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Dr Stefan Scholz

The Liverpool Heart & Chest Hospital

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bicaval

RA

LA

SVC

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EmbryonicStructures

StructuresLeft Atrial Appendage

Degenerated

Aortic ValveMuscle Bundles

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AV SAX

RA

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30-60 % of adults

Associated with PFO

Associated with

Atrial Flutter

Rarely Endocarditis

bicavalIVC

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V. cava

superior

V. cavainferior

coronary

sinus

right

sinus horn

left

sinus horn

Bulbuscordis

24 days

right

sinus horn

left

sinus horn

LV RV

35 days

RA

TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins

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Sinus

venarum

Crista

terminalis

Valve

IVC

Valve

CS

normal

prominentEustachian

Valve

Cor

triatriatum

TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins

HD Allen et al.: Heart Disease in Infants, Children and Adolescents,

6th edition, Lippincott Williams & Wilikins

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bicavalIVC

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AV SAXRA

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bicavalSVC

= Cor triatriatrum

dexter

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bicaval

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bicaval

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4 chamber

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bicaval

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2-10 % prevalence

Variable

Associated with

PFO (80 %) Thromboembolism

Rarely Endocarditis

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bicaval 4 chamber

normal endocarditis

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bicaval

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Separates muscular from

smooth part of RA

Causes supraventricular

Arrhythmia

AV block

SVC

IVC

Crista

terminalis

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bicaval

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1-8 % prevalence

Benign

Foramen ovale

omitted, hour glass

SupraventricularArrhythmia (> 3cm)

Cava-Obstruction

(rare)

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bicaval bicaval

increased flow

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bicaval

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Mm

pectinatae

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bicaval

Crista terminalis Mm pectinatae

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bicaval

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4 chamber

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Coronarysinus

Superiorvena cava Left brachio-

cephalic vein

Right anteriorcardinal vein

Left anterior

cardinal vein

Right commoncardinal vein

Left commoncardinal vein

Anastomosis

7th week

TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins

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Right brachio-

cephalic vein

Cornary

sinus

Left superior

vena cava

Right superior

vena cava

Double superior

vena cava TW Sadler : Langmans Medical Embr yology, 10th edition, Lippincott Williams & Wilkins

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0.5 % of all adults

Localised between LAAand LUPV

Often asymptomatic

In childhood 40%

associated with ASD,ISTHA...

Problems with Catheters

DDx high RA pressure

4 Kammer

1cm

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left-sided injection right-sided injection

4 chamber bicavalSVC

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AV SAXLA

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Pericardial reflection

between descending

aorta and left atrium

Enlarged with extra-

cardial thrombus,pericardial effusion

DDx abscess (CD)

Transverse

sinus

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AV SAXLA

AV SAXLA

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AV SAXLA

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Often confounded with

LAA thrombus

Warfarin - Ridge

(Coumadin-

synonymous)

Variable form

AV SAXLA

LAA

LUPV

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AV SAXLA

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Analog RA

Variable Shape

DDx can be difficult

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AV SAXLA

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3D

Lobulus 1

Lobulus 2

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AV SAXLA

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AV SAXLA

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AV SAXLA

AV SAXLA

LAA Thrombus LAA bilobr

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AV SAXLA

4 Kammer

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4 chamber

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LVOT

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Along valve closure

lines (AoV, MV)

Upstream and

downstream

Up to1mm thick und

bis 5mm long

Can embolize

DDx: Fibroelastoma

(pedunculated, larger)

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LVOT

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LVOTAV SAX

LA

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4 Kammer

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4 chamber 4 chamber

LV Thrombus

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4 chamber

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Density in comparism with surroundingstructures?

Synchronous with cardiac action?

Second sign (valve regurgitation,smoke in LAA....)?