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

  1. Dr StrotmannJ.Strotmann{at}medizin.uni-wuerzburg.de
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Citation

Strotmann JM, Voelker W, Schanzenbaecher P
Persistence of the eustachian valve in secundum atrial septal defects: possible implications for cerebral embolism and transcatheter closure procedures

Publication history

  • Accepted March 6, 2001
  • First published July 1, 2001.
Online issue publication 
July 01, 2001
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    Figure/Video Legends

    Video 1 Sequence (S) 1 to 9: - This video shows the transesophageal images of the implantation-sequence of the Amplatzer septal occluder. S1: findings prior to the intervention with a small atrial septal defect of 8 mm and a prominent persisting eustachian valve. S2: colour Doppler image of the left to right shunt via the ASD. S3: after the placement of the guidewire the rim of the eustachian valve is entrapped between the guidewire and the inferior rim of the ASD. S4: the sizing balloon also fixes the tip of the eustachian valve at the defect. S5: after the introducer sheath of the occluder is forwarded into the left atrium the eustachian valve is still trapped in the defect. S6: the left atrial disk can be expanded without complications, but still the eustachian valve seems to be adherent to the occluder. S7: the right atrial disk can also be deployed without complications. However, now it is impossible to disconnect the occluder from the catheter. S8: after the occluder had been retracted into the sheath and the sheath had been removed from the ASD the eustachian valve was again floating free in the right atrium. S9: in a second try the occluder could then be implanted correctly and the eustachian valve was no longer fixed to the septum by the device.

    Video 2 Sequence (S) 1 and 2: S1: - an echo-contrast bolus administration via the superior caval vein showed a washout phenomenon from the atrial septal defect in the right atrium and in addition it could be seen that the eustachian valve acted like a separator between the inferior and superior caval inflow of the venous blood. S2: after the implantation of the occluder a second bolus injection of echo-contrast (this time via the inferior caval vein) showed that the blood was directed to the place of the inferior part of the occluder before it was mixed with the blood from the superior caval vein.
     

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