Left atrial septal pouch in a six-year-old child: echocardiographic and magnetic resonance view

2021 ◽  
pp. 1-3
Author(s):  
Salvatore Caputo ◽  
Annalisa Silvestri ◽  
Guido Rocchi
Keyword(s):  
Transthoracic Echocardiography ◽  
Left Atrial ◽  
Interatrial Septum ◽  
Foramen Ovale ◽  
Heart Malformation ◽  
Child Patient ◽  
Septum Primum ◽  
Left And Right ◽  
Right Atria

Abstract In a 6-year-old child patient, transthoracic echocardiography revealed a large saccular structure (with anechogenic content) in the left atrium, near the fossa ovalis, and diagnosis of the left atrial septal pouch was made. The left atrial septal pouch is a kangaroo pouch-like structure on the left side of the interatrial septum, opened into the left atrial cavity without a connection between the left and right atria. It occurs when the foramen ovale is absent but the septum primum and septum secundum are only partially fused. The left atrial septal pouch is believed to be present in 47% of population. In many cases, the pocket on the atrial septum is small and it could not be detected by transthoracic echocardiography. Our description is uncommon because we diagnosed a very large septal pouch. Based on our knowledge, this is the youngest reported case of the left atrial septal pouch and the longest follow-up described in this type of congenital heart malformation.

scholarly journals Transvenous Closure of Patent Foramen Ovale: Preliminary Results with a New Self-Expanding Nitinol Wire Mesh in a Swine Model

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
F. Krizanic ◽  
M. Sigler ◽  
H. R. Figulla
Keyword(s):  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Thrombus Formation ◽  
Interatrial Septum ◽  
Wire Mesh ◽  
Swine Model ◽  
Foramen Ovale ◽  
Residual Shunt ◽  
New Device

Objectives. The transvascular closure of patent foramen ovale (PFO) with self-expanding devices carries the risk of left atrial thrombus formation related to material protruding into the left atrium. Thus, we developed a novel device with flat left atrial disc geometry. We evaluated feasibility, handling, and biocompatibility in a porcine animal model.Methods. Implantation of an Occlutech Figulla PFO device was performed in 10 mini pigs using fluoroscopy and intra-cardiac ultrasound after transseptal puncture of the interatrial septum. Angiographic follow-up was performed after six and twelve weeks.Results. Implantation was successful in 100%. There were no further implant related complications. One procedure related death occurred, as one animal died of ventricular tachycardia due to mispunture of the interatrial septum. Angiographic studies showed no residual shunt during follow-up. Histopathological evaluation could demonstrate partial neoendothelialization after 6 weeks with completion after 12 weeks. The devices were incorporated into connective tissue containing fibro muscular cells. An only mild inflammatory reaction was detected locally related to the polyester fibers.Conclusion. In terms of feasibility and handling, the new device does not seem to be inferior to other presently used implantation systems. Good biocompatibility was demonstrated with rapid and complete neoendothelialization.

Transoesophageal: Chambers and vessels

2020 ◽  
pp. 493-542
Keyword(s):  
Left Atrial ◽  
Thoracic Aortic Aneurysm ◽  
Pulmonary Veins ◽  
Transoesophageal Echocardiography ◽  
Pleural Space ◽  
Intramural Haematoma ◽  
Left And Right ◽  
Aortic Transection ◽  
And Function ◽  
Right Atria

This chapter covers the chambers and vessels in transoesophageal echocardiography. It includes the left and right ventricles (size, mass, and function); the left and right atria, including the left atrial appendage; the pulmonary veins; the coronary sinus; the interatrial and interventricular septa; the pericardium and pericardial effusion; cardiac tamponade; the aorta (size, atherosclerosis, and dissection); intramural haematoma; aortic transection; thoracic aortic aneurysm; masses; pleural space and lungs; and implanted devices.

