Most originate in the interatrial septum
in the proximity of the fossa ovalis.
Transesophageal echocardiography demonstrated a large mass composed of solid component in interatrial septum
and cystic part protruding in the left atrium.
Following transseptal puncture, a defect within the interatrial septum
was created by its subsequent dilation with a 12 mm in diameter balloon (Balt CBV, Montmorency, France) over a guide wire inserted into the left atrium under echocardiography guidance (Figure 1).
Finally this approach might be considered as first choice in redo cases especially in centers relying solely on fluoroscopy to cross the interatrial septum
Decision was made to clarify the diagnosis with a right heart catheterization and intracardiac echocardiography, which revealed an intact interatrial septum
with an evident PFO.
Histological examination showed extensive nodular thickening of the interatrial septum
due to excessive accumulation of mature adipose tissue which reached the resection surface (Figure 1(b)).
Assad, "Partial anomalous return of four pulmonary veins with intact interatrial septum
For the mass in the left atrium, after opening the right atrium and retracted to expose interatrial septum
, digital feeling of septum with the toughest area confirmed the site of attaching the pedicle were performed.
Tricuspid valve, interatrial septum
, right ventricular cavity and pulmonary artery were free of tumor extension.
A patent foramen ovale (PFO) is a common embryonic defect in the interatrial septum
and is found in 15% to 25% of the adult population; it has been related to serious clinical syndromes such as recurrent stroke, myocardial infarction and systemic embolism (13).
Even if the transseptal needle is accurately positioned on the fossa ovalis, interventionalists in cardiology may encounter difficulty in performing a transseptal needle puncture when the interatrial septum
(IAS) is fibrous, abnormally thick or when the septum has significant anatomical variations .
"They have to make a hole in the interatrial septum
to get to the left atrium; that's the part of the procedure where experience becomes very important," Henson says.