Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial(ANTIPRO). 3 years follow-up.

BACKGROUND: Most evidence for anticoagulation in aortic bioprosthesis is centered on embolic events, bleeding and re-intervention risk. The effect of anticoagulation on hemodynamics has not been previously assessed. Our hypothesis was that patients with anticoagulation (AC) early after aortic valve replacement (AVR) with porcine bioprosthesis have better hemodynamics at 3 years of follow-up. METHODS: This is a follow-up evaluation of the ANTIPRO trial. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The AC group received warfarin+aspirin and the non-AC(control) only aspirin. The primary outcome was mean gradient after 3 years of AVR and change in New York Heart Association (NYHA) class. Secondary outcomes were major and minor bleeding and embolic events. RESULTS: Of 140 participants in the study, 71 were assigned to the AC group and 69 to the control group. Mean age of the overall population was 72.4(SD: 7.1) years. Global euroSCORE was 7.65(SD: 5.73). At 3 years the mean gradient was similar between both groups (19.4(SD: 9.6 mmHg) and 18.6(SD: 8.2 mmHg) in the control and AC group respectively, p = 0.7). No differences in functional class at 3 years were found among groups. No differences were found among groups in the secondary outcomes. CONCLUSIONS: The addition of 3 months of oral anticoagulation to anti-aggregation treatment did not affect bioprosthetic hemodynamics nor functional class at years after AVR.

Warfarin use is associated with higher aortic bioprosthetic 18F-fluoride PET uptake.

BACKGROUND: Prevalence of bioprosthetic valve degeneration (BVD) is rising as the use of bioprosthetic aortic valves increases. Detecting early signs of BVD remains a challenge, with conventional imaging methods often failing to identify early deterioration stages. 18F-fuoride positron emission tomography (PET-CT) is an emerging technique that offers promising prospects to detect subclinical BVD. This study aimed to compare early PET parameters of fluoride uptake with echocardiographic hemodynamic parameters and compare outcomes according to anticoagulation in patients who received bioprosthetic valves. METHODS: This is a sub-study of the ANTIPRO clinical trial, which involved patients undergoing surgical aortic valve replacement (SAVR) with a porcine bioprosthesis and randomized them into anticoagulated and non-anticoagulated groups. Hemodynamic changes were assessed by transthoracic echocardiography (TTE), while 18F-fluoride PET-CT quantified fluoride uptake and divided the patients in two groups: high-uptake and low-uptake. Mean and maximum gradients by TTE at three years were compared between the two uptake groups. Fluoride uptake was also compared between the anticoagulated and control groups. RESULTS: We found no significant differences in transprosthetic gradients between high-uptake(21.4 ± 8.6 mmHg) and low-uptake(17.3 ± 11.2 mmHg.p = 0.244) PET-defined groups in this specific timeframe. Notably, anticoagulated patients exhibited significantly risk of higher fluoride uptake(OR = 4.34;95%CI:1.04-18.21.p = 0.045). CONCLUSIONS: No association was found between fluoride uptake and hemodynamic evaluation. Anticoagulation was associated with higher fluoride uptake. These findings highlight the emerging role of PET-CT in studying bioprosthetic aortic valves and emphasize the need for extended follow-up to evaluate the impact of anticoagulation on valve degeneration.

"A stratified pathway to stent-free reperfusion: Selecting suitable patients in ST-elevation myocardial infarction".

