scholarly journals Malposition of Septum Primum

Author(s):  
Maryam Moradian
Keyword(s):  
Heart ◽  
2020 ◽  
pp. heartjnl-2020-318127
Author(s):  
Francesco Fulvio Faletra ◽  
Laura Anna Leo ◽  
Vera Paiocchi ◽  
Susanne Schlossbauer ◽  
Jagat Narula ◽  
...  

The detailed anatomy of the interatrial septum (IAS) and mitral annulus (MA) as observed on cardiac magnetic resonance, computed tomography and two-dimensional/three-dimensional transthoracic and transesophageal echocardiography is reviewed. The IAS comprises of two components: the septum primum that is membrane-like forming the floor of the fossa ovalis (FO) and the septum secundum that is a muscular rim that surrounds the FO. The latter is an enfolding of atrial wall forming an interatrial groove. Named Waterston’s groove, it is filled with adipose tissue on the epicardial side. Thus, the safest area for transseptal puncture (TSP) is within the limits of the FO floor, which provides direct interatrial access. While crossing an intact septum is a well-established procedure, TSP is a more complex and time-consuming procedure in the presence of patent foramen ovalis, aneurysmal FO or atrial septal defect closure devices. MA comprises two distinctive segments: an anterior-straight and a posterior-curved segment. The posterior MA is a thin, discontinuous fibrous ‘string’, interspersed with adipose tissue, where four components converge: the atrial and ventricular musculature, epicardial adipose tissue and the leaflet’s hinge line. In parts of where this fibrous string is deficient or absent, the posterior leaflet is inserted directly on ventricular and atrial myocardium rendering the MA less robust and producing an ‘asymmetric’ dilation. The marked vulnerability of posterior MA to calcifications might be due to its insertion on the crest of ventricular myocardium being subject to friction injury due to the contraction and relaxation of LV.


2001 ◽  
Vol 14 (7) ◽  
pp. 732-737 ◽  
Author(s):  
Meryl S. Cohen ◽  
Paul Weinberg ◽  
Patrick D. Coon ◽  
J.William Gaynor ◽  
Jack Rychik

2015 ◽  
Vol 86 (7) ◽  
pp. 1195-1203 ◽  
Author(s):  
Stefan H. Ostermayer ◽  
Shubhika Srivastava ◽  
John T. Doucette ◽  
H. Helen Ko ◽  
Miwa Geiger ◽  
...  

1994 ◽  
Vol 73 (9) ◽  
pp. 711-713 ◽  
Author(s):  
Lida Toro ◽  
Robert G. Weintraub ◽  
Takahiro Shiota ◽  
David J. Sahn ◽  
Christine Sahn ◽  
...  

1995 ◽  
Vol 73 (5) ◽  
pp. 850-857 ◽  
Author(s):  
Alastair A. Macdonald ◽  
Christopher Dixon ◽  
Ian L. Boyd

The structure of the cardiac foramen ovale from eight genera of pinnipeds was studied using the scanning electron microscope. Specimens were obtained from fetuses or neonates of the Californian sea lion (Zalophus californianus), Antarctic fur seal (Arctocephalus gazella), walrus (Obenus rosmarus), grey seal (Halichoerus gryphus), ringed seal (Phoca hispida), bearded seal (Erignathus barbatus), Weddell seal (Leptonychotes weddelli), and crabeater seal (Lobodon carcinophagus). In each species, the structure that permits oxygenated blood from the placenta flowing in the caudal vena cava to pass directly into the left side of the heart, the foramen ovale, when viewed from the terminal part of the caudal vena cava had the appearance of the entrance to a short tunnel. A thin fold of tissue, the developed remains of the septum primum, projected from the caudal edge of the foramen ovale into the lumen of the left atrium. It constituted about 75% of the inner surface of the tunnel, and was generally unfenestrated. The wall of the interatrial septum contributed the "floor." The distal end of the tunnel was straight-edged. In most cases the septum primum was long enough to cover the foramen ovale. The siting of pulmonary veins in the roof of the left atrium appeared to be such that drainage from them after birth would press the septum primum over the foramen opening, thereby functionally closing it. Collapses of the tunnel was seen in all the neonatal seals, and in the 1-month-old neonate the fold of tissue was anchored to the interatrial septum along the surface of the crista dividens, which lay in the left atrium. Cellular protrusions and thread formation may play a role in the closure of the foramen ovale.


2015 ◽  
Vol 6 (3) ◽  
pp. 114-117
Author(s):  
Anna Coles ◽  
Bradley Haveman-Gould ◽  
Muhammad U. Farooq ◽  
Kristopher J. Selke ◽  
Philip B. Gorelick

Patent foramen ovale (PFO) has been proposed as a mechanism for cardioembolic stroke, especially in younger patient populations. Complex PFOs, with tunnel lengths exceeding 8 mm, lead to a higher risk of neurological sequelae than simple PFOs and may also be harder to detect with transthoracic echocardiography (TTE). In this article, we present a 29-year-old woman who, after polypharmacy overdose, developed deep venous thrombosis and multiple pulmonary emboli (PE) and subsequent cardioembolic stroke. Initial TTE showed intact interatrial septum with late appearance of agitated saline in the left atrium after the seventh cardiac cycle. Subsequent transesophageal echocardiography, after treatment of PE with an intravenous thrombolytic (alteplase) and anticoagulation with heparin, showed a complex PFO with a 19-mm overlap of the septum primum and secundum without active flow. It is suggested that this PFO allowed for flow only in the situation of elevated right heart strain with PE, causing cardioembolic stroke and detection of agitated saline in the left atrium on TTE. However, under normal physiological situations, which resumed after treatment of PE with alteplase and heparin, the PFO did not allow for flow. This case demonstrates the potential importance of recognition of complex PFOs in diagnosis and management of cardioembolic stroke.


2017 ◽  
Vol 24 (5) ◽  
pp. 772-777 ◽  
Author(s):  
Fabio Cuttone ◽  
Khaled Hadeed ◽  
François Lacour-Gayet ◽  
Hugues Lucron ◽  
Sebastien Hascoet ◽  
...  

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