Differential Diagnosis and Clinical Implications of Remnants of the Right Valve of the Sinus Venosus
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Club de revistas:Diagnóstico diferencial e
implicaciones clínicas de los remanentes de la valva derecha
del seno venosoRicardo Poveda Jaramillo
Fellow Anestesia Cardiovascular
Universidad CES
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Atrio derechoCresta
terminalisMitad
posterior lisa
Mitad anterior con
músculos pectinados +
auriculilla
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Estructura Cor triatriatum Dexter Red de Chiari Válvula de
EustaquioVálvula de
Tebesio
Definición y embriología
Persistencia de la valva derecha del seno venoso, quedivide la aurícula derecha en dos cámaras.
Reabsorción incompleta de la valva derecha del seno venoso y el septum spurium, formando una red reticulada de fibras.
Remanente caudal de la valva derecha del seno venoso situado en el orificio de la vena cava inferior.
Remanente caudal de la válvula derecha del seno venoso situado en el orificio del seno coronario.
Descrita por primera vez
Carl von Rokitansky (1875)
Hans Chiari (1897)
Bartolomeo Eustaquio (1563)
Adam Cristiano Tebesio (1708)
Prevalencia
<0,025% del total de cardiopatías congénitas
2% -15% con las técnicas de imagen actuales y estudios de autopsia
>50% con las técnicas de imagen actuales.13% de los pacientes con ictus criptogénico
65% -90% con las técnicas de imagen actuales y estudios de autopsia
Morfología
Ampliación de la membrana fenestrada que separa la aurícula derecha en dos cavidades
Delgada estructura similar a una red con el movimiento de látigo
• Media luna• Reborde• Red de hebras
• Membrana semilunar
• Hebras fibrosas• Membrana
fenestrada
Inserción
Cresta terminalis • Parte superior de la aurícula derecha
• Septum interatrial
• Tubérculo inferior
En el margen del orificio de IVC
Por lo general, en el margen inferior o posterior del orificio del SC
Tamaño -> 1,0 cm (longitud media 3,0 cm)
1 +- 0,4 cm (TEE en vista bicava)Prominente VE: medias> 1,0 cm
0,5 cm (rango, 0,1-1,2 cm)
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Complicaciones
Tres entidades pueden adherirse o crecer en los remanentes de la valva derecha del seno venoso: - trombos, - endocarditis infecciosa, y - tumores .
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Interacción con FOP
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Interacción con FOP
Más de 80 % de los pacientes con Red de Chiari y aproximadamente 70 % de
aquellos con Válvula de Eustaquio tienen FOP
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Interacción con FOP
• Embolias recurrentes en el lado izquierdo (accidentes criptogenéticos cerebrovasculares, infartos renales, infartos de miocardio, etc.)
• Síndrome de platipnea-ortodeoxia • Síndrome de descompresión en
buzos
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Tratamiento
Sólo sí hay comportamiento obstructivo del
remanente.
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Implicaciones
Dificulta procedimientos
invasivos percutáneos que avanzan
catéteres/dispositivos al atrio derecho
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Conclusiones
• No son variantes anatómicas exóticas
• Su no consideración puede acarrear diagnósticos y tratamientos errados
• Pueden entorpecer la realización de procedimientos
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“Se non avete fiducia in se stesso, si è due volte sconfitto
nella corsa della vita. Con fiducia, hai vinto ancora prima
di aver cominciato” Marco Tullio Cicerone
Grazie