BACKGROUND: The DANAMI-3 DEFER study demonstrated that deferring stent implantation in ST-elevation myocardial infarction (STEMI) is safe, although not superior to immediate stenting. It is possible that an individualized revascularization strategy in STEMI, achieved through appropriate patient selection, could be feasible and effective. METHODS: This prospective, non-randomized study included 198 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between October 2019 and November 2021. Patients were assigned to either the deferred stenting (DS) group (n = 19) or the control group (C) undergoing immediate stenting (n = 179) based on a multimodal approach integrating coronary angiography, intravascular imaging, physiological assessments, and clinical judgment. The primary endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). RESULTS: The DS group showed a significantly lower rate of stent implantation (10.5 % vs. 97.7 %, p < 0.001) and a higher use of thrombus aspiration (89.5 % vs. 30.7 %, p < 0.001) and glycoprotein IIb/IIIa inhibitors (31.6 % vs. 6.7 %, p < 0.001) compared to the C group. No significant differences were observed between the groups in terms of all-cause mortality (5.3 % vs. 8.9 %, p = 0.59) or MACCE (10.5 % vs. 8.4 %, p = 0.71). CONCLUSIONS: This study demonstrates the feasibility of implementing individualized reperfusion strategies in STEMI within a real-world clinical setting. The findings, while limited by the study design, generate valuable hypotheses that warrant further investigation to refine patient selection criteria and optimize outcomes.

Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial (ANTIPRO).

OBJECTIVES: Most evidence for anticoagulation (AC) in aortic bioprosthesis is centred on embolic events, bleeding and reintervention risk. The effect of AC on haemodynamics has not been previously assessed. Our hypothesis was that patients with early AC after aortic valve replacement (AVR) with porcine bioprosthesis have better haemodynamics at 1 year of follow-up. METHODS: Prospective, randomized, open-label trial conducted at 2 cardiac surgery centres. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The anticoagulated group received warfarin + aspirin and the non-anticoagulated (control) only aspirin. The primary outcome was mean gradient after 1 year of AVR and change in New York Heart Association class. Secondary outcomes were major and minor bleeding, embolic events and prosthetic leak. RESULTS: Of 140 participants in the study, 71 were assigned to the anticoagulated group and 69 to the control group. The mean age of the overall population was 72.4 (SD: 7.1) years. Global EuroSCORE was 7.65 (SD: 5.73). At 1 year, the mean gradient was similar between both groups [18.6 (SD: 1.1 mmHg) and 18.1 (SD: 1.0 mmHg) in the control and anticoagulated groups, respectively, P = 0.701]. No differences in functional class at 3 months or 1 year were found among groups. No differences were found among groups in the secondary outcomes. CONCLUSIONS: The addition of 3 months of oral AC to anti-aggregation treatment was not detected to affect bioprosthetic haemodynamics nor functional class at 1 year after AVR. Likewise, AC does not lead to the higher incidence of complications.

Complicaciones cerebrovasculares luego de angiografía coronaria en contexto de infarto agudo de miocardio. Estudio de cohorte / Cerebrovascular complications after invasive percutaneous coronary procedure for acute myocardial infarction in a patient cohort / Complicações cerebro-vasculares após procedimento coronário invasivo percutâneo para infarto do miocárdio aguda em um coorte do paciente

Resumen: Introducción: los eventos cerebrovasculares son una complicación grave, pero infrecuente, de los procedimientos coronarios invasivos. La angioplastia coronaria aumenta el riesgo de presentarla en 17 veces. Los pacientes que la sufren tienen más complicaciones agregadas y mayores tasas de mortalidad. Objetivo: determinar las características clínicas y evolutivas de los pacientes que desarrollaron un evento cerebrovascular luego de una angiografía coronaria de urgencia en el contexto de un infarto agudo de miocardio (IAM). Secundariamente, analizar la relación temporal entre ambos eventos e identificar factores previos asociados al desarrollo de la complicación neurológica. Método: cohorte retrospectiva de pacientes que sufrieron un evento cerebrovascular de cualquier tipo dentro de los 30 días posteriores a un procedimiento coronario por IAM en el Centro Cardiovascular Universitario, entre 2008 y 2017. Se analizaron características demográficas, del procedimiento coronario y del evento cerebrovascular. Resultados: 24 pacientes, 54,2% hombres; 1/3 del total tenía ataque cerebrovascular (ACV) previo. El 66,7% sufrió IAM sin elevación del segmento ST. Todos los eventos cerebrovasculares fueron isquémicos; la mayoría sobre la circulación anterior. El 62% ocurrió en las primeras 48 horas luego del procedimiento coronario, asociándose a mayor duración del procedimiento y número de vasos tratados. En tres casos se utilizó activador tisular del plasminógeno recombinante para reperfusión del evento neurológico. La mediana de NIHSS (National Institute of Health Stroke Scale) fue de 4 puntos (IQ 2-8) en IAM sin elevación del ST, y 8 puntos (IQ 3-20) en IAM con elevación del ST (p=0,20). El 79% de los pacientes sufrió complicaciones adicionales durante la hospitalización; cinco fallecieron. Conclusiones: entre quienes sufrieron complicaciones cerebrovasculares luego de angiografía coronaria pos-IAM existió una proporción similar de ambos sexos y un porcentaje elevado de pacientes con antecedentes de ACV. La forma de presentación del evento cardiovascular fue predominantemente IAM sin elevación del ST. Los eventos cerebrovasculares fueron isquémicos, en su mayoría de la circulación cerebral anterior y ocurrieron en las primeras 48 horas. El ACV/AIT (ataque isquémico transitorio) en este contexto podría asociarse a una mayor estancia hospitalaria y mortalidad.

