Fig 3 - uploaded by Blanca Mompeo
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Diaphragmatic surface of the heart. The coronary sinus is opened. It is possible to observe the differences between the right and the left part of the coronary sinus.
Source publication
We report an association between a Chiari network and an abnormally long coronary sinus. The network, at the Eustachian valve and a morphologically similar network in the Thebesian valve, was also associated with a permeable foramen ovale. We review the embryological basis, associated anomalies, pathological conditions and clinical rele-vance.
Context in source publication
Context 1
... coronary sinus was 80 mm in length between its orifice in the right atrium and the Vieussens valve, which separate the coronary sinus from the great cardiac vein. The left part of the coronary sinus was 15 mm wide and the right part 20 mm wide. The coronary sinus atrial opening was 14.7 mm in diameter and 46 mm in length (Fig. ...
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Citations
... The Chiari network is a mobile, fenestrated anatomic variant seen in the right atrium of about 1.5-3% of the population [2,3] and has been described as an embryonic remnant of the right valve of the venous sinus [4]. ...
Introduction
The Chiari network is an uncommon vestigial structure of the heart that is often clinically insignificant. We present an unusual case of infective endocarditis affecting only the Chiari network in a patient who presented with septic emboli to the lungs and brain.
Case summary
A 61-year-old man was admitted with a 2-month history of hemoptysis, pleuritic chest pain, and right upper extremity numbness and weakness. He was found to have multifocal bilateral pulmonary opacities and an abscess collection in the brain. Blood cultures grew Streptococcus intermedius and transthoracic echocardiogram (TTE) was normal. Subsequent transesophageal echocardiogram (TEE) revealed an 8.3 × 4.6 mm vegetation arising from the Chiari network, close to the right atrial appendage, without involvement of the tricuspid valve or any of the other valves. There were no atrial or ventricular septal defects. He was treated with appropriate antibiotics with improvement of symptoms. Repeat imaging showed improvement of the lung opacities, but not the brain abscess, warranting transfer to another hospital for neurosurgical intervention.
Conclusion
The diagnosis and management of isolated Chiari network endocarditis require a high index of clinical suspicion. A multidisciplinary approach incorporating both medical and surgical approaches where necessary is essential for optimal outcome.
