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

Hołda, Mateusz K.; Krawczyk‐Ożóg, Agata; Koziej, Mateusz; Pawlik, Wiesław W.; Sorysz, Danuta; Wszołek, Karolina; Dudek, Dariusz; Klimek‐Piotrowska, Wiesława

doi:10.1007/s10554-018-1342-0

Cited by 18 publications

(10 citation statements)

References 15 publications

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“…This warrants further investigation into whether LASP contributes to increased stroke risk by engendering atrial cardiomyopathy or arrhythmias. The overall prevalence of LASP in this study (31%) is lower than the prevalence in autopsy studies (39% [7]; 47% [8]) but within the range determined by prior TEE-based studies (11% to 48% [18]) and comparable with studies using CT scan (29% [20]; 37% [28]). TEE-based evaluation of the LASP has the largest variation in prevalence estimates, likely related to operator and institutional differences in protocols used for image acquisition.…”

Section: Discussionsupporting

confidence: 61%

The Left Atrial Septal Pouch: A New Stroke Risk Factor?

Kapoor

Wadi

Becerra

et al. 2021

Transl. Stroke Res.

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The left atrial septal pouch (LASP) occurs due to incomplete fusion of septa primum and secundum at the inter-atrial septum, creating an open flap that may serve as a thromboembolic source. Prior studies have demonstrated increased prevalence of LASP in cryptogenic strokes. The aim of the current study was to validate the above findings in a separate, larger group of stroke and non-stroke patients. We examined transesophageal echocardiograms (TEEs) performed between July 2011 and December 2018. LASP prevalence was determined in TEEs referred for ischemic stroke or transient ischemic attack (“stroke”) and compared with LASP prevalence in patients undergoing TEEs for other reasons (“non-stroke”). Stroke subtyping was performed using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. There were 306 TEEs from 144 non-stroke and 162 stroke patients. Mean age and sex distribution were 56 ± 1 (mean ± SE) and 65% male in the non-stroke group and 58 ± 1 and 54% male in the stroke group. The overall prevalence of LASP was 31%. The prevalence of LASP was 28% (41/144) in non-stroke patients, 25% (24/95) in non-cryptogenic stroke patients, and 43% (29/67) in cryptogenic stroke patients. LASP prevalence was significantly higher in the cryptogenic subgroup compared with the non-cryptogenic subgroup (p = 0.02). These findings demonstrate a significant association of LASP with risk of cryptogenic stroke, suggesting that LASP may serve as a thromboembolic nidus. Additional studies are needed to determine the generalizability of these findings, and their therapeutic implications, supporting LASP as a stroke risk factor.

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Section: Discussionsupporting

confidence: 61%

The Left Atrial Septal Pouch: A New Stroke Risk Factor?

Kapoor

Wadi

Becerra

et al. 2021

Transl. Stroke Res.

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“…TEE with contrast seems to be the criterion standard for detecting LASP (better than computed tomography) because it can unambiguously detect the PFO channel. Therefore, TEE with microbubbles is the best imaging modality for diagnosing SP [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Septal Pouch and Acute Thromboembolic Ischemia of the Upper Limb

et al. 2021

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Patient: Male, 60-year-old Final Diagnosis: Thromboembolic ischemia of the upper limb Symptoms: Pain and paresthesia in the right arm Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Rare coexistence of disease or pathology Background: A left atrial septal pouch (LASP) was first described in 2010 as a new anatomical entity with potential for embolic events. The prevalences of left, right, and double septal pouches are 40.8%, 5.1%, and 3.7%, respectively. There is a concern about the risk of embolic events due to formation of thrombi in a LASP (especially stroke). Case Report: A 60-year-old man presented with sudden onset of right arm pain associated with sweating and neck pain radiating to his left upper extremity. On physical examination, his right arm was cyanotic and he had pain, pares-thesia, and no radial pulse. The patient was diagnosed with acute arterial occlusion of his right upper extremity. An arterial embolectomy was performed with a Fogarty catheter at the level of the brachial artery, which resulted in immediate reperfusion. The patient had an embolic event and after efforts to identify the possible etiology, only an LASP was found. Therefore, we hypothesized that he experienced an embolic event in which a thrombus had formed at the site of the LASP. Conclusions: The present case report is designed to raise awareness of the thrombogenic potential of LASP and the possibility of an embolic event to the upper limb of patients with it. LASP can be the source of a thrombus in a patient with a non-stroke embolic event.

