The Many Faces of the Interatrial Septum: A Diagnostic Dilemma and Considerations for Defect Closure Device Selection

Daniel McGrail; Sankalp Sehgal; Mark K Tuttle; Roger Laham; Kiran Belani

doi:10.1053/j.jvca.2022.01.034

The Many Faces of the Interatrial Septum: A Diagnostic Dilemma and Considerations for Defect Closure Device Selection

J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):3156-3162. doi: 10.1053/j.jvca.2022.01.034. Epub 2022 Jan 31.

Authors

Daniel McGrail¹, Sankalp Sehgal², Mark K Tuttle³, Roger Laham², Kiran Belani⁴

Affiliations

¹ Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: dmcgrail@bidmc.harvard.edu.
² Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
³ Department of Interventional Cardiology, North Colorado Medical Center, Banner Health, Greeley, CO.
⁴ Department of Anesthesiology, Inova Heart And Vascular Institute, Inova Fairfax Hospital, University of Virginia School of Medicine Affiliate, Falls Church, VA.

PMID: 35279368
DOI: 10.1053/j.jvca.2022.01.034

Abstract

PATENT FORAMEN ovales (PFOs) and atrial septal defects (ASDs) are 2 examples of interatrial septal pathology.¹ The presence of a PFO is a well-known risk factor for cryptogenic stroke.¹^,² Newer evidence over the course of the last decade suggests percutaneous device closure of PFOs significantly reduces the subsequent risk of recurrent stroke.² Among ASDs, the ostium secundum type is the most common pathology and, due to its anatomy, is most amenable to transcatheter closure.¹ The tools that are available to percutaneously close these different pathologies vary, and choosing the correct device for the procedure can have significant impact on the clinical outcome. The authors here present a case that highlights how the differentiation of an ASD from a PFO using 2-dimensional (2D) and 3-dimensional (3D) echocardiography can affect the clinical decision-making and outcome in a challenging structural heart disease case.

Keywords: atrial septal aneurysm; atrial septal defect; cryptogenic stroke; patent foramen ovale; structural heart; transesophageal echocardiography.

Publication types

Case Reports

MeSH terms

Atrial Septum* / diagnostic imaging
Atrial Septum* / surgery
Cardiac Catheterization / methods
Echocardiography, Three-Dimensional*
Echocardiography, Transesophageal / methods
Foramen Ovale, Patent* / diagnostic imaging
Foramen Ovale, Patent* / surgery
Heart Septal Defects, Atrial* / diagnostic imaging
Heart Septal Defects, Atrial* / surgery
Humans
Treatment Outcome