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. 2016 Mar-Apr;68(2):147-52.
doi: 10.1016/j.ihj.2015.08.001. Epub 2016 Jan 18.

Morphological study of fossa ovalis and its clinical relevance

S D Joshi  1 , H K Chawre  2 , S S Joshi  3
Affiliations

Morphological study of fossa ovalis and its clinical relevance

S D Joshi et al. Indian Heart J. 2016 Mar-Apr.

Abstract

Aims: Patent foramen ovale (PFO) has been implicated in the etiology of a number of different pathologies, including cryptogenic stroke, decompression sickness in divers, etc. It can act as a channel for paradoxical embolism. PFO is not an uncommon condition, with a probe-patency in 15-35% population. The fossa ovalis (FOv) varies in size and shape from heart to heart; the prominence of annulus FOv also varies. The entire FOv may be redundant and aneurysmal. The anatomico-functional characterization of interatrial septum seems to be of paramount importance for both atrial septal defect (ASD) and PFO, not only for the device selection, but also for the evaluation of the outcome of this procedure.

Method: This study was conducted in 50 apparently normal hearts available in Department of Anatomy. After opening the right atrium, the shape of FOv was observed. The size was measured with the digital vernier caliper; the prominence and extent of limbus, and the redundancy or otherwise of FOv were noted; probe patency was confirmed.

Results: In the majority, FOv was oval (82%); average transverse diameter was 14.53mm and vertical 12.60mm. In 90%, the rim of the annulus was raised; in 20%, a recess was found deep to the margin of the annulus; and 18% showed probe patency.

Conclusion: As no study of this nature has been carried out in the Indian population, this provides pertinent information on the morphology of FOv, which may be useful for device selection in treating ASD and PFO.

Keywords: Fossa ovalis; Interatrial septum; Patent foramen ovale; Probe patency; Trans esophageal echocardiography.

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Figures

Fig. 1
Fig. 1
Schematic representation of various elements contributing to the formation of annulus FOv. FOv, fossa ovalis; CS, coronary sinus ostium.
Fig. 2
Fig. 2
Shapes of fossa ovalis (FOv). (A) Oval and (B) circular. Double-headed red arrow indicates the long axis.
Fig. 3
Fig. 3
Annulus fossa ovalis. (A) The annulus is raised along the whole circumference (black arrows). The fossa ovalis show redundancy. (B) The annulus is flat except in its upper part which shows a prominent recess (red arrows). Fossa ovalis is aneurysmal bulging towards right atrium. FOv, fossa ovalis.
Fig. 4
Fig. 4
Raised margin of annulus in its whole circumference. In the upper part, it shows a deep recess (red arrows) and slit-like recess in the lower part (white arrows). Also seen are 2 openings in the posterior part at the annulus. Fossa ovalis is seen bulging in the right atrium. FOv, fossa ovalis.
Fig. 5
Fig. 5
(A) Probe patency where orange probe has been negotiated through the right atrium (black arrow) to emerge through the left atrium. (B) 2 probes being passed through patent foramen ovale (PFO) via the right atrium. (C) The emergence of the probes into the left atrium and they are separated by a strand. FOv, fossa ovalis.
Fig. 6
Fig. 6
Photograph showing a large number of fibrous strands (red arrows) in the anteroinferior part of fossa ovalis (FOv).
See this image and copyright information in PMC

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