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“…En estos casos se considera el ETE como técnica de referencia, no habiendo podido demostrar la superioridad de la MSCT sobre el primero. Las ventanas descritas más adecuadas para examinar el SIA son la vista medio-esofágica de cuatro cámaras, el eje corto de la válvula aórtica y la vista bicava (14,15) . Nuestro estudio fue realizado con estos enfoques, por lo que es posible comparar los resultados.…”

Section: Discussionunclassified

Prevalencia de septal pouch en una cohorte derivada para ecocardiograma transesofágico

Loza

Américo

Gómez

et al. 2019

Rev. Urug. Cardiol.

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Introducción: los defectos del septum interauricular (SIA) son frecuentes. En los últimos años se ha identificado una nueva entidad conocida como septal pouch (SP). Los datos sobre su prevalencia son escasos, estimándose entre 30%-50% en la población general. El rol como fuente de cardioembolia es discutido. Objetivos: el objetivo primario es determinar la prevalencia y caracterizar el SP; en forma secundaria, definir la variabilidad interobservador para su diagnóstico. Material y método: estudio observacional, descriptivo y analítico. Se reclutaron en forma prospectiva pacientes consecutivos derivados para ecocardiograma transesofágico (ETE) entre el 20 de abril de 2018 y el 30 de agosto de 2018. Se registraron datos patronímicos, antecedentes personales de accidente cerebrovascular (ACV), ritmo cardíaco y motivo del estudio. Se evaluó la presencia de SP y se caracterizó como left-sided septal pouch (LSSP) o rigth-sided septal pouch (RSSP); se midió profundidad, presencia de trombo en su interior y se completó el estudio ecocardiográfico. Las imágenes fueron evaluadas por dos ecocardiografistas ciegos entre sí. Las variables cualitativas se presentan en frecuencia relativa (FR); las cuantitativas en mediana e intervalo intercuartilo. Se realizó test de chi cuadrado para evaluar la asociación entre la presencia de SP y la presencia de ACV o de FA. La reproducibilidad del diagnóstico de SP fue evaluada por índice Kappa. Resultados: se incluyeron 50 sujetos. La prevalencia de SP fue de 0,5 (FR), 0,46 LSSP y 0,04 RSSP. El índice Kappa interobservador para el diagnóstico fue 0,68, error estándar 0,14, con 84% de acuerdo. Catorce sujetos tenían antecedente de ACV, en nueve de ellos se diagnosticó SP (chi cuadrado p=0,21); 18 pacientes tenían fibrilación auricular/flutter, la mitad de ellos tenía SP (chi cuadrado p=1). Conclusión: la prevalencia de SP fue de la mitad de la población, predominando ampliamente el LSSP, con buena reproducibilidad en su diagnóstico. Se trata de un hallazgo subdiagnosticado; interesa continuar investigando su posible asociación con ACV. Palabras clave:DEFECTOS DEL TABIQUE INTERATRIAL ECOCARDIOGRAFÍA TRANSESOFÁGICA EMBOLIA Prevalence of septal pouch in a cohort derived for transesophageal echocardiography Summary Introduction: the interatrial septum defects are frequent. A new entity has recently been identified, known as septal pouch. Prevalence data in general population is scarce, and is estimated between 30%-50%. The role as a source of cardioembolism is unclear. Objectives: the primary objective is to determine the prevalence and characterize the septal pouch; secondarily to define the interobserver variability for the diagnosis. Material and methods: observational, descriptive and analytical study. Consecutive patients were recruited for transesophageal echocardiography between 4/20/2018 and 8/30/2018. We recorded patronymic data, personal history of stro-156 157 ke, heart rate, and the reason for the study. The presence of septal pouch was defined and characterized as left-sided septa...

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

Cited by 18 publications

References 15 publications

The Left Atrial Septal Pouch: A New Stroke Risk Factor?

The Left Atrial Septal Pouch: A New Stroke Risk Factor?

Left Atrial Septal Pouch and Acute Thromboembolic Ischemia of the Upper Limb

Prevalencia de septal pouch en una cohorte derivada para ecocardiograma transesofágico

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