Summary: Introduction: cerebrovascular events are serious but infrequent complications of invasive percutaneous coronary procedure. Coronary angioplasty increases the risk 17 times. Patients suffering this complication have higher morbidity and mortality rates. Objective: to determine the clinical and evolutionary characteristics of the patients who developed a cerebrovascular event after an emergency coronary angiography in the context of an acute myocardial infarction. Secondly, analyze the temporal relationship between both events and identify previous factors associated with the development of neurological complications. Methods: demographic, characteristics of the angiographic procedure, and cerebrovascular features of a population of patients with stroke occurring within 30 days after of invasive percutaneous coronary procedure for myocardial infarctions are described. Data was retrospectively collected from the Cardiovascular University Center (Hospital de Clínicas, Montevideo, Uruguay) between 2008-2017. Results: 24 patients, 54.2% were men; 1/3 had prior stroke; 66.7% presented non ST segment elevation myocardial infarction. All of the cerebrovascular events were ischemic, most were from the anterior circulation. 62% occurred in the first 48 hours after invasive percutaneous coronary procedure, having this group a higher percentage of percutaneous coronary angioplasty and longer procedures. In three patients recombinant tissue plasminogen activator was used for stroke treatment. NIHSS median was 4 points (IQ 2-8) in patients without ST-segment elevation myocardial infarction and 8 points (IQ 3-20) in patients with ST-segment elevation myocardial infarction (p=0.20). 79% of patients had complications during the hospitalization, and 5 died. Conclusions: there was a similar proportion of men and women, and a high percentage of patients with a history of stroke. The presentation of the cardiovascular events was predominantly non ST myocardial infarction. All the cerebrovascular events were ischemic, it occurred for most patients in the first 48 hours after invasive percutaneous coronary procedure, and the anterior brain circulation was most commonly affected. Stroke/transient ischemic attack after invasive percutaneous coronary procedure could be associated with longer hospital stays and death.

