Cor Triatriatum Dexter versus Prominent Eustachian Valve in an Adult Congenital Heart Disease Patient

Abstract

An eustachian valve (EV) remnant, if present, is usually noted by the presence of a thin ridge or a crescent-shaped fold of endocardium arising from the anterior rim of the inferior vena cava orifice due to the persistence of the right sinus venosus valve. Though the embryologic explanation of cor triatriatum dexter (CTD) is the same as that of the normal formation of the EV--lack of regression of the right sinus venosus valve--it is usually called CTD or divided right atrium when there are attachments on the atrial septum giving the appearance of a divided atrium. However, it's called prominent eustachian valve when the right sinus venosus valve has partly regressed, with no remaining septal attachments and without the appearance of a divided atrium. We present the case of an adult patient with an atrial septal defect with a high insertion of a giant EV, which mimics the echocardiographic appearance of divided right atrium.

Cor triatriatum dexter associated with atrial septal defect: Management in a complex clinical case

“…However, it is called prominent EV when the right sinus venosus valve is partly regressed, with no remaining septal attachments and without the appearance of a divided atrium. Therefore, our assumption is that the prominent and hypertrophic EV and cor triatriatum dexter are the same entity with a subdivision of the atrium into 2 completely or partially separated chambers …”

“…Therefore, our assumption is that the prominent and hypertrophic EV and cor triatriatum dexter are the same entity with a subdivision of the atrium into 2 completely or partially separated chambers. 1,2 Among other possible conditions that could mimic prominent EV, intracardiac thrombus or vegetation was considered. The thrombotic or infective origin was ruled out by the appearance of the membrane and its echodensity.…”

Cor triatriatum dexter: A rare cause of myocardial infarction and pulmonary embolism in a young adult

“…Complete persistence of the right valve of the sinus venosus results in separation between the smooth and trabeculated portions of the RA, constituting CTD. [1][2][3][4] The upstream chamber receives superior vena cava and inferior vena cava flows, and the downstream chamber incorporates the right atrial appendage. On echocardiogram, CTD may sometimes be confused with a prominent Eustachian valve.…”

“…1 CTD has varying clinical manifestations, depending on the degree of partitioning or septation of the RA, from completely asymptomatic to severe right-sided heart failure. [2][3][4] We present a case of CTD in a young adult presenting with myocardial infarction and pulmonary embolism who eventually underwent successful surgical excision of the membrane and removal of RA and tricuspid valve thrombus.…”

Cor Triatriatum Dexter, Atrial Septal Defects, and Pulmonary Stenosis—A Rare Association

“…Thus, this structure can be readily identified on cross-sectional echocardiographic examination. 4,5 The clinical presentation of CTD is highly variable and dependent on the degree of septation. When the septation is incomplete, the condition often is asymptomatic, usually detected incidentally in adults during surgery or echocardiography for other cardiac conditions.…”