Mid‐esophageal bicaval versus short‐axis view of interatrial septum in two‐dimensional transesophageal echocardiography for diagnosis and measurement of atrial septal pouches

Hołda, Mateusz K.; Krawczyk‐Ożóg, Agata; Koziej, Mateusz; Sorysz, Danuta; Hołda, Jakub; Dudek, Dariusz; Klimek‐Piotrowska, Wiesława

doi:10.1111/echo.13847

Cited by 12 publications

(5 citation statements)

References 20 publications

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“…The SP can be visualized in vivo using two methods, twodimensional transesophageal echocardiography (2D-TEE) and contrast-enhanced electrocardiogram-gated multi-slice computed tomography (MSCT) of the heart, but nothing is known about the accuracy of these two methods in detecting SPs [5,9,11]. Recent studies have also shown that the TEE with the three-dimensional (3D) modality may be superior over 2D examination [12].…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…ASP is poorly visualized in TTE, mainly because of the posterior position of the pouch in comparison to the other structures of the heart. The TEE with agitated saline is the gold standard for the diagnosis of the LASP [ 8 - 10 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Cryptogenic Stroke in a Patient With Left Atrial Septal Pouch

Khan¹,

Riasat²,

Ehtesham³

et al. 2022

Cureus

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The incomplete fusion of the septum primum and septum secundum results in the formation of the left atrial septal pouch (LASP). The clinical significance of this entity is a matter of controversy; however, it may act as a nidus for thrombus formation. We report a case of a 57-year-old male who was brought to the hospital by his girlfriend due to his bizarre behavior and confusion for one day. The initial workup for his altered mental status did not yield a diagnosis. The patient was admitted for further workup, which included an MRI of the brain that showed numerous very small-sized foci of restricted diffusion involving bilateral cerebral and cerebellar hemispheres consistent with thromboembolic infarct. The patient did not receive a tissue plasminogen activator (TPA) as he was out of the window for TPA. Transthoracic echocardiogram (TTE) with bubble study did not show patent foramen ovale (PFO) or atrial septal defect (ASD). ECG and telemetry showed normal sinus rhythm and no atrial fibrillation. A transesophageal echocardiogram (TEE) was obtained to find the source of the thromboembolic stroke. TEE discovered a 22 x 8-mm cystic structure in the interatrial septum consistent with a LASP. We hypothesize that the LASP may be a risk factor for cryptogenic stroke. Further research is needed to determine the prevalence of atrial septal pouch (ASP) in the general population, its clinical significance, and guidelines for treatment implications.

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“…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. Holda et al evaluated the inter-atrial septum of 146 patients using TEE with different imaging planes and found good agreement between the bi-caval and short-axis views (kappa 0.68) [29]. They found that the bi-caval view was slightly more sensitive in detecting LASP than the short-axis view, though the difference was statistically insignificant.…”

Section: Discussionmentioning

confidence: 99%

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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Mid‐esophageal bicaval versus short‐axis view of interatrial septum in two‐dimensional transesophageal echocardiography for diagnosis and measurement of atrial septal pouches

Abstract: The mid-esophageal bicaval view should be preferable over mid-esophageal short-axis view of interatrial septum for the diagnosis and measurement of the left SP.

Cited by 12 publications

References 20 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

Recurrent Cryptogenic Stroke in a Patient With Left Atrial Septal Pouch

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

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