Thrombus Attached to the Left Atrial Septal Pouch Assessed on 3-Dimensional Transesophageal Echocardiography

Kuwaki, Hiroshi; Takeuchi, Masaaki; Kaku, Kyoko; Haruki, Nobuhiko; Yoshitani, Hidetoshi; Tamura, Masahito; Okazaki, Masahiro; Abe, Haruhiko; Otsuji, Yutaka

doi:10.1253/circj.cj-11-0090

Cited by 24 publications

(16 citation statements)

References 4 publications

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“…An interesting hypothesis from Tugcu was that in hypertension, the increase in the intraatrial pressure might force an eventual LASP to close, accounting for the lower prevalence in hypertensive patients (also noted by Wong et al 32 ) Weighing against this possibility the fact that in all cases [13][14][15][16][17][18][19][20][21][22][23][24][25] of thrombosis in the LASP, the left atrial wall of the pouch was rigid and uncompliant to pressure. On the other hand, in our population of 446 patients with 81 LASP, we did not note an age-dependent incidence or a higher prevalence of a particular risk factor in the LASP group.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

“…Since then, a number of reports have demonstrated the presence of thrombi in the left atrial septal pouch (LASP), mostly in the setting of factors that could be assimilated to the classical triad of Virchow: atrial fibrillation, left ventricular dysfunction, or procoagulable state. [13][14][15][16][17][18][19][20][21][22][23][24][25] Despite these findings, in 2010, Tugcu et al 26 showed the absence of evidence of an association between stroke and the presence of LASP. Our investigation aims to test the hypothesis of a possible association between ischemic stroke and this anatomical feature, using a larger population and a different study design, closer to the clinical setting.…”

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confidence: 99%

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The Left Atrial Septal Pouch as a Possible Risk Factor for Stroke

et al. 2016

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The Left Atrial Septal Pouch as a Possible Risk Factor for Stroke

et al. 2016

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“…8 However, the assessment of ASP using TEE has been introduced in the literature mostly as case reports, highlighting the need for further data. Several of these stroke cases report the presence of thrombi-like structures attached to the LASP, 3,[8][9][10][11] which after initiation of anticoagulation disappeared on serial monitoring by 2DTEE 3,8-10 or on pathologic dissection are found to be complex thrombi. 11 Kuwaki et al 9 established empirically that interatrial structures are better characterized by 3DTEE when compared to 2DTEE as it allows volumetric data acquisition.…”

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Incremental Value of Live/Real Time Three‐Dimensional over Two‐Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch

et al. 2015

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An atrial septal pouch (ASP) results from partial fusion of the septum primum and the septum secundum, and depending on the site of fusion, the pouch can be left-sided (LASP) or right-sided (RASP). LASPs have been described in association with thrombi found in patients admitted with acute strokes, raising awareness of its potential cardioembolic role, especially in those with no other clearly identifiable embolic source. We retrospectively studied 39 patients in whom the presence of an ASP had been identified by three-dimensional transesophageal echocardiography (3DTEE) and who had a two-dimensional transesophageal echocardiogram (2DTEE) performed during the same clinical encounter. The incremental value provided by 3DTEE over 2DTEE included the detection of six ASPs not found by 2DTEE; the detection of two ASPs in the same subject (in four patients) not identified by 2DTEE; larger ASP measurements of length and height in over 80% of the cases; and measurement of the ASP width (elevational axis) for the calculation of the area of the ASP opening, because of its unique capability to view the pouch en face. In addition, the volume of ASP and of the echogenic masses contained in the ASP (four of 39 patients) could be calculated by 3DTEE, which is a superior parameter of size characterization when compared to individual dimensions. One of these patients who presented with ischemic stroke diagnosed by magnetic resonance imaging had a large (>2 cm) mass in a LASP, with echolucencies similar to those seen in thrombi and associated with clot lysis and resolution. This mass completely disappeared on anticoagulant therapy lending credence that it was most likely a thrombus. There was no history of stroke or any other type of embolic event in the other three patients with masses in ASP. In conclusion, this retrospective study highlights the incremental value of 3DTEE over 2DTEE in the comprehensive assessment and characterization of ASPs, which can aid in the clarification of their role in cryptogenic stroke patients.

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“…A left atrial septal pouch (LASP), which has its base opening into the left atrium, was described to have a potential to form thrombi and cause embolic events [5,6]. However, Tugcu et al reported a lack of association between the presence of a LASP and ischemic or cryptogenic stroke [7].…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale with right atrial septal pouch

Kijima

Bokhoor

Tobis

2015

Cathet Cardio Intervent

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A patent foramen ovale (PFO) is a communication across the inter-atrial septum and a right atrial septal pouch (RASP) is an indentation of the atrial septum caused by an incomplete fusion of the septum primum and septum secundum with its base opening into the right atrium. A 63-year-old male who had a history of two strokes and episodes of transient neurological deficit was diagnosed to have a small right-to-left shunt. At the time of PFO closure, an angiogram of the atrial septum revealed a small PFO associated with a RASP. The small PFO was crossed with a straight-tipped guide wire and was closed using a 25-mm GORE CARDIOFORM Septal Occluder (W.L. Gore and Associates, AZ). It is hypothesized that stagnant blood in the RASP may generate a clot that can cross the PFO and cause an infarct. © 2015 Wiley Periodicals, Inc.

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Thrombus Attached to the Left Atrial Septal Pouch Assessed on 3-Dimensional Transesophageal Echocardiography

Cited by 24 publications

References 4 publications

The Left Atrial Septal Pouch as a Possible Risk Factor for Stroke

The Left Atrial Septal Pouch as a Possible Risk Factor for Stroke

Incremental Value of Live/Real Time Three‐Dimensional over Two‐Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch

Patent foramen ovale with right atrial septal pouch

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