Chiari network diagnosed in pregnancy. Is it a risk?
GINNER O. RIZO-RIVERA, VIRGINIA ROVIRA DE RIZO, JOSÉ M. RIVERO
Hospital Victoria Motta. (67) Jinotega, Nicaragua E-mail
Recibido 07-FEB-2019 – ACEPTADO después de revisión 21-MARZO-2019.
There are no conflicts of interest to disclose.
Currently, 0.2-4% of all pregnancies in western industrialized countries are complicated by cardiovascular diseases (CVD), with an increasing number of patients suffering cardiac problems during pregnancy. Knowledge on associated cardiovascular risks during pregnancy and its timely treatment is fundamentally important to advise patients before and during pregnancy .
An 18-year-old patient, with 28 weeks of pregnancy was admitted into the obstetric control ward due to presenting palpitations and murmur with episodic dyspnea of moderate intensity with medium strain (typical of pregnancy). In the physical examination, mid-systolic ejection murmur was verified in aortic and pulmonary focus III/VI of functional characteristics.
Echocardiogram to confirm the functional nature of the murmur showed hyperechoic structure with 2 cm of length and 0.4 cm of width, extremely mobile (whiplash movement), with interatrial septum extension and independent from the tricuspid valve. There was no evidence of patent foramen ovale (Arrows, Figures 1 and 2).
These data are typical of a Chiari network, a structure constituted by reticulated network of fiber tissue, that is a remnant or a vestige of the right venous sine valve, documented in 2-3% of the population . It extends from the base of the inferior vena cava to the atrial wall, and occasionally it may prolapse during diastole into the tricuspid valve. It is usually asymptomatic, it may be complicated with atrial fibrillation, thrombi formation, catheter jamming, paradoxical embolism, infectious endocarditis and atrial tumors . If there are no associated malformations, it is suggested to classify it as heart disease WHO1 during pregnancy . The patient evolved with no complications.