Congenital Cardiac Defects, Such as Eustachian Valve, May Increase the Risk of Cryptogenic Stroke: A Case Report

Chiara Bandinelli,Marco Zoli,Giampaolo Bianchi,Anna Balducci,Giovanni Maria Puddu

doi:10.4236/wjcd.2020.106036

Abstract

Eustachian valve is an embryonic endocardial heart structure; after birth it becomes an embryogenic residue and its persistance in adult life is unusual. The literature reports some cases of association between Eustachian valve and PFO and is known that the prominent Eustachian valve can represent a way facilitating systemic embolism.Several studies also investigated the role of Eustachian valve in the pathophysiology of both migraine and cerebral embolism. In addiction is known how Eustachian valve may increase the risk of endocarditis, which mostly affects intravenous drug abusers or those with implanted medical devices or central venous catheters. The most commonly identified organism is Staphylococcus aureus (approximately 53% of cases). We present a case of a 46-year-old woman with known migraine. She was hospitalized in Stroke Unit for a cryptogenic stroke with a right-to-left shunt detected with transcranial doppler ultrasound with “bubble test” and a patent foramen ovale with right-to-left shunt with a fenestration of atrial septum and a voluminous Eustachian valve detected with transesophageal echocardiography; she developed fever with a blood cultures positive for methicillin-resis- tant Staphylococcus aureus (MRSA), even if without evidence of endocarditis vegetations. In summary, the objective of our paper is to present an example of a correlation between the persistence of the Eustachian valve with bothcryptogenetic stroke, possible valve infection and migraine.

Highlights

One-half of patients with cryptogenic stroke have a patent foramen ovale (PFO).A patent foramen ovale (PFO) is frequent and found in nearly 25% of healthy people
She was hospitalized in Stroke Unit for a cryptogenic stroke with a right-to-left shunt detected with transcranial doppler ultrasound with “bubble test” and a patent foramen ovale with right-to-left shunt with a fenestration of atrial septum and a voluminous Eustachian valve detected with transesophageal echocardiography; she developed fever with a blood cultures positive for methicillin-resistant Staphylococcus aureus (MRSA), even if without evidence of endocarditis vegetations
The Eustachian valve rarely persists into adulthood but it needs to be carefully examined with transesophageal echocardiography for diagnosis and possible hemodynamic and clinic impact, especially for an increased incidence of cerebral embolism, including ischemic stroke

Summary

Introduction

One-half of patients with cryptogenic stroke have a patent foramen ovale (PFO). A patent foramen ovale (PFO) is frequent and found in nearly 25% of healthy people. There is a valve, called Eustachian valve It is an endocardial structure extending from the anterior margin of the inferior vena cava to the anterior part of the limbus fossa ovalis. It helps blood circulating through patent foramen ovale into the left atrium. The persistence of Eustachian valve after birth is unusual. Transthoracic, transesophageal and three-dimensional echocardiography defines correctly diagnosis and anatomy of prominent Eustachian valve [3]

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