Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2015;68:250 - Vol. 68 Num.03 DOI: 10.1016/j.rec.2014.03.020

Giant Chiari Network, Foramen Ovale, and Paradoxical Embolism

Gregorio Laguna a,, Nuria Arce a, Miriam Blanco a

a Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

Refers to

Chiari Network and Paradoxical Embolism
Efrén Martínez-Quintana, Fayna Rodríguez-González
Rev Esp Cardiol. 2015;68:273
Full text - PDF

Article

.

A Chiari network is identified in the course of 1.3% to 4% of all autopsies and in 2% of patients who undergo transesophageal echocardiography. This network is associated with patent foramen ovale (PFO) in up to 80% of cases. Moreover, a number of scientific articles have linked this association to the development of stroke.

The patient, a 78-year-old man with a history of embolic stroke and no evidence of cerebrovascular disease, complained of progressive breathlessness and dyspnea even on minimal exertion (New York Heart Association class III). A transesophageal echocardiogram revealed severe degenerative mitral regurgitation, severe functional tricuspid regurgitation, and a prominent Chiari network, in the shape of an inverted conewith a cul-de-sac (Figure, white arrow), the distal end of which reached the PFO (Figure, white arrowheads). We also observed turbulent flow from the left atrium to the right atrium through the PFO (Figure, white arrow).

Figure.

The patient underwent mitral valve replacement, tricuspid valve repair, and PFO closure by means of simple suture with cardiopulmonary bypass. In the right atrium, we observed a large Chiari network (6.2 cm × 6 cm), which we resected completely (Figure, black arrow. TV, tricuspid valve).

Although this malformation is uncommon, the characteristics of the Chiari network described here might explain the pathophysiology of a paradoxical embolism. The cul-de-sac would promote blood stasis and thrombosis, the inverted cone morphology would enable the mobilization of the thrombus toward the fenestrated region (Figure, arrow), and the proximity of this region to the PFO could explain the embolism, especially during atrial diastole and Valsalva maneuvers.

Corresponding author: goyotxmed@hotmail.com

1885-5857/© 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

Cookies
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
Cookies policy
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.