Large Eustachian valve: An incidental finding yet perplexing.

Eustachian valve (EV), a remnant of the right valve of sinus venosus in the right atrium can be puzzling. Often it is confused with Chiari network or atrial adhesions and is reported with unusual complications. We report a case of large EV impeding cannulation of inferior vena cava (IVC) during aortic valve replacement. Transesophageal echocardiography diagnosed the presence of large EV and warned of the difficulty with IVC cannulation and helped preparedness for an alternative plan during surgery.

Pulmonary autograft mitral valve replacement: initial experience with the Ross II procedure.

BACKGROUND: The renewed interest in mitral valve replacement with a pulmonary autograft encouraged us to perform this procedure in selected patients. METHODS AND RESULTS: From August 2000 to February 2002, 10 patients between 30 and 52 years of age with calcific mitral valvular disease underwent the Ross II procedure. Patients were either in New York Heart Association functional class III (7/10) or IV (3/10). Transthoracic echocardiography was done in all the patients to confirm the diagnosis. A pulmonary autograft was used to replace the diseased mitral valve. Intraoperative transesophageal echocardiography confirmed normal functioning of the autograft. There were 2 early deaths. The 8 survivors are in New York Heart Association functional class I with excellent autograft and homograft function at a follow-up of 2-20 months (mean 9 months). CONCLUSIONS: This procedure is a viable option for mitral valve replacement in patients with calcific mitral valve disease. However, the procedure is technically demanding and requires a valve bank.