atrial Thrombus ◽  
Membranous Structure ◽  
Chiari Network ◽  
The Right

Chiari network is an embryonic remnant of right valve of sinus venosus due to its incomplete resorption. It is a fenestrated net-like membranous structure mostly seen in the right atrium near the opening of Inferior vena cava and Coronary sinus. It is rare, often diagnosed incidentally and is usually of no clinical significance. However, there are reports of its association with atrial fibrillation, arrhythmias, right atrial thrombus entanglement, paradoxical embolism and catheter entrapment during percutaneous interventions. Here we present a case of Chiari network in a 45 years old female diagnosed by two dimensional trans-thoracic echocardiography (2D-TTE). Our aim is to highlight clinical significance of this rare but possible congenital cardiac remnant which is often silent.  

scholarly journals Right Atrial Blood Cyst with Stones Suspended from the Coronary Sinus

2019 ◽  
Vol 19 (2) ◽  
pp. 161
Author(s):  
Feridoun Sabzi ◽  
Aghigh Heydari ◽  
Atefeh Asadmobini ◽  
Mohammad B. Heidari
Keyword(s):  
Coronary Sinus ◽  
Right Atrium ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Cystic Mass ◽  
Right Atrial ◽  
Operative Surgical Procedure ◽  
Small Stone ◽  
Chiari Network ◽  
The Right

ABSTRACT: Cardiac blood cysts are rare benign neoplasms, usually involving the cardiac valves and are remnants of the Chiari network. They are usually detected in the first six months of life and rarely occur in children or adults. We report a 76-year-old male patient who was referred to the Imam Ali Hospital affiliated with Kermanshah University of Medical Sciences, Kermanshah, Iran, in 2018 with dyspnoea. Transthoracic echocardiography revealed a small patent foramen ovale (PFO) and a circumferential mobile cystic mass in the right atrium, with the impression of a tumour or thrombus. The patient underwent open-heart surgery with cardiopulmonary bypass to repair to PFO and remove the intra-atrial lesion. During surgical examination of the right atrial cavity, a blood cyst containing small stone-like structures on the coronary sinus valve of the right atrium was found. The post-operative course was uneventful and no recurrence of tumour was detected during six months of follow-up. To the best of our knowledge, this is the first reported case of a right atrial blood cyst with a few nodule-like stones in an adult with PFO in Iran and the second case in an adult with PFO worldwide.Keywords: Cyst; Coronary Sinus; Adult; Operative Surgical Procedure; Case Report; Iran.

scholarly journals P686 Right atrial, right ventricular and pulmonary cement embolism: a rare complication of percutaneous vertebroplasty

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Akhunova ◽  
R Khayrullin ◽  
N Stekolshchikova ◽  
M Samigullin ◽  
V Padiryakov
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrium ◽  
Percutaneous Vertebroplasty ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Stable Condition ◽  
Right Atrial ◽  
Cement Embolism ◽  
The Right

Abstract A 68-year-old man was admitted to the hospital with complaints of pain in the lumbar spine. He had L5 disc herniation, Spinal stenosis of the L5 root canal - S1 on the right in the past medical history. Percutaneous vertebroplasty at the level of L3 and Th8 vertebral bodies was performed six months ago due to painful vertebral hemangioma. The man is suffering from arterial hypertension, receives antihypertensive therapy. During routine transthoracic echocardiography, a hyperechoic structure with a size of 9.5 x 0.9 cm was found in the right atrium and right ventricle. Chest computed tomography with contrast enhancement revealed signs of bone cement in the right atrium and right ventricle, in the right upper lobe artery, in the branches of the upper lobe artery, in the paravertebral venous plexuses. Considering the duration of the disease, the stable condition, the absence of clinical manifestations and disorders of intracardiac hemodynamics, it was decided to refrain from surgical treatment. Antiplatelet therapy and dynamic observation were recommended. Conclusion Percutaneous vertebroplasty is a modern minimally invasive surgical procedure for the treatment of degenerative-dystrophic diseases of the spine. However, the cement can penetrate into the paravertebral veins and migrate to the right chambers of the heart and the pulmonary artery. This clinical case demonstrates asymptomatic cement embolism of the right chambers of the heart and pulmonary artery after percutaneous vertebroplasty, detected incidentally during routine echocardiography. Abstract P686 Figure.

scholarly journals Advanced Hepatocellular Carcinoma with Subtotal Occlusion of the Inferior Vena Cava and a Right Atrial Mass

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Christian Steinberg ◽  
Suzanne Boudreau ◽  
Felix Leveille ◽  
Marc Lamothe ◽  
Patrick Chagnon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Great Majority ◽  
Right Atrial ◽  
Advanced Hepatocellular Carcinoma ◽  
Regional Lymph Nodes ◽  
The Right