Atrial septal aneurysms in childhood: prevalence, classification, and concurrent abnormalities

2013 ◽  
Vol 24 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Andreas Giannopoulos ◽  
Christoforos Gavras ◽  
Stavroula Sarioglou ◽  
Fotini Agathagelou ◽  
Irene Kassapoglou ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Interatrial Septum ◽  
Paediatric Population ◽  
Point Of View ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Increased Risk

AbstractObjectives: This study sought to investigate the prevalence of atrial septal aneurysms in the paediatric population and to define coexisting abnormalities and their incidence. Background: Few papers refer to the prevalence of atrial septal aneurysms in childhood. Methods: We enrolled a total of 4522 children aged more than 12 months who underwent a transthoracic echocardiography. Atrial septal aneurysm was defined as a protrusion of the interatrial septum or part of it >15 mm beyond the plane of the atrial septum or phasic excursion of the interatrial septum during the cardiorespiratory cycle of at least 15 mm in total amplitude and a diameter of the base of the aneurysm of at least 15 mm. Results: Atrial septal aneurysms were found in 47 children (1.04%). They involved almost the entire septum in 14 patients (28.89%) and were limited to the fossa ovalis in 33 (71.11%). An atrial septal aneurysm was an isolated structural defect in 17 (35.56%). In 30 (64.44%) patients, it was associated with interatrial shunting – atrial septal defect and patent foramen ovale. At the echo follow-up after a year, no changes were recorded. Conclusions: Prevalence of atrial septal aneurysms is almost 1%. The most common abnormalities associated are interatrial shunts, that is, a patent foramen ovale and an atrial septal defect. From a medical point of view, it is suggested that no action is to be taken during childhood, as a child with an atrial septal aneurysm is not at increased risk compared with a child without one. Follow-up is scheduled on an individual basis.

Comparative anatomy of the cardiac foramen ovale in the Pinnipedia

1995 ◽  
Vol 73 (5) ◽  
pp. 850-857 ◽  
Author(s):  
Alastair A. Macdonald ◽  
Christopher Dixon ◽  
Ian L. Boyd
Keyword(s):  
Left Atrium ◽  
Comparative Anatomy ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Interatrial Septum ◽  
Weddell Seal ◽  
Foramen Ovale ◽  
Septum Primum ◽  
Lobodon Carcinophagus ◽  
Short Tunnel

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.

scholarly journals Ischemic stroke and patent foramen ovale: case report

2006 ◽  
Vol 64 (3b) ◽  
pp. 858-861
Author(s):  
Carlos Eduardo Amaral Pereira da Silva ◽  
Thiago Cardoso Vale ◽  
Flávio José Barbosa Leite ◽  
Thais Gomes Casali ◽  
Gustavo de Moraes Ramalho ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Case Report ◽  
Patent Foramen Ovale ◽  
Clinical Presentation ◽  
Cryptogenic Stroke ◽  
Cerebral Embolism ◽  
Foramen Ovale ◽  
Left And Right ◽  
Right Atria

Approximately 40% of ischemic strokes have no clearly definable etiology and are termed cryptogenic strokes. Patent foramen ovale, a small communication between the left and right atria, is considered to be a risk factor for cerebral embolism. In this study, we report the case of a 29-year-old woman with diagnosis of ischemic stroke due to patent foramen ovale who has undergone percutaneous endovascular closure. The aim of this report is to discuss the relevant aspects of the patent foramen ovale and the cryptogenic stroke, its clinical presentation, diagnosis, management and recurrence.

scholarly journals P923 Ultrasound follow-up of left atrial appendage occlusion devices

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Molinero ◽  
P Cabeza ◽  
N Hernandez ◽  
W Delgado ◽  
E Silva
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Transthoracic Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Clot Formation ◽  
Risk Of Bleeding ◽  
Rule Out

