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Interatrial septum: A pictorial review of congenital and acquired pathologies and their management

Published:February 06, 2019DOI:https://doi.org/10.1016/j.clinimag.2019.02.002

      Highlights

      • Differentiation of the congenital and acquired interatrial septal pathologies is very important for their management.
      • Advances in CT and MRI technologies have made identification of the interatrial septal pathologies easier.
      • Radiologists play a significant role in the management of interatrial septal pathologies.

      Abstract

      There are many different congenital abnormalities and acquired pathologies involving the interatrial septum. Differentiation of these pathologies significantly affects patient management. We have reviewed the various interatrial septal pathologies and discussed their congenital associates, clinical significance, and management. After reading this article, the reader should be able to better characterize the interatrial septal pathologies using the optimal imaging tools, and have a better understanding of their clinical significance and management.

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      References

        • O'Donnell D.H.
        • Abbara S.
        • Chaithiraphan V.
        • Yared K.
        • Killeen R.P.
        • Cury R.C.
        • et al.
        Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.
        Am J Roentgenol. 2009; 193: 377-387
        • Motwani M.
        • Kidambi A.
        • Herzog B.A.
        • Uddin A.
        • Greenwood J.P.
        • Plein S.
        MR imaging of cardiac tumors and masses: a review of methods and clinical applications.
        Radiology. 2013; 268: 26-43
        • Hagen P.T.
        • Scholz D.G.
        • Edwards W.D.
        Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts.
        Mayo Clin Proc. 1984; 59: 17-20
        • Mohrs O.K.
        • Petersen S.E.
        • Erkapic D.
        • Rubel C.
        • Schräder R.
        • Nowak B.
        • et al.
        Diagnosis of patent foramen ovale using contrast-enhanced dynamic MRI: a pilot study.
        Am J Roentgenol. 2005; 184
        • Bogousslavsky J.
        • Garazi S.
        • Jeanrenaud X.
        • Aebischer N.
        • Van Melle G.
        Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group.
        Neurology. 1996; 46: 1301-1305
        • Yasunaga D.
        • Hamon M.
        MDCT of interatrial septum.
        Diagn Interv Imaging. 2015; 96: 891-899
        • Nicolay S.
        • Salgado R.A.
        • Shivalkar B.
        • Van Herck P.L.
        • Vrints C.
        • Parizel P.M.
        CT imaging features of atrioventricular shunts: what the radiologist must know.
        Insight Imaging. 2016; 7: 119-129
        • Saremi F.
        • Channual S.
        • Raney A.
        • Gurudevan S.V.
        • Narula J.
        • Fowler S.
        • et al.
        Imaging of patent foramen ovale with 64-section multidetector CT.
        Radiology. 2008; 249: 483-492
        • Krishnan S.C.
        • Salazar M.
        Septal pouch in the left atrium: a new anatomical entity with potential for embolic complications.
        JACC Cardiovasc Interv. 2010 Jan 1; 3: 98-104
        • Hołda M.K.
        • Koziej M.
        • Hołda J.
        • Piątek K.
        • Tyrak K.
        • Chołopiak W.
        • et al.
        Atrial septal pouch — morphological features and clinical considerations.
        Int J Cardiol. 2016 Oct 1; 220: 337-342
        • Landzberg M.J.
        Indications for the closure of patent foramen ovale.
        Heart. 2004; 90: 219-224
        • Mohr J.P.
        • Thompson J.L.P.
        • Lazar R.M.
        • Levin B.
        • Sacco R.L.
        • Furie K.L.
        • et al.
        A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke.
        N Engl J Med. 2001; 345: 1444-3451
        • Santhosh K.
        • Arora R.
        Cryptogenic stroke: to close a patent foramen ovale or not to close?.
        J Cent Nerv Syst Dis. 2018; 10: 1-9
        • Hung J.
        • Landzberg M.J.
        • Jenkins K.J.
        • King M.E.E.
        • Lock J.E.
        • Palacios I.F.
        • et al.
        Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement.
