Abstract
Chiari network is an embryonic remnant of the right sinus venosus. It appears as a thin, fenestrated membrane attached to two or more regions within the right atrium. Usually, a Chiari network has a benign course; however, rare complications associated with a Chiari network have been reported. We present the case of a neonate with hypoxemia and a Chiari network protruding into the right ventricular inflow tract associated with right-to-left shunting across the patent foramen ovale throughout the cardiac cycle. We noted spontaneous improvement after 3 weeks of life.
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References
Chiari H (1897) Ueber netzbildungen im rechten vorhofe des herzens. Beitr Pathol Anat 22:1–10
Powell ED, Mullaney JM (1960) The Chiari network and the valve of the inferior vena cava. Br Heart J 22:579–584. https://doi.org/10.1136/hrt.22.4.579
Schneider B, Hofmann T, Justen MH, Meinertz T (1995) Chiari’s network: normal anatomic variant or risk factor for arterial embolic events? J Am Coll Cardiol 26:203–210. https://doi.org/10.1016/0735-1097(95)00144-O
Clements J, Sobotka-Plojhar M, Exalto N, van Geijn HP (1982) A connective tissue membrane in the right atrium (Chiari’s network) as a cause of fetal cardiac arrhythmia. Am J Obstet Gynecol 142:709–712. https://doi.org/10.1016/S0002-9378(16)32448-6
Gussenhoven WJ, Essed CE, Bos E (1982) Persistent right sinus venosus valve. Heart 47:183–185. https://doi.org/10.1136/hrt.47.2.183
Bendadi F, van Tijn DA, Pistorius L, Freund MW (2012) Chiari’s network as a cause of fetal and neonatal pathology. Pediatr Cardiol 33:188–191. https://doi.org/10.1007/s00246-011-0114-6
Werner JA, Cheitlin MD, Gross BW et al (1981) Echocardiographic appearance of the Chiari network: differentiation from right-heart pathology. Circulation 63:1104–1109. https://doi.org/10.1161/01.CIR.63.5.1104
Walpot J, Sahin-Arpaci G, Sadreddini M (2015) A Chiari network mimicking a cystic structure. Netherlands Hear J 23:70–71. https://doi.org/10.1007/s12471-014-0621-1
El-Khouri H, Putman D, Rutkowski M (1998) Unusual case of prominent Chiari network trapped in the left atrium. J Am Soc Echocardiogr 11:71–73. https://doi.org/10.1016/S0894-7317(98)70123-3
Akçaboy Mİ, Ekici F, Tutar E (2006) unusually redundant Chiari network. Pediatr Cardiol 27:525–526. https://doi.org/10.1007/s00246-006-6007-4
Ko H-S, Chen M-R, Lin Y-C (2011) A huge Chiari network presenting with persistent cyanosis in a neonate. Pediatr Cardiol 32:239–240. https://doi.org/10.1007/s00246-010-9857-8
Salameh N, Nair P, Salamehova L (2017) G414(P) Unusual cause of cyanosis in a newborn. Arch Dis Childhood 102:A163
Qureshi AU, Latiff HA, Sivalingam S (2014) Persistent valve of systemic venous sinus: a cause of neonatal cyanosis. Cardiol Young 24:756–759. https://doi.org/10.1017/S1047951113001200
Trento A, Zuberbuhler JR, Anderson RH et al (1988) Divided right atrium (prominence of the eustachian and thebesian valves). J Thorac Cardiovasc Surg 96:457–463
Ward C, Joseph L, Doshi H et al (2016) Atrial septal aneurysm and Chiari network are not innocent bystanders: association with cardiomyopathy, cardiac conduction abnormalities, and arrhythmias exist. J Am Coll Cardiol 67:1324. https://doi.org/10.1016/S0735-1097(16)31325-0
Loukas M, Sullivan A, Tubbs RS et al (2010) Chiari’s network: review of the literature. Surg Radiol Anat 32:895–901. https://doi.org/10.1007/s00276-010-0639-z
Payne DM, Baskett RJ, Hirsch GM (2003) Infectious endocarditis of a Chiari network. Ann Thorac Surg 76:1303–1305. https://doi.org/10.1016/S0003-4975(03)00522-8
Szirt R, Youssef GS (2017) Acute right to left shunt—combination of tricuspid valve endocarditis, Chiari network, and ostium secundum atrial septal defect. J Cardiol cases 16:151–153
Goldschlager A, Goldschlager N, Brewster H, Kaplan J (1972) Catheter entrapment in a Chiari network involving an atrial septal defect. Chest 62:345–346. https://doi.org/10.1378/chest.62.3.345
Cooke JC, Gelman JS, Harper RW (1999) Chiari network entanglement and herniation into the left atrium by an atrial septal defect occluder device. J Am Soc Echocardiogr 12:601–603. https://doi.org/10.1016/s0894-7317(99)70009-x
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Supplementary file1—Subcostal long and short-axis views of echocardiography. Chiari Network is demonstrated in the right atrium protruding into the right ventricle through the tricuspid valve (AVI 53103 kb)
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Aljemmali, S., Bokowski, J., Morales, R. et al. Chiari Network Associated with Hypoxemia in a Neonate: Case Report and Review of the Literature. Pediatr Cardiol 41, 1529–1531 (2020). https://doi.org/10.1007/s00246-020-02432-w
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DOI: https://doi.org/10.1007/s00246-020-02432-w