Published online Jul 26, 2021. doi: 10.4330/wjc.v13.i7.204
Peer-review started: December 21, 2020
First decision: December 27, 2020
Revised: January 6, 2021
Accepted: March 26, 2021
Article in press: March 26, 2021
Published online: July 26, 2021
Catheter-based closure of patent foramen ovale (PFO) is more effective than medical therapy in the prevention of recurrent stroke. It is likely that a proportion of patients evaluated for potential transcatheter PFO closure has actually different anatomical variants particularly common in the right atrium such as eustachian valve, Chiari network, Thebesian valve and Crista Terminalis. Notably, the eustachian valve may represent an increased risk factor for left circulation thromboembolism beyond that associated with PFO size and shunting. Such patients may benefit the most from percutaneous closure procedure.
Core Tip: Eustachian valve is usually considered to be a benign finding in the absence of associated cardiac anomalies. Moreover, eustachian valve is frequently found in adult patients with septal abnormalities mainly patent foramen ovale. It may actively facilitate the mechanism of paradoxical embolism by directing the blood from the inferior vena cava towards the interatrial septum via patent foramen ovale into the left atrium. Therefore, the presence of such anatomic variant may represent per se an increased risk factor for left circulation thromboembolism.