Anatomy of the true interatrial septum for transseptal access to the left atrium

Klimek‐Piotrowska, Wiesława; Hołda, Mateusz K.; Koziej, Mateusz; Piątek, Katarzyna; Hołda, Jakub

doi:10.1016/j.aanat.2016.01.009

Cited by 69 publications

(66 citation statements)

References 25 publications

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“…Of the remaining 18 articles, we excluded 11 because they failed to report the prevalence of LSSPs in human subjects with ischemic stroke. Four studies were morphological studies [4,5,18,19], and 7 studies were imaging studies without correlation with stroke subjects [20][21][22][23][24][25][26]. Next, we carefully assessed the studies for patients with cryptogenic stroke.…”

Section: Resultsmentioning

confidence: 99%

Left-Sided Atrial Septal Pouch as a Risk Factor of Cryptogenic Stroke: A Systematic Review and Meta-Analysis

Hołda

2018

Cerebrovasc Dis

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Background: Despite some evidence of left-sided septal pouch (LSSP) involvement in the pathogenesis of cardioembolic stroke, the question of LSSP clinical significance still remains unsolved. In this study, we aimed to determine the association between the LSSP presence and cryptogenic stroke using meta-analytical approach. Methods: We performed a systematic review of electronic databases for studies that compared the presence of LSSP in subjects with cryptogenic stroke and non-stroke control. Data were extracted and pooled into a meta-analysis. Results: Seven studies (400 cryptogenic stroke patients and 1,456 non-stroke controls) were included in the meta-analysis. A total of 138 LSSPs were identified among the cryptogenic stroke patients, with a pooled prevalence of 29.8% (95% CI 17.5–43.7%), and 268 LSSPs were identified in the non-stroke controls, with a pooled prevalence of 21.0% (95% CI 13.7–29.5%). After meta-analysis, the risk of cryptogenic stroke was higher in patients with an LSSP than in patients without LSSP (OR 1.52; 95% CI 1.15–2.00; p < 0.001). No significant heterogeneity was detected across the included studies (p > 0.05). Conclusion: Our meta-analysis demonstrated association between LSSP and cryptogenic stroke. In our univariate analysis, the risk of cryptogenic stroke is higher among patients with LSSP than in cases without the LSSP.

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Section: Resultsmentioning

confidence: 99%

Left-Sided Atrial Septal Pouch as a Risk Factor of Cryptogenic Stroke: A Systematic Review and Meta-Analysis

Hołda

2018

Cerebrovasc Dis

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“…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%

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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“…The ostia of the great veins and FO lie close to one another . This anatomical proximity enables fetal blood to be directed from the inferior vena cava directly into foramen ovale .…”

Section: Discussionmentioning

confidence: 97%

Distances between transseptal puncture site and anatomical landmarks

Derejko¹,

Hasiec

Bardyszewski³

et al. 2019

Cardiovasc electrophysiol

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The aim of the study was to provide quantitative data and to look for new landmarks useful during transseptal puncture (TSP) using a fluoroscopy‐guided approach. Methods and results A total of 104 patients at mean age 57 ± 12 years, of whom 92% underwent pulmonary vein isolation, were analysed. Before TSP catheters were placed in the coronary sinus (CS) and His bundle region. A guidewire running from femoral vein through great veins was left loose in superior vena cava. Before TSP X‐ray images were taken in right anterior oblique (RAO) 45° and RAO 53° projections. Locations posterior to TSP site in RAO were described with negative values and those anterior with positive values. The measured distances in millimeters were as follows: (a) between TSP site and posterior atrial wall (RAO 45 = –21 ± 7 mm; RAO 53 = –19 ± 6 mm (b) between TSP site and free guidewire (RAO 45 = –5 ± 4 mm, RAO 53 = –3 ± 4 mm (c) between TSP site and CS ostium (RAO 45 = 9 ± 6 mm; RAO 53 = 8 ± 5 mm (d) between TSP site and His region (RAO 45 = 29 ± 8 mm; RAO 53 = 30 ± 8 mm). We observed correlations between measured distances and age, body mass index and sizes of cardiac chambers. The distance between TSP site and the line projected by the guidewire running between great veins, measured in mid‐RAO projections, was very small. Conclusion The distances between TSP site and standard anatomical landmarks used during TSP vary with regard to age, physique and cardiac chamber dimensions. TSP site, as assessed in mid RAO, is in direct vicinity to the line projected by a guidewire running between the great veins.

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Anatomy of the true interatrial septum for transseptal access to the left atrium

Cited by 69 publications

References 25 publications

Left-Sided Atrial Septal Pouch as a Risk Factor of Cryptogenic Stroke: A Systematic Review and Meta-Analysis

Left-Sided Atrial Septal Pouch as a Risk Factor of Cryptogenic Stroke: A Systematic Review and Meta-Analysis

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

Distances between transseptal puncture site and anatomical landmarks

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