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Koziej, Hołda, and Piątek: Potential sites of thrombosis in the left atrium

Introduction: Blood clots have a tendency to form within the left atrium and may cause episodes of systemic embolisms. The left atrial appendage (LAA) is widely recognized as a site of blood stasis, but in a substantial proportion of patients with systemic embolisms there is no visible source of thrombi. It raises the question whether there are other sites of blood stasis in the left atrium.

Objectives: To evaluate potential sites of thrombi within left atrium, and to present its morphological evaluation.

Materials and methods: 130 randomly selected autopsied hearts were dissected from humans aged 7–94 years (26.2% females). The diameters of the ostium and external circuit of the LAA were measured. The morphology of the interatrial septum and the patterns by which the septum primum and septum secundum fused were assessed. The depth of the left septal pouch was measured. Presence of other cavities, recesses and muscular bridges within the left atrium were evaluated.

Results: Patent foramen ovale was noted in 23.3% of the specimens. A septal pouch that opened into the left atrial cavity was found in 66 (50.8%) cases with a mean depth of 9.2 ± 5.5 mm. Muscle bridges were found in 21.5% of cases. Mean diameter of the LAA ostium was 14.2 ± 2.3 mm and mean LAA circuit was 5.8 ± 1.1 cm. The LAA circuit increased with age (r = 0.26, P = 0.00) and was significantly larger in males (P = 0.016).

Conclusions: Septal pouches that open into the left atrium (left and double septal pouch) and muscle bridges may act as sites of thrombosis. In 74.1% of patients interatrial septum can be a source of systemic embolisms. In addition to the left atrial appendage occlusion and the patent foramen ovale closure, we propose simultaneous closure of the septal pouch. We present morphological evaluation of the LAA which will be useful to cardiologists during LAA closure.

Acknowledgements: Dr WieslawaKlimek-Piotrowska MD, PhD, for supervising this project.




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