title: The "pull-push" technique to deal with a redundant eustachian valve interfering with placement of a PFO occluder.
abstract: OBJECTIVE
  To evaluate the role of a new technique to deal with a redundant Eustachian valve (EV) interfering with placement of a patent foramen ovale (PFO) occluder.
  
  
  BACKGROUND
  The EV is a remnant of the embryonic valve of the sinus venosus. In rare occasions, it is large and redundant and it may interfere with catheters and devices used in cardiac catheterization.
  
  
  METHODS
  We have developed a new technique to control the EV in order to avoid interferences with the device for closure of atrial septal defects and PFO's. This technique is called "pull-push" technique and consists in pulling down on the inferior vena cava the redundant EV by using a 6 Fr pigtail catheter while a second operator pushes the right atrial disc out of the long sheath.
  
  
  RESULTS
  Here, we report on two patients with a patent foramen ovale, in whom the EV prevented the right atrial disc of an Amplatzer PFO occluder to be completely flat against the interatrial septum. Finally, we used this technique in one more patient to avoid any interference of a very redundant EV during placement of a Starflex device.
  
  
  CONCLUSIONS
  In conclusion. the so called "pull-push" technique is an alternative and easy technique to control the EV in order to avoid interferences with the device for closure of atrial septal defects and PFO's
authors.affiliation: Pediatric Cardiology, Istituto Policlinico San Donato, San Donato Milanese, Italy. gianfra.but@lycos.com
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Butera
authors.forename: Antonio
authors.initials: A
authors.lastname: Montinaro
authors.forename: Mario
authors.initials: M
authors.lastname: Carminati
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000002:abnormalities*