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European Journal of Echocardiography Advance Access originally published online on July 4, 2008
European Journal of Echocardiography 2008 9(6):861-864; doi:10.1093/ejechocard/jen198
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Right atrial inflow obstruction of the inferior vena cava due to atrial septal aneurysm and an elongated Eustachian valve

Jeroen Walpot1,*, Corstiaan Storm1, Johan Bosmans2, Bernard P. Paelinck2, W. Hans Pasteuning1, Jenne Wielenga3, Cees Klazen1, Raymond Hokken1, Jetze Sorgedrager1 and Jules Teeuwen1

1 Department of Cardiology, Ziekenhuis Walcheren, Koudekerkseweg 88, Postbus 3200, 4380 DD Vlissingen, The Netherlands
2 Department of Cardiology, University Hospital Antwerp, Antwerp-Edegem, Belgium
3 Department of Internal Medicine, Ziekenhuis Walcheren, Vlissingen, The Netherlands

Received 2 April 2008; accepted after revision 4 June 2008; online publish-ahead-of-print 4 July 2008.

* Corresponding author. Tel: +31 118 425000; fax: +31 118 425331. E-mail address: j.walpot{at}zzlnd.nl


  Abstract

We describe a patient with oedema of the legs and ascites due to right atrial (RA) inflow obstruction, caused by atrial septal aneurysm (ASA) and an elongated Eustachian valve (EV). Both structural abnormalities created a narrow inflow channel to the free RA cavity. RA inflow obstruction is usually related to constrictive pericardial disease and pericardial tamponade. Other cardiac causes of RA inflow obstruction are rare and include lipomatous hypertrophy of interatrial septum, tumour or thrombus in the right atrium (RA). Reports, describing inflow obstruction in the RA as a consequence of an elongated EV or an ASA, are extremely rare.

Keywords: Right atrial inflow obstruction; Inferior vena cava; Elongated Eustachian valve; Atrial septal aneurysm; Transesophageal echocardiography; Congenital heart disease


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