Resumo: Introdução: o acidente vascular cerebral é uma complicação séria, mas pouco frequente, da procedimiento coronário invasivo percutâneo. Angioplastia coronariana aumenta o risco 17 vezes. Pacientes que sofrem dessa complicação têm mais complicações e maiores taxas de mortalidade. Objetivo: determinar as características clínicas e evolutivas dos pacientes que desenvolveram um evento cerebrovascular após uma angiografia coronária de emergência no contexto de um infarto agudo do miocárdio. Em segundo lugar, analise a relação temporal entre os dois eventos e identifique os fatores anteriores associados ao desenvolvimento de complicações neurológicas. Métodos: uma coorte retrospectiva dos pacientes que sofreram um acidente vascular cerebral nos primeiros 30 dias de um procedimento coronário para o infarto agudo do miocárdio, e a análise dos seus dados demográficos e características de processo coronária e acidente vascular cerebral é realizada é descrito. Dados do Centro Cardiovascular Universitário do Hospital de Clínicas de Montevidéu, Uruguai, foram obtidos retrospectivamente a partir das datas entre 2008 e 2017. Resultados: 24 pacientes; 54,2% eram homens; 1/3 haviam sofrido um ataque cerebrovascular prévio; 66,7% apresentavam infarto agudo do miocárdio sem supradesnivelamento do segmento ST. Todos os eventos cerebrovasculares foram isquêmicos, a maioria era da circulação anterior. 62% dos eventos cerebrovasculares ocorreram nas primeiras 48 horas após o procedimento coronário, tendo encontrado nesse grupo procedimentos mais longos e com mais angioplastias coronarianas realizadas. Em 3 pacientes, a ativador do plasminogênio tissular recombinante foi usada para tratar o acidente vascular cerebral. O NIHSS mediana foi de 4 pontos (IQ 2-8) no infarto agudo do miocárdio, sem elevação do segmento ST, e 8 pontos (IQ 3- 20) no infarto agudo do miocárdio com elevação do segmento ST (p = 0,20) . 79% dos pacientes sofreram complicações durante a internação e 5 morreram. Conclusões: houve uma proporção semelhante de ambos sexos e uma alta porcentagem de pacientes com história de acidente vascular cerebral. A apresentação do evento cardiovascular foi predominantemente IAM sem supradesnivelamento do segmento ST. O ataque cerebrovascular foi isquêmico, ocorreu mais freqüentemente nas primeiras 48 horas e afetou principalmente a circulação cerebral anterior. Acidente vascular cerebral após intervenção coronária percutânea poderia estar associada a uma permanência hospitalar mais longa e mortalidade.

Valvuloplastia aórtica percutánea en la estenosis aórtica severa del adulto: indicaciones y morbimortalidad. Análisis del registro de valvuloplastias aórticas de un centro cardiovascular universitario / Percutaneous aortic valvuloplasty in severe adult aortic stenosis: indications, morbidity and mortality. Analysis of the aortic valvuloplasty registry of an university cardiovascular center / Valvoplastia aórtica percutânea na estenose aórtica adulta grave: indicações e morbimortalidade. Análise do registro de valvoplastia aórtica do um centro cardiovascular da universidade

Resumen: Introducción: la estenosis aórtica severa es una enfermedad frecuente, y la sustitución valvular es el único tratamiento eficaz. La valvuloplastia aórtica percutánea (VAP) tiene beneficios transitorios y su indicación está restringida a pacientes inestables como terapia puente o paliativa. A nivel nacional existe escasa evidencia sobre los resultados de esta técnica. Objetivo: determinar la indicación, eficacia, complicaciones y mortalidad de las VAP realizadas en nuestro centro entre enero de 2006 y setiembre de 2018. Secundariamente, determinar la terapia definitiva aplicada y el tiempo transcurrido hasta la misma. Método: estudio retrospectivo y descriptivo. Incluyó los pacientes a los que se le realizó VAP en el período. Se revisaron las historias clínicas para extracción de variables. Las variables cualitativas se presentan en valor absoluto y porcentaje; cuantitativas en mediana e intervalo intercuartilo. Se utilizó prueba de Wilcoxon para variables dependientes, tomando p<0,05 como nivel de significación. Para sobrevida se realizaron curvas de Kaplan-Meier. Protocolo aprobado por el Comité de Ética institucional. Resultados: 28 casos; 17 (60,7%) mujeres; la mediana de edad fue de 79,5 años (IQ 73-85,5). El objetivo de la VAP fue: puente a la decisión en 11 casos (39,2%), al tratamiento definitivo en 12 (42,8%) y paliativo en 5 (18%). La VAP fue considerada exitosa en 57,1% de los casos. Las indicaciones más frecuentes fueron: insuficiencia cardíaca refractaria en 10 casos (35,7%) y shock cardiogénico en 9 (32,1%). Diecinueve pacientes fallecieron (67,8%). La sobrevida fue 59 días (IQ 5-412). Seis pacientes recibieron tratamiento definitivo (cuatro recibieron implante valvular percutáneo y dos cirugía cardíaca). El tiempo de la VAP al implante percutáneo fue 233 días y 47 días a la cirugía abierta. Conclusiones: las indicaciones más frecuentes de la VAP fueron puente a tratamiento definitivo y decisión. La VAP fue exitosa en más del 50% de los casos. Las complicaciones mayores marcaron el pronóstico. La mortalidad fue elevada en el seguimiento. Un número reducido accedió al tratamiento definitivo (predominando el implante percutáneo).

