Cardiologist discovers new heart structure called left atrial septal pouch

Dr. Subramaniam C. Krishnan discovered the left atrial septal pouch (LASP), a heart structure present in about one-third of adult hearts that may cause cryptogenic strokes. A clinical trial at Fuwai Hospital showed that closing this pouch reduces brain lesions. Meanwhile, Tulane University students discovered a pelvic muscle variation, the iliac attachment of the psoas major, present in 28% of specimens, highlighting that human anatomy still holds surprises.

Discovery of the left atrial septal pouch

• ▪Dr. Subramaniam C. Krishnan discovered the left atrial septal pouch in 2004 while studying preserved human hearts at the Jesse E. Edwards Registry of Cardiac Disease in St. Paul, Minnesota.
• ▪Dr. Subramaniam C. Krishnan and his colleague published the first formal description of the left atrial septal pouch in the journal Clinical Cardiology in 2010.

Anatomy of the left atrial septal pouch

• ▪Subsequent anatomical studies conducted after 2010 found the left atrial septal pouch present in approximately one-third of adult human hearts.
• ▪The left atrial septal pouch is an anatomical structure opening into the left atrium of the heart, measuring approximately 8 to 11 millimeters deep.

Stroke risks of the pouch

• ▪Observational studies suggest the left atrial septal pouch may contribute to cryptogenic strokes because blood can stagnate and form clots inside the pouch.
• ▪A randomized trial at Fuwai Hospital in Beijing demonstrated that mechanically closing the left atrial septal pouch reduced recurrent, MRI-detected ischemic brain lesions.

Patent foramen ovale closure

• ▪Decades of epidemiology, imaging, and randomized trials eventually established patent foramen ovale closure as an accepted therapy for selected stroke patients.
• ▪Anatomical observations of the left atrial septal pouch led Dr. Subramaniam C. Krishnan to develop an implant-free therapeutic strategy to close patent foramen ovale tunnels.

Discovery of a new pelvic muscle attachment

• ▪An anatomical study of 200 donated specimens at Tulane University revealed the iliac attachment of the psoas major was present in 28% of the examined sides.
• ▪Tulane University researchers reviewed historical anatomical literature in French and German to confirm that the pelvic muscle attachment had not been previously documented.
• ▪Tulane University students Cooper Bruce and Dominic Roy initiated their research after noticing an unusual muscle structure during a routine cadaver dissection.
• ▪Tulane University undergraduate students Cooper Bruce and Dominic Roy identified a previously unknown pelvic muscle attachment, termed the iliac attachment of the psoas major.

Shift toward preventive cardiology

• ▪Preventive cardiology advances include improved imaging, a deeper understanding of inherited risks like lipoprotein(a), and new treatments for cholesterol, diabetes, and obesity.
• ▪Dr. Pinakin Parekh, a cardiologist in Singapore, stated that modern cardiology is shifting toward early diagnosis to identify heart disease risks before symptoms occur.

Debatable claims

• ▪Cardiologists should routinely close the left atrial septal pouch to prevent strokes
• ▪Gross human anatomy remains a fertile field for major medical discoveries