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Case Reports
. 2019 Dec 4;4(1):7-17.
doi: 10.1016/j.case.2019.10.009. eCollection 2020 Feb.

Ridges and Pouches: A Case Series of Anomalous Atrial Septal Fusion

David Zisa  1 , Francesco F Faletra  2 , Benjamin S Wessler  1 , Neil J Halin  1 , Pranitha Reddy  1 , Ayan R Patel  1 , Natesa G Pandian  1   3
Affiliations
Case Reports

Ridges and Pouches: A Case Series of Anomalous Atrial Septal Fusion

David Zisa et al. CASE (Phila). .
No abstract available

Keywords: Anomalous left atrial ridge; Atrial septal pouch; Atrial septum; Cardiac source of embolism; Transseptal puncture.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Two-dimensional transesophageal echocardiographic images of the interatrial septum at 0° (top left), 52° (top right), and 60° (bottom), showing an anomalous left atrial septal pouch (arrow) from case 1. AV, Aortic valve; LA, left atrium, RA, right atrium.
Figure 2
Figure 2
Three-dimensional transesophageal echocardiographic images from case 1 demonstrate that the left atrial septal pouch is associated with an anomalous left atrial ridge (arrow); the imaging characterizes its tubular structure on the left atrial side of the interatrial septum (en face view from left atrial perspective).
Figure 3
Figure 3
Chest computed tomographic image demonstrating the left atrial septal pouch associated with anomalous left atrial ridge (black arrow) with contrast within it (A) and two-dimensional transthoracic echocardiographic image in apical four-chamber view (B) showing thickening of the interatrial septum with hint of the anomalous left atrial ridge (white arrow) from case 1.
Figure 4
Figure 4
Two-dimensional transesophageal echocardiographic images of the interatrial septum at 0° (A), 62° (B), and 118° (C) showing the left atrial septal pouch (arrow) in case 2. LA, Left atrium; RA, right atrium.
Figure 5
Figure 5
Saline contrast imaging in the bicaval view showing a left atrial septal pouch (arrow) and absence of an atrial septal defect both at rest (A) and with Valsalva maneuver (B) from case 2. LA, Left atrium; RA, right atrium.
Figure 6
Figure 6
Chest computed tomographic image demonstrating the left atrial pouch (arrows) with contrast within it (A). Two-dimensional transthoracic echocardiographic image in apical four-chamber view shows thickening of the interatrial septum (B) but does not definitively demonstrate left atrial septal pouch seen on TEE and CT from case 2. LA, Left atrium, LV, left ventricle, RA, right atrium, RV, right ventricle.
Figure 7
Figure 7
Two-dimensional transesophageal echocardiographic images of the interatrial septum at 0° (A), 34° (B), and 60° (C) showing a left atrial septal pouch (arrow) from case 3. AV, Aortic valve; LA, left atrium; RA, right atrium; RV, right ventricle.
Figure 8
Figure 8
Two-dimensional transesophageal echocardiographic images of the interatrial septum at 121° (A) and color Doppler imaging (B) showing a left atrial septal pouch (arrow) with color flow within it from case 3. No interatrial shunt is seen. LA, Left atrium; RA, right atrium.
Figure 9
Figure 9
Three-dimensional transesophageal echocardiographic images from case 3 demonstrate that in association with the left atrial septal pouch, there is also an anomalous left atrial ridge (arrows). Three-dimensional imaging characterizes its tubular structure on the left atrial side of the interatrial septum from case 3. (A, B) Superior and inferior plane of the interatrial septum. (C, D) En face view from left atrial side. RA, Right atrium.
Figure 10
Figure 10
Three-dimensional transesophageal echocardiographic image of the left side of the interatrial septum clearly shows a thick ridge (arrows) extending from the superior vena cava (SVC) to the inferior margin of the fossa ovalis (FO) in case 4. Ao, Aorta; CS, coronary sinus; MV, mitral valve.
Figure 11
Figure 11
Two-dimensional transesophageal echocardiographic images of the interatrial septum at 108° (A) demonstrates a left atrial septal pouch. Saline contrast study at 98° (B) demonstrates the absence of an interatrial shunt, and three-dimensional transesophageal echocardiographic image (C) demonstrates an associated anomalous left atrial ridge (arrows) from case 5. LA, Left atrium; RA, right atrium; SVC, superior vena cava.
Figure 12
Figure 12
Two-dimensional transesophageal echocardiographic images of the interatrial septum at 115° (top left), color Doppler at 0° (top right), and three-dimensional transesophageal echocardiographic image (bottom) showing a left atrial septal pouch from case 6 (arrows). Ao, Aorta; LA, left atrium; MV, mitral valve; RA, right atrium.
Figure 13
Figure 13
Two-dimensional transesophageal echocardiographic images of the interatrial septum at 0° (A) and 53° (B) in case 7 showing a left atrial septal pouch (arrows). LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
Figure 14
Figure 14
Chest computed tomographic image demonstrating the anomalous left atrial septal pouch (arrow) with contrast within it from case 7. Axial view (A) and sagittal view (B).
Figure 15
Figure 15
Three-dimensional imaging of interatrial septum in case 8, showing a left atrial septal pouch (asterisk) from the left atrial perspective.
Figure 16
Figure 16
Two-dimensional transesophageal echocardiographic images of the interatrial septum from case 8 showing the left atrial septal pouch (A, B). Repeat two-dimensional TEE 1 year later showing a mobile echodense structure arising from within the pouch suggestive of thrombus (C, D). AV, Aortic valve; LA, left atrium; RA, right atrium.
Figure 17
Figure 17
Imaging from case 9. (A) Two-dimensional TEE demonstrating a left atrial septal pouch (asterisk) and an area of thickening on the roof of the pouch that is consistent with a left atrial ridge (white arrow). Three-dimensional imaging of the interatrial septum from the left atrial perspective (B) shows the orifice of the left atrial septal pouch (solid black arrow) and the left atrial ridge (dashed black arrow). AV, Aortic valve; LA, left atrium; RA, right atrium.
Figure 18
Figure 18
Anatomic variants of the interatrial septum demonstrating different types of fusion between septum primum and septum secundum.
See this image and copyright information in PMC

References

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