Pathophysiology of paradoxical embolism: evaluation of the role of interatrial septum anatomy based on the intracardiac echocardiography assessment of patients with right-to-left shunting

AbstractBackground: Detailed anatomic variants of the interatrial septum in patients with right-to-left shunt and contribution of specific anatomies to the risk of ischaemic recurrences has not yet been comprehensively classified. Objective: To report a classification of the anatomic variants of the interatrial septum as observed by intracardiac echocardiography and its correlation with clinical and functional characteristics. Methods: We retrospectively reviewed the medical and instrumental data of 520 consecutive patients (mean age 44±15. 5 years, 355 women) who had over a 10-year period undergone intracardiac echocardiography and right-to-left shunt catheter-based closure. The four main features used to analyse were: (a) diameter of the oval fossa, (b) presence and length of the channel, (c) presence and degree of atrial septal aneurysm, and (d) rim thickness. The presence of Eustachian valve was also tabulated. Results: The combinations of interatrial septum anatomical features were classified into six main anatomical subgroups. Recurrent embolism, multiple ischaemic foci on brain magnetic resonance imaging, high grade shunt, and permanent shunt before transcatheter closure procedure were associated with type 2, type 4, and type 6. Type 4 anatomical subtype (OR 4.1, 1.5–8 [95% CI], p<0.001) and type 2+presence of Eustachian valve (OR 4.3, 1.6–9 [95% CI], p<0.001) were the strongest predictors of recurrent ischaemic events before transcatheter closure. Conclusion: Our study showed that interatrial septum anatomy greatly differs among patients with right-to-left shunt, as well as the risk of ischaemic recurrences in different anatomies.

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P578 Transcatheter closure of multi-fenestrated atrial septal aneurysm mimiking a secundum atrial septal defect: correct diagnosis and device selection by intracardiac echocardiography

European Heart Journal ◽

10.1016/s0195-668x(03)94016-4 ◽

2003 ◽

Vol 24 (5) ◽

pp. 97

Author(s):

G RIGATELLI

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Correct Diagnosis ◽

Intracardiac Echocardiography ◽

Atrial Septal Aneurysm ◽

Secundum Atrial Septal Defect ◽

Device Selection

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Persistence of the eustachian valve in secundum atrial septal defects: possible implications for cerebral embolism and transcatheter closure procedures

Heart ◽

10.1136/hrt.86.1.e5 ◽

2001 ◽

Vol 86 (1) ◽

pp. e5-e5

Author(s):

J M Strotmann ◽

W Voelker ◽

P Schanzenbaecher

Keyword(s):

Potential Role ◽

Septal Defect ◽

Transcatheter Closure ◽

Unknown Origin ◽

Cerebral Stroke ◽

Eustachian Valve ◽

Septal Defects ◽

Atrial Septal Defects ◽

Brainstem Stroke

Transcatheter closure of large secundum atrial septal defects is now accepted clinical practice. With the introduction of easily applicable closure devices the indications for this procedure have been expanded to include the closure of patent foramen ovale after cerebral stroke of unknown origin. In some of these patients a persistent eustachian valve is present. The clinical relevance of this finding is still unclear. A 36 year old patient with a brainstem stroke of unknown origin and a secundum atrial septal defect in combination with a persisting prominent eustachian valve is reported. The potential role of the eustachian valve in the genesis of the stroke and the difficulties during transcatheter closure of the defect because of the persisting valve are discussed.

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Modified Technique to Control the Eutachian Valve During Transcatheter Closure of Atrial Septal Defect/Patent Foramen Ovale

European Heart Journal Supplements ◽

10.1093/eurheartj/suab069.009 ◽

2021 ◽

Vol 23 (Supplement_D) ◽

Author(s):

Sahar El Shedoudy ◽

Fatma Abo Elsoud ◽

Eman El Dokhlaha ◽

Reem Rashed ◽

Mohammad Abdelghani

Keyword(s):

Atrial Septal Defect ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Transcatheter Closure ◽

Vena Cava ◽

Right Atrial ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Eustachian Valve ◽

Jude Medical

Abstract Objective to describe an approach to perform safe transcatheter closure of Atrial Septal Defect (ASD)/Patent Foramen Ovale (PFO) associated with large redundant Eustachian Valve. Background Transcatheter device closure of ASD/PFO is feasible in a great majority of patients. However, the presence of a huge mobile Eustachian Valve can compromise device placement. Patients and Methods Six patients (3 PFO and 3 ASD patients) with a huge redundant Eustachian valve were included. Two patients had PFO with long tunnel and were closed with Occlutech FigullaFlex II PFO occluders sized 23/25 and 27/30 respectively. The other PFO patient had an associated atrial septal aneurysm (ASA) and was closed with a 25 mm Amplatzer Multi-Fenestrated Septal Occluder “cribriform” device (St. Jude Medical – Abbott Vascular). The three ASDs were closed by regular ASD occluders (2 Flex II ASD Occluders sized 30 and 33 mm and 1 Amplatzer ASD Occluder sized 24 mm). Eustachian valve was successfully held with a steerable ablation catheter to deflect it against the lateral right atrial wall, keeping it away from the inter-atrial septum to prevent its entrapment or interference with the cable, the sheath or the device. Results All ASDs/PFOs have been successfully closed with no complications with free inferior vena cava (IVC) flow, with no residual inter-atrial shunt and the eustachian valve is not interfering with the device. Conclusions Safe percutaneous ASD/PFO closure can be achieved with proper control of a large redundant Eustachian valve.

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