Chiari’s network: association with other congenital heart diseases

Abstract

AimThe study was performed to assess the prevalence of Chiari’s Network (CN) in a pediatric outpatient department population by using transthoracic echocardiography (TTE) and to determine its association with other cardiac anomalies.Methods2232 children who underwent cardiac examination and TTE at the pediatric cardiology outpatient department of our institution between April 2013 and April 2014 were included in the study. Routine M-mode, 2-D, and Doppler studies were applied. All co-existent lesions were recorded. Ratio between heights of early and late diastolic flow velocity peaks (E/A) were <1 in tricuspid and mitral valves considered as possible right and left diastolic dysfunctions respectively.ResultsOf 2232 children, CN was detected in 76 patients (3.41%) and found most frequently during the first month. Atrial septal defect and patent foramen ovale (ASD/PFO) was the most common congenital defect seen with CN (55.3%). Ten children (13.2%) had peripheral pulmonary stenosis (PPS) and seven (9.21%) showed atrial septal aneurism (ASA) associated with CN. Of patients with CN, a total of 11 patients (14.5%), 10 of them 1-8 days old and 1 of them 17 days old, had E/A<1 in tricuspid valve. Three (3.9%) patients 1-12 days old demonstrated E/A<1 in tricuspid and mitral valves. Twenty-nine of the studied patients (11%) demonstrated E/A<1 in tricuspid valve (90% 1-30 days old). Of the total 2232 patients, 267 individuals (8.4%) showed ASA whereas there were only 7 cases (9.6%) of CN patients.ConclusionCN is an uncommon and incidental finding that should be recognized appropriately. This may not be always a normal variant. Proper documentation of CN is critical regarding possible future complications.

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