Septal pouch in the left atrium: a new anatomical entity with potential for embolic complications.
OBJECTIVE
The purpose of this study was to develop a better understanding of the pathophysiology of the condition, we studied the patterns by which the septum primum (SP) and septum secundum (SS) fuse.


BACKGROUND
A patent foramen ovale (PFO) is a communication across the interatrial septum between a nonadherent SP and SS and is considered to be a risk factor for serious clinical syndromes.


METHODS
We examined the interatrial septum in 94 randomly selected autopsied hearts, with a focus on the SP and SS and the patterns by which the 2 structures fuse.


RESULTS
Of the 94 specimens that were suitable for analysis, 26 (27.66%) had a PFO. Of the remaining 68 hearts, complete fusion of the SP and SS along the entire zone of overlap was seen in 27 (28.7%) hearts. In the remaining 41 hearts (60.29%), a PFO was absent, but incomplete fusion of the SP and SS was seen. Of 41 hearts, 37 (90%) had a septal pouch that opened into the left atrial (LA) cavity. Four hearts (10%) had a pouch accessible from the right atrium. Hearts with left-sided pouches tended to be younger (50 +/- 18 years of age) than hearts where there was complete fusion (age 63 +/- 23 years) (p = 0.06).


CONCLUSIONS
Our data suggest that when a foramen ovale closes spontaneously, the SP and SS fuse initially at the caudal limit of the zone of overlap of the 2 structures. This incomplete fusion results in a pouch that, in the majority of instances, communicates with the LA cavity.
Krishnan
Subramaniam C
SC
University of California at Irvine Medical Center, Orange, California 92868, USA. krishnan@uci.edu
Salazar
Miguel
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology* / Q000473:pathology; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000473:pathology*; D006325:Heart Atria / Q000002:abnormalities; D006343:Heart Septal Defects / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D055815:Young Adult