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Fig. 1 | Critical Care

Fig. 1

From: Prevalence and impact of Eustachian valve on the diagnosis of patent foramen ovale in patients ventilated for an acute respiratory distress syndrome

Fig. 1

Transesophageal contrast study conducted in a ventilated ARDS patient with a prominent Eustachian valve and a patent foramen ovale with grade 2 interatrial right-to-left shunt. The bicaval view depicts an Eustachian valve in both two- and real-time three-dimensional imaging (upper panels, arrow). When the contrast study is performed through the superior vena cava (SVC), the microbubbles fail to reach the fossa ovalis, and the right atrium is incompletely opacified due to the presence of the Eustachian valve (arrow), in both the longitudinal bicaval view (90°, middle left panel) and transverse view (0°, middle right panel). When the contrast study is performed through the inferior vena cava (IVC), right atrial opacification is complete and allows the identification of a patent foramen ovale with microbubbles entering the left atrium during the first three cardiac cycle (arrows), in both the longitudinal bicaval view (90°, lower left panel) and transverse view (0°, lower right panel). Abbreviations: LA left atrium, RA right atrium, Ao ascending aorta, SVC superior vena cava, IVC inferior vena cava

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Critical Care

ISSN: 1364-8535