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.

scholarly journals Intravenous Leiomyomatosis of the Uterus: A Retrospective Single-Center Study in 14 Cases

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Qingbo Su ◽  
Xiquan Zhang ◽  
Hui Zhang ◽  
Yan Liu ◽  
Zhaoru Dong ◽  
...  
Keyword(s):  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Pelvic Cavity ◽  
Intravenous Leiomyomatosis ◽  
Abdominal Incision ◽  
Imaging Results ◽  
The Right

Purpose. This study aimed to retrospectively review the diagnosis and surgical treatment of uterine intravenous leiomyomatosis (IVL). Methods. The clinical data of 14 patients with uterine IVL admitted to our hospital between 2013 and 2018 were retrospectively analyzed, including their demographics, imaging results, surgical procedures, perioperative complications, and follow-up results. Results. The tumors were confined to the pelvic cavity in 7 patients, 1 into the inferior vena cava, 4 into the right atrium, and 2 into the pulmonary artery (including 1 into the superior vena cava). Only one case was misdiagnosed as right atrial myxoma before the operation, which was found during the surgery and was treated by staging surgery; all the other patients underwent one-stage surgical resection. Three patients underwent complete resection of the right atrial tumor through the abdominal incision, and one patient died of heart failure in the process of resection of heart tumor without abdominal surgery. During the 6–60 months of follow-up, 4 patients developed deep venous thrombosis of the lower extremity, and 1 patient developed ovarian vein thrombosis and pulmonary embolism. After anticoagulation treatment, the symptoms disappeared. One patient refused hysterectomy and the uterine fibroids recurred 4 years after the operation. Conclusion. Specific surgical plans for uterine IVL can be formulated according to cardiac ultrasound and computed tomography (CT). For the first type of tumor involving the right atrium, the right atrium tumor can be completely removed through the abdominal incision alone to avoid thoracotomy. The disease is at high risk of thrombosis and perioperative routine anticoagulation is required.

scholarly journals P1464 A case of cortriatriatum dexter accidentally discovered in an adult

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H S A Abdelgawad ◽  
M Abdelnabi ◽  
A Almaghrabi ◽  
M Shehata ◽  
M A Abdelhay
Keyword(s):  
Transesophageal Echocardiography ◽  
Right Atrium ◽  
Vena Cava ◽  
Interatrial Septum ◽  
Right Atrial ◽  
Cor Triatriatum ◽  
Free Wall ◽  
3D Transesophageal Echocardiography ◽  
Cor Triatriatum Dexter ◽  
The Right

Abstract Introduction Cor triatriatum dexter, or partitioning of the right atrium (RA) to form a triatrial heart, is an extremely rare congenital anomaly that is caused by the persistence of the right valve of the sinus venosus. The incidence of cor triatriatum is approximately 0.1% of congenital heart malformation. Typically, the right atrial partition is due to exaggerated fetal eustachian and the besian valves, which together form an incomplete septum across the lower part of the atrium. This septum may range from a reticulum to a substantial sheet of tissue Case report: 45-years old female patient with history of surgical closure of an atrial septal defect at the age of 14 years .She presented to our medical facility complaining of exertional dyspnea and bilateral lower limb edema for 4 years. On clinical examination, she had bilateral congested neck veins, a pansystolic murmur over the tricuspid area and a tender hepatomegaly. 2D Transthoracic Echocardiography revealed an unusual membranous structure that stretched across the right atrium with attachments superiorly at the free wall and inferiorly at the inter-atrial septum with a severe tricuspid regurgitation (Panel A)Intravenous agitated saline injection revealed an incomplete membrane. (Panel B).2D Transesophageal echocardiography showed an unusually prominent eustachian valve arose normally from the ostium of the inferior vena cava (IVC) and was pointing towards the interatrial septum just below the level of the fossa ovalis and no residual ASD could be seen. (Panel C) . 3D transesophageal echocardiography with zoomed mode from right atrial perspective confirmed the presence of an incomplete membrane extending transversely from the ostium of IVC and interatrial septum immediately below the fossa ovalis but not reaching RA free wall (arrow), no obstruction to the flow of the IVC, superior vena cava (SVC) , coronary sinus (CS) and the tricuspid valve (TV) was seen .(Panels D,E,F). Conclusion Since many patients are asymptomatic, the diagnosis of cor triatriatum dexter often is determined at postmortem examination. Antemortem diagnosis can be determined by echocardiography. 3D transesophageal echocardiography was able to detect cor triatriatum dexter that can be easily missed by 2D echocardiography. Abstract P1464 Figure.

scholarly journals Coronary sinus atrial septal defects in adults over the past 20 years at new Tokyo hospital: case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Haruhiko Sugimori ◽  
Tatsuya Nakao ◽  
Yuki Ikegaya ◽  
Daisuke Iwahashi ◽  
Shoichi Tsuda ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Surgical Repair ◽  
Wide Spectrum ◽  
Superior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Right Atrial ◽  
Valvular Regurgitation ◽  
Type Iv ◽  
The Right

Abstract Background An isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed. Case presentation The patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. Conclusions CS ASD (Kirklin and Barratt–Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.