        J Am Coll Cardiol. 2000; 35: 1311-1316
        • Dearani J.A.
        • Ugurlu B.S.
        • Danielson G.K.
        • Daly R.C.
        • CGA McGregor
        • Mullany C.J.
        • et al.
        Surgical patent foramen ovale closure for prevention of paradoxical embolism-related cerebrovascular ischemic events.
        Circulation. 1999; 100II171-5
        • Thomson L.E.J.
        • Crowley A.L.
        • Heitner J.F.
        • Cawley P.J.
        • Weinsaft J.W.
        • Kim H.W.
        • et al.
        Direct en face imaging of secundum atrial septal defects by velocity-encoded cardiovascular magnetic resonance in patients evaluated for possible transcatheter closure.
        Circ Cardiovasc Imaging. 2008; 1: 31-40
        • Dehghani H.
        • Boyle A.J.
        Percutaneous device closure of secundum atrial septal defect in older adults.
        Am J Cardiovasc Dis. 2012; 2: 133-142
        • Du Z.D.
        • Hijazi Z.M.
        • Kleinman C.S.
        • Silverman N.H.
        • Larntz K.
        Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial.
        J Am Coll Cardiol. 2002; 39: 1836-1844
        • Berger F.
        • Vogel M.
        • Alexi-Meskishvili V.
        • Lange P.E.
        • Lochan R.
        • Worms A.
        • et al.
        Comparison of results and complications of surgical and amplatzer device closure of atrial septal defects.
        J Thorac Cardiovasc Surg. 1999; 118: 674-680
        • Ashley E.A.
        • Niebauer J.
        Cardiology explained. Medicina.
        Remedica, London2004
        • Webb G.
        • Gatzoulis M.A.
        Atrial septal defects in the adult: recent progress and overview.
        Circulation. 2006; 114: 1645-1653
        • Rajiah P.
        • Renapurkar R.
        • Kanne J.
        Diagnosis of ostium primum defect at multidetector CT in an adult.
        J Thorac Imaging. 2009; 24: 234-236
        • Siripornpitak S.
        • Pornkul R.
        • Khowsathit P.
        • Layangool T.
        • Promphan W.
        • Pongpanich B.
        Cardiac CT angiography in children with congenital heart disease.
        Eur J Radiol. 2013 Jul; 82: 1067-1082
        • Thangaroopan M.
        • Truong Q.A.
        • Kalra M.K.
        • Yared K.
        • Abbara S.
        Rare case of an unroofed coronary sinus: diagnosis by multidetector computed tomography.
        Circulation. 2009; 119
        • Bonardi M.
        • Valentini A.
        • Camporotondo R.
        Unroofed coronary sinus and persistent left superior vena cava: a case report.
        J Ultrasound. 2012; 15: 179-182
        • Kong P.K.
        • Ahmad F.
        Unroofed coronary sinus and persistent left superior vena cava.
        Eur J Echocardiogr. 2007; 8: 398-401
        • Kwak J.G.
        • Lee C.
        • Choi E.Y.
        • Song J.Y.
        • Lee C.H.
        Dilated unroofed coronary sinus mimicking cor triatriatum in cardiac-type total anomalous pulmonary venous connection.
        J Card Surg. 2012; 27: 621-623
        • Pérez Matos A.J.
        • Planken R.N.
        • Bouma B.J.
        • Groenink M.
        • Backx A.P.C.M.
        • de Winter R.J.
        • et al.
        Unroofed coronary sinus newly diagnosed in adult patients after corrected congenital heart disease.
        Neth Hear J. 2014; 22: 240-245
        • Cabanes L.
        • Mas J.L.
        • Cohen A.
        • Amarenco P.
        • Cabanes P. a
        • Oubary P.
        • et al.
        Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography.
        Stroke. 1993; 24: 1865-1873
        • Oyedeji A.T.
        • Okunola O.
        • Sani M.U.
        Atrial septal aneurysm mimicking a cor triatriatum sinister: a case report and review of the literature.
        Clin Med Insight Case Rep. 2012; 5: 143-147
        • Ewert P.
        • Berger F.
        • Vogel M.
        • Dähnert I.
        • Alexi-Meshkishvili V.
        • Lange P.E.
        Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement.
        Heart. 2000; 84: 327-331
        • Morelli S.
        • Voci P.
        • Morabito G.
        • Sgreccia A.
        • De Marzio P.
        • Marzano F.
        • et al.
        Atrial septal aneurysm and cardiac arrhythmias.
