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      Abnormal Atrial Depolarization Associated with Chiari Network?


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          The Chiari network, a congenital remnant of fetal membrane in the right atrium, is infrequently associated with complications, such as supraventricular tachyarrhythmias. There have however been no known reports of basic electrocardiographic significance of the Chiari network. We present three consecutive cases of Chiari network found in the presence of abnormal interatrial conduction (P-waves ≧110 ms), which is a potential predictor of atrial tachyarrhythmias.

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          Chiari's network: normal anatomic variant or risk factor for arterial embolic events?

          This study was performed to assess the prevalence of Chiari's network in patients undergoing transesophageal echocardiography and to determine whether this anomaly is associated with other cardiac lesions or is characterized by typical clinical findings. Chiari's network is a congenital remnant of the right valve of the sinus venosus. It has been found in 1.3% to 4% of autopsy studies and is believed to be of little clinical consequence. Video recordings of 1,436 consecutive adult patients evaluated by transesophageal echocardiography over a 30-month period were reviewed for the presence of Chiari's network. Echocardiographic contrast studies had been performed in all patients with Chiari's network and were compared with those of 160 consecutive patients without a Chiari net, serving as a control group. Chiari's network was present in 29 of 1,436 patients (prevalence 2%). A frequently associated finding was a patent foramen ovale in 24 (83%) of the 29 patients with Chiari's network versus 44 (28%) of 160 control patients (p < 0.001). Intense right-to-left shunting occurred significantly more often in patients with Chiari's network than in control patients (16 [55%] of 29 patients vs. 19 [12%] of 160 control patients, p < 0.001). Another frequent association was an atrial septal aneurysm in 7 (24%) of 29 patients. The indication for transesophageal echocardiography was a suspected cardiac source of arterial embolism in 24 (83%) of 29 patients with a Chiari net, 13 of whom (54%) had recurrent embolic events. Chiari's network was significantly more common in patients with unexplained arterial embolism than in patients evaluated for other indications (24 [4.6%] of 522 patients vs. 5 [0.5%] of 914 patients, p < 0.001). Potential causes for arterial embolism were present in 9 of the 24 patients with a Chiari net and embolic events (atrial septal aneurysm in 7, cerebrovascular lesion in 2). In 15 (62%) of 24 patients only a patent foramen ovale could be identified. Three patients had deep venous thrombosis and pulmonary embolism at the time of arterial embolism; none had a thrombus detected within the network. In patients undergoing transesophageal echocardiography, the prevalence of Chiari's network was 2%, which is consistent with autopsy studies. By maintaining an embryonic right atrial flow pattern into adult life and directing the blood from the inferior vena cava preferentially toward the interatrial septum, Chiari's network may favor persistence of a patent foramen ovale and formation of an atrial septal aneurysm and facilitate paradoxic embolism.
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            Echocardiographic appearance of the Chiari network: differentiation from right-heart pathology.

            As echocardiography is being used more often, its value and accuracy are becoming more fully appreciated. Coincident with wider application of this imaging technique is the potential for identifying normal anatomic variants and their possible erroneous interpretation as pathologic states. In this report we describe the M-mode and two-dimensional echocardiographic features of a congenital remnant known as the Chiari network. This structure can present as a highly mobile, highly reflectant echo target that can be seen in several locations in the right atrium. We report here an index case that could be well examined echocardiographically and that was a cause of considerable concern due to the presence of congestive heart failure and a history of staphylococcal endocarditis. The presence of the Chiari network was confirmed pathologically. Subsequently, we found similar echocardiographic findings in 19 of 1248 patients (1.5%) studied in our laboratory. This congenital remnant, which is found pathologically in 2-3% of normal hearts, could be confused with valve disruption, vegetation or other mass lesion, particularly when associated with a suggestive clinical situation.
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              Interatrial block: pandemic prevalence, significance, and diagnosis.


                Author and article information

                S. Karger AG
                September 2007
                07 November 2006
                : 108
                : 3
                : 214-216
                Departments of Medicine, aSaint Vincent Hospital, and bDivision of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass., USA; cDivision of Cardiology, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
                96780 Cardiology 2007;108:214–216
                © 2007 S. Karger AG, Basel

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                Figures: 1, References: 10, Pages: 3
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