Unusual Elongation of the Eustachian Valve

Abstract

SUMMARYWe report a patient with a snake-shaped, mobile mass in the right atrium. The mass was determined to be an elongated Eustachian valve which was a persistent part of the embryologic valve of the sinus venosus. (Int Heart J 2007; 48: 113-116) Key words: Eustachian valve, Right atrium, Mass IN fetal life, the direction of oxygen-rich blood from the inferior vena cava into the systemic circulation through the foramen ovale is controlled by the Eustachian valve (EV).1) After birth, it may disappear or may be seen in echocardiographic examinations as a nonfunctional, thin, filamentous structure originating from the orifice of the inferior vena cava.2) Here we report an unusually elongated EV in a 20-year-old man. CASE REPORTA 20-year-old man was admitted to our hospital due to mild dyspnea and fatigue on exertion. There were no specific findings in his medical history. At admission, the systolic blood pressure was 120 mmHg, diastolic blood pressure 70 mmHg, pulse rate 90/minute, respiration rate 20/minute, and body temperature 37.0°C. A physical examination was normal. The cardiothoracic ratio was within normal limits in teleradiography. Normal sinus rhythm was present in an electrocardiographic examination. Routine blood tests were normal. Transthoracic echocardiography (TTE) was performed in an attempt to explain the etiology of the dyspnea. Left ventricular (LV) wall thickness, LV systolic and diastolic dimensions, and LV ejection fraction were normal. There were no abnormalities in the valvular structures. Systolic pulmonary artery pressure was normal. However, a snake-shaped, thin, linear and mobile mass (about 35 mm in length) was seen in the right atrium on apical 4-chamber view (Figure 1). One edge of the mass was attached to the wall of the right atrium and the other edge was free. The structure was not obstructing transtricuspid blood flow. When transesophageal From the