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The Aortic Ductus Diverticulum—Innocent Bystander or Potential Source of Thromboembolic Stroke? J Comput Assist Tomogr 2022; 46:392-396. [DOI: 10.1097/rct.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The Left Atrial Septal Pouch: A New Stroke Risk Factor? Transl Stroke Res 2021; 12:205-211. [PMID: 33393056 PMCID: PMC7925453 DOI: 10.1007/s12975-020-00864-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022]
Abstract
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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Celik E, Pennig L, Laukamp KR, Hammes J, Maintz D, Kabbasch C, Abdullayev N, Bunck AC, Achenbach T, Caldeira L, Hickethier T. Are left atrial diverticula and left-sided septal pouches relevant additional findings in cardiac CT? Correlation between left atrial outpouching structures and ischemic brain alterations. Int J Cardiol 2020; 317:216-220. [DOI: 10.1016/j.ijcard.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/11/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
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Faletra FF, Leo LA, Paiocchi VL, Schlossbauer SA, Pedrazzini G, Moccetti T, Ho SY. Revisiting Anatomy of the Interatrial Septum and its Adjoining Atrioventricular Junction Using Noninvasive Imaging Techniques. J Am Soc Echocardiogr 2019; 32:580-592. [PMID: 30803863 DOI: 10.1016/j.echo.2019.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 10/27/2022]
Abstract
Interest in the anatomy of the interatrial septum (IAS) and its adjoining atrioventricular (AV) junction has risen enormously in the past two decades with the simultaneous evolution of left-sided percutaneous structural heart disease and complex electrophysiologic procedures. These procedures require, in fact, a direct route to the left atrium through the IAS. Thus, a thorough understanding of the complex anatomy of the IAS and AV junction is essential for performing a safe and effective transseptal puncture. There is a large amount of literature carefully describing the anatomy of the IAS and AV junction. These studies are based almost exclusively on anatomic specimens. Conversely, in this review the authors emphasize the role of noninvasive imaging techniques, in particular cardiac magnetic resonance, two- and three-dimensional transesophageal echocardiography, and computed tomography in visualizing specific aspects of the normal IAS and AV junction. Where appropriate, the authors present images side by side, with corresponding anatomic specimens.
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Affiliation(s)
- Francesco F Faletra
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
| | - Laura Anna Leo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Vera Lucia Paiocchi
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Giovanni Pedrazzini
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom
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Hołda MK, Koziej M, Wszołek K, Pawlik W, Krawczyk-Ożóg A, Sorysz D, Łoboda P, Kuźma K, Kuniewicz M, Lelakowski J, Dudek D, Klimek-Piotrowska W. Left atrial accessory appendages, diverticula, and left-sided septal pouch in multi-slice computed tomography. Association with atrial fibrillation and cerebrovascular accidents. Int J Cardiol 2017. [DOI: 10.1016/j.ijcard.2017.06.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The left atrial septal pouch as a risk factor for stroke: A systematic review. Arch Cardiovasc Dis 2017; 110:250-258. [DOI: 10.1016/j.acvd.2017.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
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Hołda MK, Koziej M, Hołda J, Piątek K, Tyrak K, Chołopiak W, Bolechała F, Walocha JA, Klimek-Piotrowska W. Atrial septal pouch — Morphological features and clinical considerations. Int J Cardiol 2016; 220:337-42. [DOI: 10.1016/j.ijcard.2016.06.141] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/12/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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Elsayed M, Hsiung MC, Meggo-Quiroz LD, Elguindy M, Uygur B, Tandon R, Guvenc T, Keser N, Vural MG, Bulur S, Chahwala JR, Abtahi F, Nanda NC. Incremental Value of Live/Real Time Three-Dimensional over Two-Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch. Echocardiography 2015; 32:1858-67. [DOI: 10.1111/echo.13111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mahmoud Elsayed
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Ming C. Hsiung
- Division of Cardiology; Cheng Hsin General Hospital; Taipei Taiwan
| | - L. David Meggo-Quiroz
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Mostafa Elguindy
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Begum Uygur
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Rohit Tandon
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Tolga Guvenc
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Nurgul Keser
- Department of Cardiology; Sakarya University Medical Faculty; Sakarya Turkey
| | - Mustafa G. Vural
- Department of Cardiology; Sakarya University Medical Faculty; Sakarya Turkey
| | - Serkan Bulur
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Jugal R. Chahwala
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Firoozeh Abtahi
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham Alabama
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Abstract
The left atrial septal pouch (LASP) is an anatomic variant of the atrial septum that forms a blind-ending pouch, communicating exclusively with the left atrium (LA). Case reports have demonstrated thrombus within LASP and in the setting of cryptogenic stroke. Initial epidemiologic results are mixed, one study showing and others not showing an association between LASP and cryptogenic stroke. Additional investigation should take place to determine the clinical significance of LASP and what interventions are required to prevent ischemic stroke in at-risk individuals.
