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European Journal of Echocardiography 2008 9(1):158-159; doi:10.1016/j.euje.2007.05.006
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Eustachian valve interfering with transcatheter closure of patent foramen ovale

Philip Roelandt and Werner Budts*

Department of Cardiology, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium

Received 26 April 2007; accepted after revision 10 May 2007; online publish-ahead-of-print 9 July 2007.

* Corresponding author. Tel: +32 16 344369; fax: +32 16 344240. E-mail address: werner.budts{at}uz.kuleuven.ac.be


   Abstract
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A prominent Eustachian valve (EV) is a common finding in patients with a patent foramen ovale (PFO). Its presence might compromise transcatheter closure of the PFO.

Keywords: Intrasept; Patent foramen ovale; Transoesophageal echocardiography; Percutaneous closure

A prominent Eustachian valve (EV) is a common finding in patients with a patent foramen ovale (PFO). Its presence might compromise transcatheter closure of the PFO.

Three selected patients who suffered from a recent cryptogenic stroke were referred for percutaneous PFO closure. In all, closure was attempted with the Intrasept device (Cardia, Burnsville, US). Left and right umbrella were deployed in the left and right atrium, respectively. However, in all these patients, one of the six arms of the right umbrella hooked on a prominent EV (Figure 1 A and B). Manipulation using the guiding sheath resulted in correct positioning of the device in two patients (Figure 2). In one patient the device needed to be retrieved, which was performed very easily, finishing the procedure by using a disk device.


Figure 1
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  		Figure 1 (A) Transoesohageal image of the Intrasept device with one right arm hooked on the Eustachian valve (white arrow). AO, aorta; EV, Eustachian valve; LA, left atrium, RA; right atrium. (B) Fluoroscopic image of the Intrasept device with one right arm hooked on the Eustachian valve (white arrow).

 


Figure 2
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  		Figure 2 Fluoroscopic corrected position of the Intrasept device (white arrow).

 
The EV is an embryonic remnant and directs the blood from the inferior vena cava to the interatrial septum. When the PFO remains open, it increases the probability of a paradoxical embolism.1 Therefore, percutaneous closure is suggested in patients with cryptogenic stroke, especially in those with a high risk PFO anatomy (spontaneous right-to-left shunt, atrial septal aneurysm, tunnel-like PFO).2

To conclude, in these particular cases one arm of the right umbrella hooked on the EV. Persistent malpositioning of the device could result in future problems related to a remaining right-to-left shunt. Therefore it is very important to make sure that the device is in the correct position, especially in patients with a prominent EV.


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  1. Schuchlenz HW, Saurer G, Weihs W, Rehak P. Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events. J Am Soc Echocardiogr. (2004) 17:231–3.[CrossRef][Web of Science][Medline]
  2. Landzberg MJ, Khairy P. Indications for closure of patent foramen ovale. Heart (2004) 90:219–24.[Free Full Text]

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This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
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Right arrow Articles by Roelandt, P.
Right arrow Articles by Budts, W.
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