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A Worm in the Heart: One of a Kind!

Published:December 21, 2022DOI:https://doi.org/10.1053/j.jvca.2022.12.015
      To the Editor:
      The presence of artifacts during transesophageal echocardiography (TEE) is well-described. The patient was a 21-year-old woman who had previously undergone tetralogy of Fallot repair as an infant and now presented for pulmonic valve replacement due to severe pulmonic regurgitation. She reported a chronic history of recurrent right pleural effusion that required intermittent drainage. Intraoperative TEE showed a slender, writhing structure lateral to the right atrium, which was attached to it at one point (Fig 1; Video 1). The structure was floating outside the right atrium and showed unique mobility that disappeared after the right pleural cavity was opened. During surgery, the structure was identified as a broken loculated membrane in a pleural effusion. Though TEE detection and quantification of pleural effusion are well-established, the current presentation was highly unusual.
      • Capper SJ
      • Ross JJ
      • Sandström E
      • et al.
      Transoesophageal echocardiography for the detection and quantification of pleural fluid in cardiac surgical patients.
      ,
      • Orihashi K
      • Hong YW
      • Chung G
      • et al.
      New applications of two-dimensional transesophageal echocardiography in cardiac surgery.
      Fig 1
      Fig 1Midesophageal 4-chamber view with transesophageal probe rotated towards the right side showing a worm-like structure (red arrow) attached to the right atrium (red star). The pleural effusion is indicated by a red circle.

      Conflict of Interest

      None.

      Appendix. Supplementary materials

      References

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