Prominent eustachian valve: An uncommon cause of a common problem during extracorporeal membrane oxygenation support

Abstract

Suck down events in an extracorporeal membrane oxygenation (ECMO) circuit, due to vein wall being suctioned onto the cannula inflow ports, lead to low circuit flows. These low flow states can be reversed with fluid administration. We present a patient with a prominent eustachian valve (EV) which was encountered while managing the patient on ECMO post lung transplantation for pleuroparenchymal fibroelastosis. We hypothesize

Asymptomatic Cardiac Anomalies and Percutaneous Procedures: Beware

“…EV can complicate navigation of the catheter, resulting in guidewire entrapment or procedural failure if the free end of the EV is mistaken for a rim of an ASD. 4,5 One report describes the entrapment of a pacemaker lead requiring the use of a bipolar active fixation lead with a retractable screw after multiple unsuccessful attempts with a tined lead. 6 If noticed on transthoracic echocardiographic exam, pre-or intra-procedural TEE exam can delineate the location, shape, and size of the EV and, therefore, help better plan for the procedure with preparation of appropriate guidewires and a back-up surgical approach.…”