Left Atrial Septal Pouch as a Source of Recurrent Multisystem Arterial Embolism.

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.