Key result
Left atrial septal pouch linked to recurrent multisystem arterial emboli.
Why the study?
Left atrial septal pouch is an under-recognized interatrial septal variant with potential thrombogenic properties, but evidence regarding its clinical significance and management remains limited.
Case Report (n=1)
This case highlights that a left atrial septal pouch can be a rare but important cardioembolic source for recurrent multisystem arterial emboli, necessitating careful echocardiographic evaluation.
LASP evaluation in recurrent emboli is hypothesis-generating; leaves open need for prospective management trials.
BACKGROUND: Left atrial septal pouch (LASP) is an under-recognized interatrial septal variant with potential thrombogenic properties. Evidence regarding its clinical significance and management remains limited. CASE SUMMARY: A 57-year-old woman with recurrent embolic cerebral infarcts presented with acute right flank pain. Computed tomography (CT) revealed an acute right renal infarct and chronic left renal cortical scarring. Right renal artery angiography demonstrated fibromuscular dysplasia treated with balloon angioplasty. Transesophageal echocardiogram identified an LASP. Rhythm monitoring excluded atrial fibrillation, and the hypercoagulability work-up was negative. The multisystem embolic pattern, including a prior left renal infarct with a normal left renal artery, supported cardioembolism from the LASP. Anticoagulation was switched from apixaban to rivaroxaban, and the patient was referred for LASP closure evaluation. DISCUSSION: Recent meta-analyses demonstrate a significant association between LASP and cryptogenic stroke, yet no consensus guidelines exist. TAKE-HOME MESSAGE: This case illustrates that LASP can cause recurrent multisystem arterial emboli, highlighting the need for evidence-based treatment strategies.
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Pillai et al. (2026) conducted a case report in Left atrial septal pouch with recurrent multisystem arterial embolism (n=1). Anticoagulation switch (apixaban to rivaroxaban) and referral for LASP closure was evaluated. Left atrial septal pouch (LASP) was identified as the source of recurrent multisystem arterial emboli in a 57-year-old woman, highlighting the need for evidence-based treatment strategies.
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