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. 2010 Dec;3(12):1276-83.
doi: 10.1016/j.jcmg.2010.11.001.

Septal pouch in the left atrium and risk of ischemic stroke

Aylin Tugcu  1 , Kazue Okajima, Zhezhen Jin, Tatjana Rundek, Shunichi Homma, Ralph L Sacco, Mitchell S V Elkind, Marco R Di Tullio
Affiliations

Septal pouch in the left atrium and risk of ischemic stroke

Aylin Tugcu et al. JACC Cardiovasc Imaging. 2010 Dec.

Abstract

Objectives: We sought to assess the association between the presence of a septal pouch in the left atrium and ischemic stroke.

Background: It has been suggested that the presence of a left septal pouch (LSP) may favor the stasis of blood and possibly result in thromboembolic complications. However, the embolic potential of an LSP is not known.

Methods: The association between an LSP and risk of stroke was assessed using a population-based case-control study design. The presence of an LSP was assessed by transesophageal echocardiography in 187 patients >50 years of age with a first-ever ischemic stroke (96 men, mean age 70.6 ± 9.0 years) and in 157 control subjects matched to patients by age, sex, and race/ethnicity. The association between an LSP and risk of stroke was assessed after adjustment for other stroke risk factors.

Results: Patients with LSPs were younger than control subjects (67.5 ± 9.1 years vs. 69.6 ± 8.8 years; p = 0.046), with a lower prevalence of hypertension (68.0% vs. 80.3%; p = 0.01). There were no differences in the prevalence of LSPs between stroke patients and control subjects (28.9% vs. 29.3%, respectively; p = 0.93). The subgroup of 69 patients (36.9%) with cryptogenic stroke showed a similar prevalence of LSPs (31.9% vs. 29.3%; p = 0.70). Multivariable analysis showed that the presence of an LSP was not associated with ischemic stroke (odds ratio: 1.09; 95% confidence interval: 0.64 to 1.85) or cryptogenic stroke (odds ratio: 1.41; 95% confidence interval: 0.71 to 2.78).

Conclusions: This study does not demonstrate evidence of the association of the presence of an LSP with ischemic stroke or cryptogenic stroke. The stroke risk associated with LSPs requires further evaluation in the younger stroke populations. The cofactors that may turn an LSP from an innocent bystander to a causative mechanism for stroke remains to be elucidated.

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Figures

Figure 1
Figure 1
(A) Example of direct visualization of LSP (arrow) by TEE. In longitudinal plane, an incomplete fusion is visible in the cranial segment of the zone of overlap between SP and SS. (B) Differentiation of LSP from PFO by contrast TEE. Injection of agitated contrast saline with a Valsalva maneuver demonstrates the absence of microbubbles crossing the interatrial septum, excluding the presence of a PFO. LSP = left sided pouch; PFO = patent foramen ovale; SP = septum primum; SS = septum secundum; TEE = transesophageal echocardiography.
Figure 1
Figure 1
(A) Example of direct visualization of LSP (arrow) by TEE. In longitudinal plane, an incomplete fusion is visible in the cranial segment of the zone of overlap between SP and SS. (B) Differentiation of LSP from PFO by contrast TEE. Injection of agitated contrast saline with a Valsalva maneuver demonstrates the absence of microbubbles crossing the interatrial septum, excluding the presence of a PFO. LSP = left sided pouch; PFO = patent foramen ovale; SP = septum primum; SS = septum secundum; TEE = transesophageal echocardiography.
See this image and copyright information in PMC

Comment in

References

    1. Sacco RL, Ellenberg JH, Mohr JP, et al. Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann Neurol. 1989;25:382–90. - PubMed
    1. Lechat P, Mas JL, Lascault G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318:1148–52. - PubMed
    1. Webster MW, Chancellor AM, Smith HJ, et al. Patent foramen ovale in young stroke patients. Lancet. 1988;2:11–2. - PubMed
    1. Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med. 1992;117:461–5. - PubMed
    1. Belkin RN, Hurwitz BJ, Kisslo J. Atrial septal aneurysm: association with cerebrovascular and peripheral embolic events. Stroke. 1987;18:856–62. - PubMed

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