Right Atrial Surgery without Caval Snaring

2005 ◽  
Vol 1 (2) ◽  
pp. 75-78 ◽  
Author(s):  
Reddy Dandolu ◽  
Douglas Eaton ◽  
Aras Ali ◽  
Nannette Schwann ◽  
Andrew Wechsler
Keyword(s):  
Animal Model ◽  
Right Atrium ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Drainage System ◽  
Mitral Valve Surgery ◽  
Right Atrial ◽  
Percutaneous Cannulation ◽  
The Right

Background During tricuspid valve replacement in a patient with previous mitral valve surgery, we made an incidental observation that the right atrium can be opened without caval snaring and without air entering the venous reservoir. We tested this hypothesis on an animal model. Methods Two patients underwent right atrial surgery using percutaneous cannulation, and no air was entrained without caval snaring. This principle was tested in an animal model using 2 pigs weighing 80 kg each. Percutaneous cannulae were placed under epicardial echo guidance with their tips 4 cm from the right atrium. A “collapsible bag with air drainage system” was introduced into the venous return system to quantify air return from the superior vena cava (SVC) and inferior vena cava (IVC). Two types of percutaneous cannulae with (Cardiovations Quick Draw) and without (Biomedicus) proximal side holes were tested. Results In the animal model using Biomedicus cannulae, upon opening the right atrium, air was entrained from the SVC cannula at 60 mL/minute with no air in the IVC. There was no difference in the amount of air between the two cannulae. Pressures measured were 5 cm of water in the IVC and −20 cm water in the SVC. Epicardial ultrasound demonstrated complete collapse of both vena cavae. Partial clamping of the SVC cannula reduced the amount of air to 60 cc/min, and placing a small straight clamp at the SVC atrial junction eliminated the air. No air was noted in IVC cannula. Conclusions Inferior vena caval drainage by percutaneous cannula does not entrain air with either type of cannula and without snaring (both in clinical cases and animal model). This might be explained by the presence of a competent Eustachian valve. However, the SVC is not immune to air. Minimal air (approximately 60 mL/minute) could be managed by partial clamping or completely be avoided by placing a small straight clamp without snaring.

scholarly journals Two Cases of Cardiac Implantable Electronic Device Placement via Persistent Left Superior Vena Cava

2020 ◽  
Author(s):  
Syed Haseeb Raza Naqvi ◽  
Ishfaq Ahmed ◽  
Pir Sheeraz Ali ◽  
Jehan Zab ◽  
Han Naung Tun
Keyword(s):  
Coronary Sinus ◽  
Right Atrium ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Permanent Pacemaker ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Left Subclavian Vein ◽  
The Right

Persistent left superior vena cava (PLSVC) is the most common variation of anomalous venous return to the heart and present in 0.1–0.5% of the general population. The left anterior cardinal veins typically obliterate during early cardiac development but failure of involution results in PLSVC. It is an asymptomatic congenital anomaly, usually discovered while performing interventions through the left subclavian vein or during cardiovascular imaging. PLSVC can be associated with cardiac arrhythmias and congenital heart disease. We present two cases of PLSVC: first, a 68-year-old male who presented with complete heart block, for which a temporary pacemaker was initially inserted followed by a permanent pacemaker; second, a 53-year-old female with a history of hypertension and ischemic cardiomyopathy with a left ventricular ejection fraction of 25%, and a survivor of sudden cardiac death, who underwent an implantable cardioverter-defibrillator (ICD) for secondary prevention. Both cases of PLSVC were detected incidentally during the transvenous approach to the heart. PLSVC was suspected by the unusually left medial position of the lead, while cineflouroscopy showed the venous trajectory toward the coronary sinus and drainage into the right atrium. It is technically difficult to cross the wire through the tricuspid valve when coming from the PLSVC and coronary sinus without making a loop in the right atrium, which is known as a wide loop technique. PLSVC is an uncommon anomalous anatomical variant and should be recognized appropriately by specialists who frequently carry out procedures through the left subclavian vein, such as implantation of permanent pacemaker, ICD and cardiac resynchronization therapy. It should also be recognized that wide loop formation of the right ventricular lead in the right atrium is helpful to cross the tricuspid valve and to affix the lead in the right ventricle.

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