Atrial septal pouch — Morphological features and clinical considerations

Hołda, Mateusz K.; Koziej, Mateusz; Hołda, Jakub; Piątek, Katarzyna; Tyrak, Kamil; Chołopiak, Weronika; Bolechała, Filip; Walocha, Jerzy; Klimek‐Piotrowska, Wiesława

doi:10.1016/j.ijcard.2016.06.141

Cited by 50 publications

(84 citation statements)

References 24 publications

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“…The maximum depth (D) and ostium height (H) of the pouches were measured in the multi-planar reconstruction for MSCT. The BiCaval 90°-120° view was used when measuring in 2D-TEE, which anatomically corresponds to the long axis of the SP [1]. The 2D-TEE measurements were performed in the 60-70% phase (diastole).…”

Section: Image Interpretationmentioning

confidence: 99%

“…The ostium height (H) was defined for left-sided SPs as the maximum distance between its free wall and left atrial wall and for right-sided SPs as the largest distance between the fossa ovalis floor and the left surface of the antero-superior rim. The SP volume was calculated using the formula: [1]. All of the measurements were made by two independent researchers (M.K.H and A.K-O.)…”

Section: Image Interpretationmentioning

confidence: 99%

“…The atrial septal pouch (SP) is a new anatomical entity within the human interatrial septum [1,2]. A SP is a kangaroo pouch-like structure (diverticulum) that occurs when the patent foramen ovale (PFO) channel is absent but the septum primum and septum secundum are partially fused, with no connection between both atria.…”

Section: Introductionmentioning

confidence: 99%

“…A SP is a kangaroo pouch-like structure (diverticulum) that occurs when the patent foramen ovale (PFO) channel is absent but the septum primum and septum secundum are partially fused, with no connection between both atria. The diverticulum may be located either on the left or right side of the interatrial septum; left and right SPs may also coexist in the same heart (double SP) [1]. The term "left-sided SP" describes a pouch located on the left side of the interatrial septum (left and double); while the "right-sided SP" is used when the pouch is present on the right side of the septum (right and double).…”

Section: Introductionmentioning

confidence: 99%

“…The term "left-sided SP" describes a pouch located on the left side of the interatrial septum (left and double); while the "right-sided SP" is used when the pouch is present on the right side of the septum (right and double). The high prevalence of SPs (over 50% of the healthy population) indicates that the pouch is not a pathology, but rather is an element of normal human anatomy [1,[3][4][5]. However, the left-sided SP, as an element of human morphology, may play a significant clinical role in the pathogenesis of cerebrovascular accidents and atrial fibrillation.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches

Hołda

Krawczyk‐Ożóg

Koziej

et al. 2018

Int J Cardiovasc Imaging

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The aim of this study is to compare the two-dimensional transesophageal echocardiography (2D-TEE) with multi-slice computed tomography (MSCT) and with autopsied material to evaluate the ability and precision of the imaging methods for the detection and assessment of septal pouch (SP). One hundred and fifty patients that underwent both 2D-TEE and MSCT and 50 autopsied human hearts were investigated. In MSCT, the interatrial septum was classified as a left SP in 37.3%, right SP in 3.3%, and patent foramen ovale (PFO) channel in 3.3%. In 2D-TEE, the interatrial septum was classified as a left SP in 39.3%, right SP in 11.3%, double SP in 4.7%, and PFO channel in 2.0%. The weighted kappa coefficient between MSCT and 2D-TEE in assessing the septum morphology was 0.59. The prevalence of the left SP is lower when it is evaluated by MSCT or 2D-TEE than by anatomical study, but this difference is insignificant (37.3% vs. 44.0%, p = 0.40, and 39.3% vs. 44.0%, p = 0.56, respectively). The prevalence of left SPs is lower when detected by MSCT or 2D-TEE than during autopsy, but the difference is statistically insignificant (37.3% vs. 44.0%, p = 0.40, and 39.3% vs. 44.0%, p = 0.56, respectively). Both 2D-TEE and MSCT are comparable techniques for detecting left-sided SPs with the insignificant lower prevalence of detecting left-sided SPs compared to autopsied material. However, TEE with the contrast seems to be superior over MSCT due to the possibility of unambiguous PFO channel detection. Therefore, TEE with contrast should be preferred over MSCT in the identification of left-sided SPs.