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Affiliation(s)
- Jonathan M Wong
- a Department of Medicine , California Pacific Medical Center , San Francisco , CA , USA
| | - Mark Fisher
- b Department of Neurology , University of California , Irvine , CA , USA.,c Departments of Anatomy & Neurobiology and Pathology & Laboratory Medicine , University of California , Irvine , CA , USA
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Wong JM, Lombardo DM, Barseghian A, Dhoot J, Hundal HS, Salcedo J, Paganini-Hill A, Wong ND, Fisher M. Left atrial septal pouch in cryptogenic stroke. Front Neurol 2015; 6:57. [PMID: 25852636 PMCID: PMC4371703 DOI: 10.3389/fneur.2015.00057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/02/2015] [Indexed: 12/31/2022] Open
Abstract
Background: The left atrial septal pouch (LASP), an anatomic variant of the interatrial septum, has uncertain clinical significance. We examined the association between LASP and ischemic stroke subtypes in patients undergoing transesophageal echocardiography (TEE). Methods: We determined the prevalence of LASP among consecutive patients who underwent TEE at our institution. Patients identified with ischemic strokes were further evaluated for stroke subtype using standard and modified criteria from the Trial of Org 10172 in Acute Stroke Treatment (TOAST). We compared the prevalence of LASP in ischemic stroke, cryptogenic stroke, and non-stroke patients using prevalence ratios (PR). Results: The mean age of all 212 patients (including stroke and non-stroke patients) was 57 years. The overall prevalence of LASP was 17% (n = 35). Of the 75 patients who were worked-up for stroke at our institution during study period, we classified 31 as cryptogenic using standard TOAST criteria. The prevalence of LASP among cryptogenic stroke patients (using standard and modified TOAST criteria) was increased compared to the prevalence among other ischemic stroke patients (26 vs. 9%, p = 0.06; PR = 1.8, 95% CI = 1.1–3.1, and 30 vs. 10%, p = 0.04; PR = 2.2, 95% CI = 1.2–4.1, respectively). Conclusion: In this population of relatively young patients, prevalence of LASP was increased in cryptogenic stroke compared to stroke patients of other subtypes. These findings suggest LASP is associated with cryptogenic stroke, which should be verified by future large-scale studies.
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Affiliation(s)
- Jonathan M Wong
- Department of Medicine, California Pacific Medical Center , San Francisco, CA , USA
| | - Dawn M Lombardo
- Division of Cardiology, Department of Internal Medicine, University of California Irvine , Irvine, CA , USA
| | - Ailin Barseghian
- Division of Cardiology, Department of Internal Medicine, University of California Irvine , Irvine, CA , USA
| | - Jashdeep Dhoot
- Division of Cardiology, Department of Internal Medicine, University of California Irvine , Irvine, CA , USA
| | - Harkawal S Hundal
- Division of Cardiology, Department of Internal Medicine, University of California Irvine , Irvine, CA , USA
| | - Jonathan Salcedo
- Division of Cardiology, Department of Internal Medicine, University of California Irvine , Irvine, CA , USA
| | | | - Nathan D Wong
- Division of Cardiology, Department of Internal Medicine, University of California Irvine , Irvine, CA , USA
| | - Mark Fisher
- Department of Neurology, University of California Irvine , Irvine, CA , USA ; Departments of Anatomy and Neurobiology, University of California Irvine , Irvine, CA , USA ; Departments of Pathology and Laboratory Medicine, University of California Irvine , Irvine, CA , USA
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Wayangankar SA, Patel JH, Patel B, Stavrakis S, Sivaram CA. Clinical and Echocardiographic Variables Associated With LA Septal Pouch. JACC Cardiovasc Imaging 2013; 6:833-5. [DOI: 10.1016/j.jcmg.2012.09.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/27/2012] [Indexed: 11/15/2022]
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