Pseudo atrial septum defect from a Eustachian valve on transesophageal echocardiogram

Excerpt

A 70-year-old male patient was admitted to our hospital with new-onset atrial fibrillation and heart failure. Transthoracic echocardiogram demonstrated rheumatic mitral stenosis (Fig. 1). Transesophageal echocardiogram (TEE) performed for preoperative evaluation of mitral valve apparatus confirmed the diagnosis of severe mitral stenosis. Standard images of the right atrium showed a possible ostium secundum atrial septal defect (ASD). Color Doppler showed flow across the presumed defect, thus excluding a dropout artifact. However, on astute assessment with multiple views, the true atrial septum was visualized, and it was the space between a prominent Eustachian valve (EV) and the atrial septum that gave a false impression of a defect. This was confirmed with agitated saline contrast, which showed no flow across the true atrial septum (Fig. 2).

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