Anatomic Variants and Pitfalls Flashcards
What is the purpose of the Eustachian valve?
The eustachian valve (also known as the “valve of the inferior vena cava”) is a ridge of variable thickness in the inferior right atrium. It is a remnant of a fetal structure that directed incoming oxygenated blood to the foramen ovale and away from the right atrium.
Highly oxygenation fetal blood in the IVC goes directly to the coronaries via the Eusatchian valve thorough the fossa ovalis
Chiari networks can result in what?
Thromboembolic phenomenon
What is the Crista Terminalis thought to promote?
Atrial Tachyarrythmias
high density of adrenergic nerve fibers
Other than thromboembolic events, what are chiari networks also associated with? (Name 3)
- PFO
- Aneurysmal intraatriaal septum
- Atrial Arrythmias
What is the Thebesian Valve?
Valve of the Coronary Sinus
What is the problem with a prominent thebesian valve?
Problems with retrograde cardioplegia due to insertion of the cannula into the coronary sinus
What is another name for the Moderator Band?
septomarginal trabecula
What is another name for the Coumadin Ridge?
A coumadin ridge, also called warfarin ridge or left lateral ridge, is a band-like embryological remnant in the left atrium between the left superior pulmonary vein and the left atrial appendage. The ridge contains the ligament of Marshall, autonomic nerve bundle, and small atrial or sinoatrial node artery.
What is the primary problem with Cor Triatriatum Sinister from a physiological standpoint?
LV inlet obstruction
“Mitral stenosis like physiology”
What is the primary problem with Cor Triatriatum Sinister from a surgical standpoint?
Open-chamber procedure
What is the primary etiology with Cor Triatriatum Sinister?
Failure of resorption of common pulmonary veins during embryogenesis
Which Cor triatriatum is more common:
Sinister or Dexter?
Sinister > Dexter
Label 1
1 Eustachian Valve
Label 2
2 Septum Primum
Label 3
3 Septum Secundum
What can be associated with lipomatous hypertrophy?
Atrial Arrythmias
Where is the location of the fat that develops within the lipomatous hypertrophy?
Superior Interatrial Groove
AKA
Waterston’s Groove
Identify the green structure
It’s “serpentine” and hypermobile on the echo clip
Chiari Network
Where does the Chiari network originate from?
Eustachian Valve
Are the chiari networks clinically significant?
No
but can be associated with PFO, Aneurysmal intraatrial septums or thromboembolic disease
What is the major echo differences from chiari network vs. eustachian valve
Chiari Network = Serpentine and Mobile
Eustachian valve = Thicker less mobile
What is the Eustachian valve an embryological remnaant of?
Sinus Venosus
Identify 1
1 Crista Terminalis
Identify 2
2 Eustachian Valve
Identify 3
3 Coronary Sinus
How do you identify a secundum ASD vs. Sinus Venosus ASD?
Look at where the Crista Terminalis is
Secundum ASD = Inferior / Caudad in reference to crista terminalis
Sinus Venosus ASD = Superior / Cephalad in reference to crista terminalis
What is a secundum ASD Associatad with
- Mitral Valve Prolapse
What is a sinus venousus ASD associated with?
Anomalous venous drainage* or *anomalous venous return
What does the moderator band carry?
What is the function of this?
Carries part of the RBB of the AV bundle of the conduction system to the anterior papillary muscle
Function = Electrical shortcut across the chamber of the ventricle seems to facilittae conduction time, aallowing coordinated contraction of the anterior papillary muscle
What view is this?
What is this structure?
TG RV inflow View
Moderator Band
How many lobes is MOST common in the left atrial appendage?
2 lobes = 54%
What is at the arrow
False tendon
What is another name for False Tendon?
LV bands
Are these clinically significant?
No, They are false tendons (LV bands)
What is the estimated cutoff for intraatrial aneurysm?
How would you obtain this?
1.1 - 1.5 cm
In image, you see 2.9 cm which can be diagnostic for intraatriaal aneurysms
What are aneurysmal intraatriaal septums associated with?
- PFO (50-89%)
- Strokes
What is the prevalence of aneurysmal intertatrial septums?
1.0 - 2.2%
How much higher are aneurysmaal interatrial septum patients with PFO at risk for stroke compared to PFO alone?
3-5x higher
Omniplane at 0 degres and turned to the right:
Label 1
Right Lower Pulmonary Vein
Omniplane at 0 degres and turned to the right:
Label 2
Right Upper Pulmonary Vein
Label each arrow
See image
Label 1
Left Atrial Appendage
Label 2
Coumadin Ridge
AKA Warfarin Ridge
AKA Ligament of Marshall
Label 3
LUPV
What is the structure at the purple arrow?
Left Atrial Appendage Membrane
The probe was at 0 degrees and turned LEFT.
What is this?
Left Lower Pulmonary Vein
Label 1
Right PA
Label 2
Transverse Sinus
Label 3
Aorta
What TEE view is this?
ME Ascending Aorta SAX
Can the oblique sinus be seen on TEE?
No
Label 1
Lambl’s excrescences
Lambl’s excrescences are filiform fronds that occur at sites of valvular closure. They may be found without any other evidence of cardiac disease. They originate as small thrombi on endocardial surfaces where the valve margins make contact. These are the sites of minor endothelial damage, due to wear and tear.
What is at 1 on the Aortic Valve?
Papillary Fibroelastoma
Where are fibroelastomas seen in relation to the valve position?
Downstream
Ex: LV side fo the MV and Aorta sie of the AV)
What is the crista supraventricularis?
Crista supraventricularis is a muscular ridge within the right ventricle of the heart.
It is located between the tricuspid and pulmonic valves, at the junction of the right ventricular anterior (free) wall and the interventricular septum.
