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Chiari Network

Chiari Network Venous Valves


Presentation

  • Chiari networks are present in the right atrium in a minority of the population and are usually of no clinical significance.[ncbi.nlm.nih.gov]
  • We present the case of a 62-year-old man with infectious endocarditis in a Chiari network. Chiari networks are present in 1.5% to 3% of the population.[ncbi.nlm.nih.gov]
  • A Chiari's network, noted in approximately 2% of the general population, is a congenital remnant of the sinus venosum valve present in the right atrium.[ncbi.nlm.nih.gov]
  • In this presented case, the Chiari network displayed a protective function, but the expansion and organization of the thromboembolus caught there made it resistant to lytic therapy.[ncbi.nlm.nih.gov]
  • We present three consecutive cases of Chiari network found in the presence of abnormal interatrial conduction (P-waves or 110 ms), which is a potential predictor of atrial tachyarrhythmias.[ncbi.nlm.nih.gov]
Fever
  • We report the case of a 41-year-old woman who presented with fever and chills. She had a history of infective endocarditis caused by methicillin-sensitive Staphylococcus aureus a year ago.[ncbi.nlm.nih.gov]
  • Thisreport describes the case of a male patient with catarrhal symptoms, generalizedtenderness, and low-grade fever, diagnosed with atrial fibrillation and -throughechocardiography- a mobile, elongated mass in the right atrium.[ppct.caicyt.gov.ar]
Chills
  • We report the case of a 41-year-old woman who presented with fever and chills. She had a history of infective endocarditis caused by methicillin-sensitive Staphylococcus aureus a year ago.[ncbi.nlm.nih.gov]
Intravenous Drugs
  • Page 77 - Influence of human immunodeficiency virus i infection and degree of immunosuppression in the clinical characteristics and outcome of infective endocarditis in intravenous drug users. Arch Intern Med... ‎[books.google.com]
Hypoxemia
  • Srinivas CV, Collins N, Borger MA, Horlick E, Murphy PM (2007) Hypoxemia complicating LVAD insertion: novel application of the Amplatzer PFO occlusion device. J Card Surg 22:156–158 CrossRef PubMed Google Scholar 38.[link.springer.com]
Heart Disease
  • Cor triatriatum dexter versus prominent Eustachian valve in an adult congenital heart disease patient. Congenit Heart Dis. 2013;8:589-91. Medline 3. Bhatnagar KP, Nettleton GS, Campbell FR, Wagner CE, Kuwabara N, Muresian H.[revespcardiol.org]
  • In congenital heart disease cyanosis is generally due to right to left shunting through congenital cardiac defects, bypassing the pulmonary alveoli, or due to acquired intrapulmonary shunts (central cyanosis).[cachnet.org]
  • In: Allen HD, Gutgesell HP, Clark EB, Driscoll DJ (eds) Moss and Adams’ heart disease in infants, children, and adolescents including the fetus and young adults, vol 1, 6th edn. Lippincott Williams & Wilkins, Philadelphia, p 87 Google Scholar 10.[link.springer.com]
  • Cor triatriatum dexter versus prominent eustachian valve in an adult congenital heart disease patient . Congenit Heart Dis 2012 , . doi: 10.1111/j.1747-0803.2012.00648.x . [Epub ahead of print]. 6. Aypar , E , Sert , A , Odabas , D .[cambridge.org]
  • J Clin Ultrasound 1995; 23:502–4Fiorilli, R Argento, G Tomasco, B Serino, W Valdes-Cruz LM, Cayre RO: Anomalies of the tricuspid valve and right atrium, Echocardiographic Diagnosis of Congenital Heart Disease.[anesthesiology.pubs.asahq.org]
Withdrawn
  • When the cannula is withdrawn slightly, the fibers appear snagged to its tip. The balloon is often not easily visualized because of thin wall and filling with saline/blood cardioplegia, which has similar acoustic properties to blood.[journals.lww.com]
Excitement
  • Some dream of meeting their favorite celebrity, enjoying the fun and thrills of a theme or amusement park, traveling to an exciting destination, being a VIP on a day of shopping, or receiving the latest in electronics.[kidswishnetwork.org]

Workup

  • As a part of the workup for respiratory distress at the referring hospital, a chest CT scan had been obtained [Figure 1].[annals.in]
Staphylococcus Aureus
  • She had a history of infective endocarditis caused by methicillin-sensitive Staphylococcus aureus a year ago. Echocardiography did not reveal the presence of any vegetation on any of the cardiac valves.[ncbi.nlm.nih.gov]
2:1 Atrioventricular Block
  • An 82-year-old woman with 2:1 atrioventricular block underwent a pacemaker implantation procedure, but a tined lead became entrapped by the Chiari network.[ncbi.nlm.nih.gov]

Treatment

  • Transoesophageal echocardiogram confirmed entrapment of a thrombus within the Chiari network, which was not visualised following treatment on repeat scanning 1 month later.[ncbi.nlm.nih.gov]
  • Elevated pre-treatment levels of PAI-1 may reduce the efficacy of thrombolytic therapy by preventing or retarding clot dissolution.[ncbi.nlm.nih.gov]
  • In this presented case, the Chiari network displayed a protective function but the expansion and organisation of the thromboembolus found there made it resistant to lytic treatment.[ncbi.nlm.nih.gov]
  • Following thrombolytic treatment the right atrial serpiginous thrombus and apical thrombus disappeared. The patient was discharged 10 days later in excellent general condition on oral anticoagulant treatment.[heart.bmj.com]
  • Differentetiological entities were proposed, and finally heparin treatment was started,which resolved the mass with persistence of a filamentous structure consistentwith Chiari s network.[ppct.caicyt.gov.ar]

Prognosis

  • Treatment and prognosis A cor triatriatum is usually fatal within the first two years of life. The membrane can be surgically resected.[radiopaedia.org]

Etiology

  • Cardiac chiari network as an etiology for embolic stroke. J Stroke Cerebrovasc Dis 1994; 4 (4):238-241. Rizzello V, Lombardo A, Colizzi C, Pennestrì F.[ppct.caicyt.gov.ar]
  • Without argument, paradoxical embolism, defined as an arterial embolic event without evidence of a left-sided source, is one possible etiology for cryptogenic stroke.[citoday.com]

Pathophysiology

  • Patent Foramen Ovale: Current Pathology, Pathophysiology, and Clinical Status J. Am. Coll.[wikidoc.org]
  • Although the paradoxical embolism following Chiari network is uncommon, the characteristics of the Chiari network described here might explain the pathophysiology of a paradoxical embolism [4]. Also, how to deal with Chiari network is controversial.[oatext.com]

Prevention

  • The network perhaps functioned as an inferior vena cava filter preventing massive pulmonary embolus.[ncbi.nlm.nih.gov]
  • Here the authors describe how the Chiari network may have prevented the occurrence of a fatal massive pulmonary embolism in a patient with a high pro-thrombotic tendency, and review the current literature regarding the action of this anatomic variant[ncbi.nlm.nih.gov]
  • Elevated pre-treatment levels of PAI-1 may reduce the efficacy of thrombolytic therapy by preventing or retarding clot dissolution.[ncbi.nlm.nih.gov]
  • Tines equipped near the tip of a pacemaker lead are intended to prevent dislodgment, but entrapment of the tined tip by intracardiac structures is probable.[ncbi.nlm.nih.gov]
  • Also preventing from right atrium catheter implantation, pace wire lead insertion and CPB cannulation are related to Chiari network [12-14]. In thrombophilia it acts such as inferior vena cava filter and prevents emboli [15].[oatext.com]

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