Abstract：Objective This study aims to determine the detection rate and anatomical observation of left atrial septal pouch (LASP) based on coronary CT angiography (CTA) combined with three-dimensional reconstruction technology. Methods A cross-sectional study was conducted. A total of 332 subjects who underwent coronary CTA examination in Dezhou Hospital of Qilu Hospital of Shandong University from December 2021 to January 2022 were enrolled. The participants included 200 males and 132 females aged 31 to 83 (57.3±9.4) years. According to their age, they were divided into group A (≥50 years old) with 271 cases and group B (<50 years old) with 61 cases. Three-dimensional reconstruction technology was used to observe LASP based on the CTA images of subjects. The observation items were as follows: (1) to compare differences in the detection rate of LASP between sex and age groups A and B; observe the shape and opening direction of LASP; and (2) measure and compare the pouch depth, pouch wall thickness, and pouch mouth width of LASP between groups A and B. Results (1) Among 332 subjects, 69 cases (20.8%) of LASP were detected; of which, 46 cases (23.0%, 46/200) were males and 23 cases (17.4%, 23/132) were females, with no significant difference (χ2=1.50, P=0.220). LASP was detected in 56 cases (20.7%, 56/271) in group A and 13 cases (21.3%, 13/61) in group B, with no significant difference (χ2=0.01, P=0.910). The shape of the pouch mouth was mostly arc, and the opening faces upward or front and upper, of which 30 cases face upward and 39 cases face front and upper. (2) The pouch depth, pouch wall thickness, and pouch width of 69 LASP cases were 2.59-15.44 (7.79±2.91), 0.58-3.21 (1.57±0.41), and 0.80-4.75 (1.98±0.72) mm, respectively; the values in patients in aged ≥50 years were (7.64±2.77) mm, (1.58±0.43)mm, and (1.95±0.74) mm, while those in aged <50 years were (8.43±3.50) mm, (1.51±0.34) mm, and (2.09±0.68) mm, respectively. No significant difference was found between different age group (t=0.87,0.55,0.63; all P values >0.05). Conclusion Coronary CTA combined with three-dimensional reconstruction technique can be used to observe the morphological characteristics of the capsular pouch. The method shows no difference in the detection rate between sex and age as well as in the depth, wall thickness, and mouth width of the capsular pouch between people aged ≥50 and <50 years.
Krishnan SC, Salazar M.Septal pouch in the left atrium: a new anatomical entity with potential for embolic complications[J]. JACC Cardiovasc Interv, 2010, 3(1): 98-104. DOI:10.1016/j.jcin.2009.07.017
[2]
Hołda MK, Krawczyk-Ożóg A, Koziej M, et al.Left-sided atrial septal pouch is a risk factor for cryptogenic stroke[J]. J Am Soc Echocardiogr, 2018,31(7):771-776. DOI: 10.1016/j.echo.2018.01.023
[3]
Hołda MK, Koziej M, Holda J, et al.Atrial septal pouch-morphological features and clinical considerations[J]. Int J Cardiol, 2016, 220: 337-342. DOI:10.1016/j.ijcard.2016.06.141
[4]
官政燕, 刘昱博, 王先文, 等. 房间隔囊袋的研究进展[J].中华心血管病杂志,2021,49(8):828-832. DOI: 10.3760/cma.j.cn112148-20210129-00105.Guan ZY, Liu YB, Wang XW, et al.Research progress on the diagnosis and management of atrial septal pouch[J].Chin J Cardiol,2021,49(8):828-832. DOI: 10.3760/cma.j.cn112148-20210129-00105
[5]
Kabirdas D, Nekkanti R.Webbed left atrial septal pouch-a new anatomical variant[J]. Echocardiography, 2018, 35(6): 889-892. DOI:10.1111/echo.13904
[6]
Hołda MK, Krawczyk-Ożóg A, Koziej M, et al.Mid-esophageal bicaval versus short-axis view of interatrial septum in two-dimensional transesophageal echocardiography for diagnosis and measurement of atrial septal pouches[J]. Echocardiography, 2018,35(6):827-833. DOI: 10.1111/echo.13847
[7]
Hołda MK, Krawczyk-Ożóg A, Koziej M, et al.Cardiac computed tomography compared with two-dimensional transesophageal echocardiography for the detection and assessment of atrial septal pouches[J]. Int J Cardiovasc Imaging, 2018,34(8):1305-1313. DOI: 10.1007/s10554-018-1342-0
[8]
姚明, 程谦涛, 汪玲, 等. 卵圆孔未闭导致反复缺血性卒中一例[J].中华解剖与临床杂志,2021,26(3):360-361. DOI: 10.3760/cma.j.cn101202-20200527-00175.Yao M,Cheng QT,Wang L,et al.Cryptogenic stroke with patent foramen ovale: a case report[J].Chin J Anat Clin,2021,26(3):360-361. DOI: 10.3760/cma.j.cn101202-20200527-00175
[9]
Tugcu A, Okajima K, Jin Z, et al.Septal pouch in the left atrium and risk of ischemic stroke[J]. JACC Cardiovasc Imaging, 2010, 3(12): 1276-1283. DOI:10.1016/j.jcmg.2010.11.001
[10]
Wong JM, Lombardo DM, Barseghian A, et al.Left atrial septal pouch in cryptogenic stroke[J]. Front Neurol, 2015, 6: 57. DOI: 10.3389/fneur.2015.00057
[11]
Ohanyan A, Cuminetti G, Morissens M.Beware of the LASP! A structure with thrombogenic potential[J]. Echocardiography, 2020, 37(1): 152-153. DOI: 10.1111/echo.14564
[12]
Ferreira E, Cavalcanti de Oliveira D, Braga Barros A, et al. Left atrial septal pouch and acute thromboembolic ischemia of the upper limb[J]. Am J Case Rep, 2021, 22: e932582. DOI: 10.12659/AJCR.932582
[13]
Sun JP, Meng F, Yang XS, et al.Prevalence of atrial septal pouch and risk of ischemic stroke[J]. Int J Cardiol, 2016, 214: 37-40. DOI: 10.1016/j.ijcard.2016.03.119
[14]
Strachinaru M, Castro-Rodriguez J, Verbeet T, et al.The left atrial septal pouch as a risk factor for stroke: a systematic review[J]. Arch Cardiovasc Dis, 2017, 110(4): 250-258. DOI:10.1016/j.acvd.2017.01.001
2023, Vol. 28 
