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Adult Congenital Heart Disease
Published in Takahiro Shiota, 3D Echocardiography, 2020
Pastora Gallego, Silvia Montserrat
3D TEE allows a detailed anatomical observation of the interatrial septum, including the remnants of the fetal circulation: the fossa ovalis (FO) and the foramen ovale.10 More than 25% of normal adults present a patent foramen ovale, which under some circumstances may have pathologic relevance. Moreover, most of the structural interventions in the left heart require transseptal crossing of the interatrial septum through the FO. Therefore, an adequate knowledge of the anatomical features of the interatrial septum, as well as its normal and pathologic variants is definitely required. Figure 16.10 shows an en face view of the atrial septum as viewed from the RA (Figure 16.10A) and from the LA (Figure 16.10B) aspects. The FO does not lie exactly in the middle of the atrial septum but instead is displaced a little inferoposteriorly. Inferior to the FO is the inferior vena cava (IVC), and inferoanteriorly, the coronary sinus (CS). The superior vena cava (SVC) enters from above along the posterior aspect of the atrial septum. The tricuspid valve (TV) lies anteriorly. The aortic valve and root lie centrally in the heart, wedged between the two atria and resting on the atrial septum. Thus, the anterosuperior border of the FO is related to the aortic root. The muscular rim characterizes the RA aspect, whereas the LA aspect is flat.
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The use of contrast increases the detection of right-to-left shunts. TEE is indicated if TTE is negative, and there is still a suspected embolic source in the heart, such as in the: Venous system (i.e. via a right-to-left shunt, such as a PFO).Interatrial septum (e.g. atrial septal aneurysm).Left atrium or LAA.Aortic arch.
Thorax
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The heart is a cone-shaped muscular organ weighing around 250 g situated in the middle mediastinum. It consists of four chambers, the right and the left atria separated by a thin interatrial septum and the right and left ventricles separated by a thick interventricular septum (Figure 2.9).
Is combined use of radiofrequency ablation and balloon dilation the future of interatrial communications?
Published in Expert Review of Cardiovascular Therapy, 2022
The atrial flow regulator is a self-expandable nitinol mesh device braided into two flat discs, in which there is a fixed fenestration to provide a controllable interatrial shunt [88]. The fenestration has multiple diameters (6, 8, and 10 mm) and is designed to allow interatrial bidirectional flow. Similar to an atrial septal defect or patent foramen ovale occluder, the device is placed within the interatrial septum after a transseptal puncture. Atrial flow regulators have been implanted in patients with HFpEF, HFmEF, and severe PAH [17,88–90]. Although spontaneous closure has been reported in the preclinical research, clinical studies have suggested device patency of nearly 100% during the follow-up [62]. A 10–12 F delivery sheath is required for device implantation via femoral venous access. With a similar design and implantation technique to that of the atrial flow regulator, a D-shunt atrium shunt device is a double disc and buckle-shaped mesh plug made of nickel-titanium alloy [91]. During a 6-month follow-up period, the clinical outcome was satisfactory, with symptomatic improvement in patients with chronic heart failure.
Prevalence and diagnostic value of extra-left ventricle echocardiographic findings in transthyretin-related cardiac amyloidosis
Published in Amyloid, 2022
Gianluca Di Bella, Francesco Cappelli, Roberto Licordari, Paolo Piaggi, Mariapaola Campisi, Diego Bellavia, Fabio Minutoli, Luca Gentile, Massimo Russo, Cesare de Gregorio, Federico Perfetto, Anna Mazzeo, Calogero Falletta, Francesco Clemenza, Giuseppe Vita, Scipione Carerj, Giovanni Donato Aquaro
Standard apical four and five-chambers views were used to detect CouR (cm2), CriT (cm2) and EusV (cm2). A mean value obtained in five-chamber, LV outflow long-axis, and parasternal long-axis were used to quantify MAL (mm). Additionally, AVP (mm) was acquired in a five-chamber view at the mitral annulus. A mean value obtained in parasternal long-axis view and short-axis view of the aortic valve was used to quantify the anterior ascending aortic wall (mm) (red arrows on Figure 3). Moreover, interatrial septum thickness was measured in an apical four-chamber view in septum primum within 5 mm from the atrioventricular valves plane. All parameters were measured at tele-diastole. In an echocardiographic core lab, two skilled cardiologists independently performed all examinations and measurements, blinded to clinical patient data and to diagnosis.
Current practice in atrial septal defect occlusion in children and adults
Published in Expert Review of Cardiovascular Therapy, 2020
Wail Alkashkari, Saad Albugami, Ziyad M. Hijazi
Transthoracic echocardiography (TTE) may demonstrate a clearly visible defect in the atrial septum, best seen in the apical four-chamber, short-axis view at the level of the aorta and subcostal long-axis views. However, it is common to see ‘echo dropout’ in the region of the interatrial septum where bubble contrast with provocation (e.g. including a sharp nasal sniff, a cough, or the relaxation phase of the Valsalva maneuver) improves diagnostic accuracy. TTE reveals the hemodynamic consequences of ASD related shunting; such as RA dilation, RV dilation/failure, tricuspid annular dilation and TR, and PAH. It is not uncommon to find mild elevation in pressure gradient across the tricuspid and pulmonary valves due to increase flow. It is important to assess the LV which may look smaller due to septal shifting and may demonstrate LV systolic or diastolic dysfunction due to the ASD or the concomitant hypertension and coronary disease. TTE is also an important tool to search for evidence of other congenital and structural lesions such as pulmonary stenosis, bicuspid aortic valve disease, patent ductus arteriosus, ventricular septal defect, and mitral valve disease. Such findings may alter management in terms of appropriateness of device closure of the ASD or a preferred surgical approach [15].