title: Prominent persisting Eustachian valve initiates spontaneous right-to-left shunt and paradoxical embolism in a patient with patent foramen ovale.
abstract: The Eustachian valve (EV) is an embryological remnant of the inferior vena cava valve that prenatally directs the oxygenated blood from inferior vena cava across the patent foramen ovale (PFO) into systemic circulation. We present a 30-year-old man with PFO whose prominent EV initiated spontaneous right-to-left shunt without Valsalva maneuver and promoted paradoxical embolism. Even when the persistence of EV is prominent in adult, it has been considered to be benign finding in the absence of the associated cardiac anomalies. EV should be considered as an adjunctive risk factor for paradoxical embolism in patients with PFO.
authors.affiliation: Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan. yujik@saitama-med.ac.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Dembo
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Takeda
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000328:Adult; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging* / Q000209:etiology; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging*; D006351:Heart Valves / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D012307:Risk Factors; D014463:Ultrasonography; D014636:Valsalva Maneuver