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Section: Image Interpretationmentioning

confidence: 99%

Section: Image Interpretationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches

Hołda

Krawczyk‐Ożóg

Koziej

et al. 2018

Int J Cardiovasc Imaging

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Formation of the interatrial septum: Insights obtained from cardiac computed tomographic angiography

Tahara,

Motoyama,

Malik

et al. 2024

Clinical Anatomy

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We previously described a septal variant termed left atrial septal pouch (LASP). Present in a third of hearts, it results from incomplete fusion of the septum primum (SP) and septum secundum (SS). We assessed the prevalence of LASP using 64‐section multidetector computed tomography and further characterized the different variants. Among 864 scans, 770 were of sufficient quality for assessment (428 male, aged 59.2 ± 11.7 years). They were classified on the basis of the degrees of fusion of the SP and SS into a completely fused septum (CFS), patent foramen ovale (PFO), or LASP. The lengths of the SS, SP, and overlapping SP, the maximal length of the foramen ovale (FO) floor, and the atrial dimensions were compared. A PFO was seen in 181 patients (23.5%), a LASP in 242 (31.4%), and a CFS in 339 (44.0%). There were significant differences in the length of the SS (PFO—13.6 ± 4.3 mm, LASP—17.6 ± 4.8 mm, CFS—14.3 ± 7.7 mm, p < 0.001). Hearts with LASPs had a longer overlapping SP than those with PFOs (PFO—6.3 ± 4.5 mm, LASP—13.1 ± 5.2 mm, p < 0.001). The maximal lengths of the FO floor showed differences in short axis (SAX) view (PFO—21.7 ± 4.5 mm, LASP—15.3 ± 4.3 mm, CFS—16.3 ± 4.3 mm, p < 0.001). Hearts with PFO and LASP showed similar SP lengths (27.3 ± 6.6 mm vs. 26.4 ± 6.6 mm, p = 0.10). There was a positive linear correlation between the length of the SS and the overlapping SP (R2 = 0.28, p < 0.001) with a weaker negative correlation between the SS length and maximal length of the FO floor (R2 = 0.02, p < 0.001). The groups showed similar atrial dimensions and volumes. Present in a third of patients, hearts with LASP have longer SS and overlapping SP.

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Morphological Characteristics of Interatrial Septum and Its Clinical Relevance

Chopra,

Manik

et al. 2024

Cathet Cardio Intervent

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BackgroundThe development of new trans‐septal transcatheter interventions for patients with structural heart disease necessitates a precise and comprehensive understanding of the anatomy of the interatrial septum (IAS). The scarcity of gross anatomical studies has triggered our interest in exploring the morphometry and morphology of IAS.AimsTo study the morphology, morphometry and variations of the interatrial septum in autopsied human hearts.MethodsThe study was conducted on 97 autopsied fresh human hearts, in which we observed the position and shape of fossa ovalis (FOv), along with prominence of the limbus and its location. The diameter of FOv, thickness of its floor, redundancy and any variation in the IAS were noted.ResultsIn most cases (72.9%), the FOv was situated toward the inferior vena cava and was oval shaped (69.8%), with mean horizontal and vertical diameters of 17.21 ± 4.11 mm and 12.74 ± 3.78 mm, respectively. The limbus was prominent in 72.2% specimens, most commonly prominent all around (36.6%), followed by antero‐superior (28.2%), antero‐inferior (16.9%) and anterior (8.5%) prominence. The mean thickness of the floor of FOv was 0.71 ± 0.98 mm, and redundancy was observed in 47% of samples. Probe patency was seen only in 10.3% specimens. The right surface of the IAS showed more variations (71.1%) compared to the left (44.3%), in form of recesses, atrial septal pouches, fibrous strands, retinacular‐type fibrous networks and combination of more than one type.ConclusionVariations in the location of FOv, the prominence of limbus and the common occurrence of anatomical variants of the IAS mandate the preprocedural imaging of the region to reduce the failure rate and complications.

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Atrial septal pouch — Morphological features and clinical considerations

Cited by 50 publications

References 24 publications

Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches

Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches

Formation of the interatrial septum: Insights obtained from cardiac computed tomographic angiography

Morphological Characteristics of Interatrial Septum and Its Clinical Relevance

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