Abstract Background Left atrial appendage (LAA) occlusion devices represent an important alternative to anticoagulation in patients with atrial fibrillation (AF) with high risk of bleeding and who have suffered any hemorrhagic event. At first, a transesophageal ultrasound is performed to examine cardiac cavities, take measures of LAA and discharge the presence of thrombi. We redo a new transesophageal ultrasound as a control three months later after having installed the device. The purpose of this article is to show our experience in ultrasound follow up of LAA occlusion. Methodology All measures of LAA were taken with the transoesophageal ultrasound device by the same operator. According to the size acquired from the appendage of each patient, they were divided into a first group with the implementation of the Watchman device (23 patients) and Amplatzer (6 patients). A transthoracic echocardiography control was performed on each patient to rule out the presence of complications after the intervention, before to be discharged from hospital. After three months, a new transoesophageal study was repeated to assess the correct position of the device and to rule out the presence of any disfunctions or clot formation. Results A total of 29 patients with AF (CHADSVASC 4.09 HASBLED 2.96) with a high risk of bleeding and after having suffered any complications (41% brain bleeding, 31% major gastrointestinal bleeding, 27% advanced chronic kidney disease) were presented for the implantation of a LAA closure device. Firstly, LAA size was confirm and the presence of a thrombi was rule out. No patient suffered complications during the procedure that was confirmed with transthoracic echocardiography (discharging the presence of perforation, pericardial effusion or tamponade). At three months later, we performed a new transoesophageal as a control for the assessment of the place and presence of GAPs, if any (80% correct-placed, 15% placed with a gap of 2-4 mm with passage of flow throughout). In a 10-month follow-up, it was found that practically 93% of patients were still without anticoagulation, except two patients, one of them (CHADSVASC 4 HASBLED 2) had to reintroduce oral anticoagulation due to the fact of the clot formation on the device. The second one (CHADSVASC 4 HASBLED 2) had to reintroduce temporarily fractionated heparin due to stent thrombosis in the femoral artery. None of them presented any ischemic complications or new haemorrhagic events. Conclusions LAA occlusion devices are an effective and safe alternative to anticoagulation in patients with atrial fibrillation with predisposition to bleeding where ultrasound techniques play an essential role in all stages of procedure (prior to implantation of the device, during and at the follow-up).

Transthoracic anatomy and pathology: Chambers and vessels

2020 ◽  
pp. 127-286
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Systolic Function ◽  
Interventricular Septum ◽  
Interatrial Septum ◽  
Cardiac Tumours ◽  
Left And Right ◽  
The Right ◽  
Right Atria ◽  
Global Systolic Function

This chapter deals with the anatomy and pathology of the chambers and vessels in transthoracic echocardiography. It covers the left ventricle, global systolic function, regional systolic function, diastolic function and dysfunction, heart failure, the right ventricle, pulmonary hypertension, the left and right atria, the interatrial septum and interventricular septum, pericardium, pericardial effusion, cardiac tamponade, pericarditis, constrictive pericarditis, the aorta, primary cardiac tumours and other masses, extra-cardiac tumours, cardiomyopathies, and athlete’s heart.

Comparison of time- and voltage-dependent K+ currents in myocytes from left and right atria of adult mice

2003 ◽  
Vol 285 (5) ◽  
pp. H1837-H1848 ◽  
Author(s):  
Alan E. Lomax ◽  
Colleen S. Kondo ◽  
Wayne R. Giles
Keyword(s):  
Current Density ◽  
Right Atrium ◽  
Left Atrial ◽  
Right Atrial ◽  
Atrial Myocytes ◽  
Adult Mice ◽  
Voltage Dependent ◽  
Left And Right ◽  
The Right ◽  
Right Atria

Consistent differences in K+ currents in left and right atria of adult mouse hearts have been identified by the application of current- and voltage-clamp protocols to isolated single myocytes. Left atrial myocytes had a significantly ( P < 0.05) larger peak outward K+ current density than myocytes from the right atrium. Detailed analysis revealed that this difference was due to the rapidly activating sustained K+ current, which is inhibited by 100 μM 4-aminopyridine (4-AP); this current was almost three times larger in the left atrium than in the right atrium. Accordingly, 100 μM 4-AP caused a significantly ( P < 0.05) larger increase in action potential duration in left than in right atrial myocytes. Inward rectifier K+ current density was also significantly ( P < 0.05) larger in left atrial myocytes. There was no difference in the voltage-dependent L-type Ca2+ current between left and right atria. As expected from this voltage-clamp data, the duration of action potentials recorded from single myocytes was significantly ( P < 0.05) shorter in myocytes from left atria, and left atrial tissue was found to have a significantly ( P < 0.05) shorter effective refractory period than right atrial tissue. These results reveal similarities between mice and other mammalian species where the left atrium repolarizes more quickly than the right, and provide new insight into cellular electrophysiological mechanisms responsible for this difference. These findings, and previous results, suggest that the atria of adult mice may be a suitable model for detailed studies of atrial electrophysiology and pharmacology under control conditions and in the context of induced atrial rhythm disturbances.

