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Incremental Value of Live/Real Time Three‐Dimensional over Two‐Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch
Author(s) -
Elsayed Mahmoud,
Hsiung Ming C.,
MeggoQuiroz L. David,
Elguindy Mostafa,
Uygur Begum,
Tandon Rohit,
Guvenc Tolga,
Keser Nurgul,
Vural Mustafa G.,
Bulur Serkan,
Chahwala Jugal R.,
Abtahi Firoozeh,
Nanda Navin C.
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13111
Subject(s) - septum secundum , transesophageal echocardiogram , pouch , medicine , echogenicity , cardiology , magnetic resonance imaging , radiology , nuclear medicine , ultrasonography , surgery
An atrial septal pouch ( ASP ) results from partial fusion of the septum primum and the septum secundum, and depending on the site of fusion, the pouch can be left‐sided ( LASP ) or right‐sided ( RASP ). LASP s have been described in association with thrombi found in patients admitted with acute strokes, raising awareness of its potential cardioembolic role, especially in those with no other clearly identifiable embolic source. We retrospectively studied 39 patients in whom the presence of an ASP had been identified by three‐dimensional transesophageal echocardiography (3 DTEE ) and who had a two‐dimensional transesophageal echocardiogram (2 DTEE ) performed during the same clinical encounter. The incremental value provided by 3 DTEE over 2 DTEE included the detection of six ASP s not found by 2 DTEE ; the detection of two ASP s in the same subject (in four patients) not identified by 2 DTEE ; larger ASP measurements of length and height in over 80% of the cases; and measurement of the ASP width (elevational axis) for the calculation of the area of the ASP opening, because of its unique capability to view the pouch en face. In addition, the volume of ASP and of the echogenic masses contained in the ASP (four of 39 patients) could be calculated by 3 DTEE , which is a superior parameter of size characterization when compared to individual dimensions. One of these patients who presented with ischemic stroke diagnosed by magnetic resonance imaging had a large (>2 cm) mass in a LASP , with echolucencies similar to those seen in thrombi and associated with clot lysis and resolution. This mass completely disappeared on anticoagulant therapy lending credence that it was most likely a thrombus. There was no history of stroke or any other type of embolic event in the other three patients with masses in ASP . In conclusion, this retrospective study highlights the incremental value of 3 DTEE over 2 DTEE in the comprehensive assessment and characterization of ASP s, which can aid in the clarification of their role in cryptogenic stroke patients.