Elongated eustachian valve dividing the right atrium

A 64-year-old man underwent transthoracic echocardiography after a syncopal event. Two-dimensional imaging demonstrated a linear density that appeared to divide the right atrium. Color doppler imaging demonstrated that inflow from the inferior vena cava, but not from the superior vena cava, was obstructed by this density. Injection of agitated saline through an upper extremity vein demonstrated that the linear density did create a functional separation of the right atrium. The contrast material also crossed the interatrial septum within two cardiac cycles. This constellation of findings is consistent with an elongated eustachian valve and a patent foramen ovale.