Restrictive foramen ovale as the cause of the predominance of the fetal right heart

2018 ◽  
Author(s):  
A.V. Makogon , I.V. Andrushina
Keyword(s):  
Fetal Heart ◽  
Coarctation Of The Aorta ◽  
Interatrial Septum ◽  
Z Score ◽  
Foramen Ovale ◽  
Right Heart ◽  
Two Phase ◽  
Obstetric Management ◽  
The Right

Objective: сurrently antenatal premature closure (restriction) foramen ovale (RFO) is under recognised. The case of the RFO is analysed. Materials. Pregnant woman E was undergone diagnostic ultrasound at 33 weeks of gestation and monitoring up to delivery (39 weeks). The newborn has been followed up 3 months. Fetal heart was examined in general order and in the bicaval view. ПРЕНАТАЛЬНАЯ ДИАГНОСТИКА Рестриктивное овальное окно 231 как причина увеличения правых отделов сердца 2018 Т 17 № 3; 225-231 Results. Fetal examination revealed cardiomegaly, predominance of the right heart, aneurysm of the interatrial septum, high blood velocity through the foramen ovale channel (67.18 sm/s). The diameter of the aortic isthmus (AI) was 3.4 mm (Z-score — 2.06). We concluded that it was ROO. The conclusion of the echocardiography was coarctation of the aorta (CoA). The diameter of the AI reached 4.6 mm (Z-score — 1.01) up to 39 weeks of gestation. The newborn’s echocardiography is normal. Conclusion. Fetal heart ultrasound examination is important for obstetric management in the third trimester of gestation and follow up the newborn. It is necessary to include the PFO into differential diagnosis of the fetal heart right-sided dominance as the most probable cause and to follow up this fetus to delivery. Normally two-phase blood flow in AI is possible at the end of pregnancy.

scholarly journals Acquired left-to-right shunting through a valve-incompetent foramen ovale in a cat with hypertrophic cardiomyopathy and congestive heart failure

2020 ◽  
Vol 6 (2) ◽  
pp. 205511692095960
Author(s):  
Randolph L Winter ◽  
Ryan N Jennings ◽  
James P Cronin ◽  
Jaylyn D Rhinehart ◽  
Karsten E Schober
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Atrial ◽  
Ventricular Outflow Tract ◽  
Interatrial Septum ◽  
Left Ventricular ◽  
Foramen Ovale ◽  
Concentric Hypertrophy ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow ◽  
Atrial Enlargement

Case summary An 8-year-old spayed female domestic shorthair cat was presented for a recheck evaluation of hypertrophic cardiomyopathy and chronic kidney disease. Three years prior to presentation, the patient was diagnosed with obstructive hypertrophic cardiomyopathy and started on atenolol. The left ventricular outflow tract obstruction subsequently resolved. Biochemical analysis a week prior to presentation demonstrated severe azotemia. Transthoracic echocardiograph revealed pericardial effusion, pleural effusion, severe left ventricular concentric hypertrophy, severe left atrial enlargement and continuous left-to-right flow through the interatrial septum near the fossa ovalis. The patient was euthanized owing to poor prognosis, and gross examination at necropsy revealed a valve-incompetent patent foramen ovale secondary to severe left atrial dilation. Relevance and novel information To our knowledge, this is the first report of an acquired left-to-right shunt through a valve-incompetent foramen ovale in a cat with hypertrophic cardiomyopathy. Severe left atrial dilation was suspected to cause interatrial shunting through the valve-incompetent foramen ovale, and this finding may be relevant to echocardiographic evaluations in other cats.

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