        Int J Cardiol. 1995; 49: 257-265
        • Belkin R.N.
        • Kisslo J.
        Atrial septal aneurysm: recognition and clinical relevance.
        Am Heart J. 1990; 120: 948-957
        • Hanley P.C.
        • Tajik A.J.
        • Hynes J.K.
        • Edwards W.D.
        • Reeder G.S.
        • Hagler D.J.
        • et al.
        Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases.
        J Am Coll Cardiol. 1985; 6: 1370-1382
        • Pearson A.C.
        • Nagelhout D.
        • Castello R.
        • Gomez C.R.
        • Labovitz A.J.
        Atrial septal aneurysm and stroke: a transesophageal echocardiographic study.
        J Am Coll Cardiol. 1991; 18: 1223-1229
        • Galrinho A.
        • Branco L.M.
        • De Sousa L.
        • Pinto F.
        • Ferreira R.
        Giant interatrial septal aneurysms mimicking quistic masses: two cases with different therapeutic options.
        Rev Port Cardiol. 2010; 29: 1429-1432
        • Burger A.J.
        • Sherman H.B.
        • Charlamb M.J.
        Low incidence of embolic strokes with atrial septal aneurysms: a prospective, long-term study.
        Am Heart J. 2000; 139: 149-152
        • Kassop D.
        • Donovan M.S.
        • Cheezum M.K.
        • Nguyen B.T.
        • Gambill N.B.
        • Blankstein R.
        • et al.
        Cardiac masses on cardiac CT: a review.
        Curr Cardiovasc Imaging Rep. 2014; 7: 1-13
        • Laura D.M.
        • Donnino R.
        • Kim E.E.
        • Benenstein R.
        • Freedberg R.S.
        • Saric M.
        Lipomatous atrial septal hypertrophy: a review of its anatomy, pathophysiology, multimodality imaging, and relevance to percutaneous interventions.
        J Am Soc Echocardiogr. 2016; 29: 717-723
        • Rojas C.A.
        • Jaimes C.E.
        • El-Sherief A.H.
        • Medina H.M.
        • Chung J.H.
        • Ghoshhajra B.
        • et al.
        Cardiac CT of non-shunt pathology of the interatrial septum.
        J Cardiovasc Comput Tomogr. 2011; 5: 93
        • Naseerullah F.S.
        • Javaiya H.
        • Murthy A.
        Cardiac lipoma: an uncharacteristically large intra-atrial mass causing symptoms.
        Case Rep Cardiol. 2018; 63531982
        • Meaney J.F.M.
        • Kazerooni E.A.
        • Jamadar D.A.
        • Korobkin M.
        CT appearance of lipomatous hypertrophy of the interatrial septum.
        Am J Roentgenol. 1997; 168: 1081-1084
        • Xanthos T.
        • Giannakopoulos N.
        • Papadimitriou L.
        Lipomatous hypertrophy of the interatrial septum: a pathological and clinical approach.
        Int J Cardiol. 2007; 121: 4-8
        • Shinto A.
        • Kamaleshwaran K.
        • Sudhakar N.
        • Shibu D.
        • Kurup E.R.R.
        Persistent high grade flurodeoxyglucose uptake in lipomatous hypertrophy of the interatrial septum on dual time point imaging and with ambient warming.
        World J Nucl Med. 2014; 13: 62
        • Klein M.A.
        • Scalcione L.R.
        • Youn T.
        • Shah R.A.
        • Katz D.S.
        • Sung W.W.
        • et al.
        Intensely hypermetabolic lipomatous hypertrophy of the interatrial septum on 18-FDG PET with MRI and CT correlation.
        Clin Nucl Med. 2010; 35: 972-973
        • Zukotynski K.A.
        • Israel D.A.
        • Kim C.K.
        FDG uptake in lipomatous hypertrophy of the interatrial septum is not likely related to brown adipose tissue.
        Clin Nucl Med. 2011 Sep; 36: 767-769
        • Bajaj R.R.
        • Deva D.
        • Kirpalani A.
        • Yan R.T.
        • Chow C.M.
        • Lo V.
        • et al.
        Cardiac magnetic resonance imaging for non-invasive diagnosis of lipomatous hypertrophy of inter-atrial septum.
        Indian Heart J. 2014; 66: 244-246
        • Tatli S.
        • O'Gara P.T.
        • Lambert J.
        • Kwong R.
        • Byrne J.G.
        • Yucel E.K.
        MRI of atypical lipomatous hypertrophy of the interatrial septum.
        Am J Roentgenol. 2004; 182: 598-600
        • Abbas A.
        • Garfath-Cox K.A.G.
        • Brown I.W.
        • Shambrook J.S.
        • Peebles C.R.
        • Harden S.P.
        Cardiac MR assessment of cardiac myxomas.
        Br J Radiol. 2015; 88
        • Hoffmeier A.
