Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-27T22:32:55.317Z Has data issue: false hasContentIssue false
  • English
  • Français

The anatomy of interatrial communications – what does the interventionist need to know?

Published online by Cambridge University Press:  19 August 2008

José Diogo Ferreira Martins  and
Robert H. Anderson
José Diogo Ferreira Martins
Affiliation:
Department of Paediatric Cordiology, Hospital de Santa Cruz, Lisbon, Portugal;
Robert H. Anderson
Affiliation:
Cardiac Unit, Institute of Child Health,University College, London, United Kingdom
Get access Rights & Permissions [Opens in a new window]

Abstract

Increasingly, the interventional cardiologist is seeking to close interatrial communications by inserting devices by means of catheterisation. So as to optimise these procedures, it is adavantageous to have a firm grasp of the anatomy of the normal atrial septal structures, this then providing the basis to understand the morphology of the holes which can exist between the chambers, not all of which are true septal defects.A true septal structure can be removed without exiting from the cavities of the heart. It is the flap valve of the oval fossa, along with the anterior rim of the fossa, which fulfill this criterion. The remainder of the extensive rim of the normal fossa is no more than an infolding between the walls of the right and left atriums and their venous tributaries, and has different dimensions at various points around the ircumference. The so-called muscular atrioventricular “septum” is a sandwich incorporating a layer of epicardial fibro-adipose tissue. True defects of the atrial septum, therefore, exist because of deficiency, perforation, or absence of the flap valve. Most of these defects will prove suitable for interventional closure, but potential caveats include multiple defects, aneurysm of the flap valve, or adjacency of the fossa to the venous orifices. The other interatrial communications, namely the sinus venosus, coronary sinus, and “ostium primum” defects are outside the confines of the oval fossa. Recognition of this feature is the key to their diagnosis, and their ifferentiation from true atrial septal defects. Of these defects, only the coronary sinus defect is likely to be suitable for device closure, and then only in the very rare circumstances when it is seen in isolation

Keywords

Atrial septumatrial septal defectoval fossa defectsinus venosus defectcoranary sinus defectostium primum defect
Type
Continuing Medical Education
Information
Cardiology in the Young , Volume 10 , Issue 5 , September 2000 , pp. 464 - 473
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Lock, JE, Rome, JJ, Davis, R, Van, Praagh S, Perry, SB, Van, Praagh R, Keane, JF. Transcatheter closure of atrial septal defects. Experimental studies. Circulation 1989; 79: 1091–1099Google Scholar
2Ferreora, SMAG, Ho, SY, Anderson, RH. Morphotologic study of defects of the atrial septum within the oval fossa: Application for transcheter closeure of left-to-right shunt. Br Hearr J 1992; 67: 316–320.Google Scholar
3Chan, KC, Godman, MJ. Morphological variations of fossa ovalis atrialseptal defects (secundum): feasibility for transcutaneous closure with the clam–shell device. Br Heart J 1993; 69: 52–55.Google Scholar
4Bemurat, L, Jimenez, M, Roudaut, R, Laborde, N, Roques, X, Grimaud, JP, Choussat, A. Surgical evaluation of transthoracic tridimensional echocardiography in the anatomic study of atrial septal defect. Arch Mai Coeur Vaiss 1999; 92: 573–580.Google Scholar
5Anderson, RH, Brown, NA, The anatomy of the heart revisited. Anac Rec 1996 246 1–7.Google Scholar
6Cosio, FC, Anderson, RHKuck, KBecler, ABorggrefe, MCampbell, RWFGaita, F, Haïssaguerre, M,Rufilanchas, JJ, Thiene, G, Wellens, HJJ, Langberg, J, Benditt, DG, Bharati, S, Klein, G, Marchlinski, F, Saksena, S. Living anatomy of the atrioventricular junctions. A guide to electrophysiological mapping. A consensus statement from the Cardiac Nomenclature Study Group, Working Group of Arrhythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE. Circulation 1999; 100: e31–e37; EurHeartJ 1999; 2O: 1068–1075; J Cardiovasc Electrophysiol 1999; 10; 1162–1170.Google ScholarPubMed
7Anderson, RHWebb, SBrown, NA 1999 Clinical anatomy of the atrial septum with reference to ist development components Clin Anat 1999; 12: 362–374.3.0.CO;2-F>CrossRefGoogle Scholar
8Chauvin, M, Shah, DC, Haissaguerre, M, Marcellin, L, Brechenmacher, C, The anatomic basic of connectios between the coronary sirus musculature and the left attium is bumans Circulation 2000; 101: 645–656.Google Scholar
9Hagen, PT, Scholz, DG, Edwards, WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Proc Staff Meet Mayo Clin 1984; 59: 1489–1494.Google ScholarPubMed
10Fukazawa, MFukushige, JVeda, KAtrial septal defects in neonates with references to spontaneous closure Am Heart J 1988; 116: 123–127.Google Scholar
11Chan, KCGodman, MJWalsh, K, Wilson, N, Redington, A, Gibbs, JLTranscatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentric UK experience. Heart 1999; 82: 300–306.Google Scholar
12Elzenga, NJ. The role of echocardiography in transcatheter closure of atrial septal defects. Cardiol Young 2000; 10… (thisissue)Google Scholar
13Lock, JE, Cockerham, JT, Keane, JF, Wakely, PE, Fellows, KE. Transcatheter umbrella closure of congenital heart defects. Circulation 1987; 75: 593–599.Google Scholar
14Al Zaghal, MAZaghal, AM, Li, J, Anderson, RH, Lincoln, C, Shore, D, Rigby, ML. Anatomical criteria for the diagnosis of sinus venosus defects. Heart 1997; 78: 298–304.Google Scholar
15Ettedgui, JA,Siewers, RD,Zuberbuhler, JR,Anderson, RH. Echocardiographic diagnosis of inferior sinus venosus defects. Cardiol Young 1992; 2: 338–341.Google Scholar
16Anderson, RH, Baker, EJ, Ho, SY, Rigby, ML, Ebels, T. The morphology and diagnosis of atrioventricular septal defects. Cardiol Young 1991; 1: 290–305.Google Scholar
17Falcao, S, Daliento, L, Ho, SY, Rigby, ML, Anderson, RH. Cross sectional echocardiographic assessment of the extent of the atrial septum relative to the atrioventricular junction in atrioventricular septal defect. Heart 1999; 81: 199–205.Google Scholar