        • Sindermann J.R.
        • Scheld H.H.
        • Martens S.
        Cardiac tumors--diagnosis and surgical treatment.
        Dtsch Arztebl Int. 2014; 111: 205-211
        • Kayançiçek H.
        • Khalil E.
        • Keskin G.
        • Alataş Ö.
        • Hafız E.
        • Faruk Doğan Ö.
        Ten years' clinical experience of cardiac myxoma: diagnosis, treatment, and clinical outcomes.
        Anatol J Cardiol. 2018; 19: 157-158
        • Roever L.
        • Casella-Filho A.
        • Dourado P.M.M.
        • Resende E.S.
        • Chagas A.C.P.
        Cardiac tumors: a brief commentary.
        Front Public Health. 2014; 2: 264
        • Turhan S.
        • Ozcan O.U.
        • Erol C.
        Imaging of intracardiac thrombus.
        vol. 55. Cor et Vasa, 2013
        • Pasternak R.
        • Cannom D.
        • Cohen L.
        Echocardiographic diagnosis of large fungal verruca attached to mitral valve.
        Br Heart J. 1976; 38: 1209-1212
        • Mazzola A.
        • Spano J.P.
        • Valente M.
        • Gregorini R.
        • Villani C.
        • Di Eusanio M.
        • et al.
        Leiomyosarcoma of the left atrium mimicking a left atrial myxoma.
        J Thorac Cardiovasc Surg. 2006; 131: 224-226
        • Quigley M.M.
        A unique atrial primary cardiac lymphoma mimicking myxoma presenting with embolic stroke: a case report.
        Blood. 2003; 101: 4708-4710
        • Lone R. a
        • Ahanger a G.
        • Singh S.
        • Mehmood W.
        • Shah S.
        • Lone G.
        • et al.
        Atrial myxoma: trends in management.
        Int J Health Sci. 2008; 2: 141-151
        • Malik S.B.
        • Kwan D.
        • Shah A.B.
        • Hsu J.Y.
        The right atrium: gateway to the heart—anatomic and pathologic imaging findings.
        Radiographics. 2015; 35: 14-31
        • Waller B.F.
        • Grider L.
        • Rohr T.M.
        • Mclaughlin T.
        • Taliercio C.P.
        • Fetters J.
        Intracardiac thrombi: frequency, location, etiology, and complications: a morphologic review—part IV.
        Clin Cardiol. 1995; 18: 669-674
        • Hilberath J.N.
        • Oakes D.A.
        • Shernan S.K.
        • Bulwer B.E.
        • D'Ambra M.N.
        • Eltzschig H.K.
        Safety of transesophageal echocardiography.
        J Am Soc Echocardiogr. 2010; 23: 1115-1127
        • Pinede L.
        • Duhaut P.
        • Loire R.
        Clinical presentation of left atrial cardiac myxoma: a series of 112 consecutive cases.
        Medicine (Baltimore). 2001; 80: 159-172
        • Lacobellis A.
        • Puletti M.
        • Vitarelli A.
        Images in cardiology: worm-shaped thrombus mimicking Chiari's network in a cocaine user.
        Heart. 2002; 88: 4
        • Weinsaft J.W.
        • Kim H.W.
        • Shah D.J.
        • Klem I.
        • Crowley A.L.
        • Brosnan R.
        • et al.
        Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance. Prevalence and markers in patients with systolic dysfunction.
        J Am Coll Cardiol. 2008; 52: 148-157
        • Caspar T.
        • El Ghannudi S.
        • Ohana M.
        • Labani A.
        • Lawson A.
        • Ohlmann P.
        • et al.
        Magnetic resonance evaluation of cardiac thrombi and masses by T1 and T2 mapping: an observational study.
        Int J Card Imaging. 2017; 33: 551-559
        • Pazos-López P.
        • Pozo E.
        • Siqueira M.E.
        • García-Lunar I.
        • Cham M.
        • Jacobi A.
        • et al.
        Value of CMR for the differential diagnosis of cardiac masses.
        JACC Cardiovasc Imaging. 2014; 7: 896-905
        • Desai M.Y.
        • Jellis C.L.
        Differentiation of cardiac masses by CMR: judging a character by the company it keeps.
        JACC Cardiovasc Imaging. 2014; 7: 906-908
        • Egolum U.O.
        • Stover D.G.
        • Anthony R.
        • Wasserman A.M.
        • Lenihan D.
        • Damp J.B.
        Intracardiac thrombus: diagnosis, complications and management.
        Am J Med Sci. 2013; 345: 391-395
        • Abraham K.P.
        • Reddy V.
        • Gattuso P.
        Neoplasms metastatic to the heart: review of 3314 consecutive autopsies.
        Am J Cardiovasc Pathol. 1990; 3: 195-198