Summary: Introduction: severe aortic stenosis is frequent and valve replacement is the only effective treatment. Percutaneous aortic valvuloplasty has transient benefits, and its indication is restricted to unstable patients as a bridge to other treatment or palliative therapy. In our country, there is a few evidence of this technique. Objective: to determine the indication, efficacy, complications and mortality of percutaneous aortic valvuloplasty performed in our center between January 2006 - September 2018. Secondarily, to determine which was the definitive therapy and it´s delay. Method: retrospective and descriptive study. All patients who received valvuloplasty during the study period were included. Clinical histories were reviewed. Qualitative variables were presented in absolute value and percentage; the quantitative ones, in median and interquartile interval. Wilcoxon test was applied to dependent variables, p <0.05. Kaplan Meier curves were performed to analize survival. Protocol was approved by ethics committee. Results: 28 cases. 17 (60.7%) were female. Average age was 79.5 years (IQ 73-85.5). The objective of percutaneous aortic valvuloplasty was bridge therapy to decision in 11 cases (39.2%), bridge to definitive treatment in 12 (42.8%) and palliative in 5 (18%). The most frequent indications were: refractory heart failure in 10 cases (35.7%) and cardiogenic shock in 9 (32.1%). Valvuloplasty was successful in 57.1% of cases. 19 patients died (67.8%). The median survival was 59 days (IQ 5-412). 6 patients received definitive treatment (4 percutaneous implantation and 2 open cardiac surgery). The time from percutaneous aortic valvuloplasty to percutaneous aortic valve implantation was 233 days and 47 days to open surgery. Conclusions: the most frequent indications for percutaneous aortic valvuloplasty were bridge therapy to definitive treatment and decision. Percutaneous aortic valvuloplasty was successful in more than 50% of cases. Major complications determined the prognosis. Mortality was high at follow-up. A small number acceded to definitive treatment (predominantly percutaneous implantation).

Resumo: Introdução: a estenose aórtica grave é frequente, a substituição valvar é o único tratamento efetivo. A valvoplastia aórtica percutânea tem resultados transitórios, sua indicação é restrita a pacientes instáveis como ponte ou terapia paliativa. Em nível nacional, há poucas evidências. Objetivo: determinar a indicação, eficácia, complicações e mortalidade das valvoplastias aórticas percutâneas realizadas em nosso centro entre janeiro de 2006 a setembro de 2018. Determinar secundariamente a terapia definitiva e o tempo até ela. Método: estudo retrospetivo, descritivo. Todos os pacientes que receberam valvuloplastia aórtica percutânea durante o período do estudo foram incluídas. Histórias clínicas foram revisadas. As variáveis qualitativas são apresentadas em valor absoluto e percentagem; os quantitativos em intervalo mediano e interquartil. O teste de Wilcoxon foi utilizado para variáveis dependentes, p <0,05. Para sobrevivência, as curvas de Kaplan Meier foram realizadas. Protocolo aprobado pelo comitê de ética. Resultados: 28 casos. 17 (60,7%) eram mulheres e a idade média foi de 79,5 anos (QI 73-85,5). O objectivo da valvoplastia foi ponte para decisão terapêutica em 11 casos (39,2%), ponte para tratamento definitivo em 12 casos (42,8%) e paliativo em 5 casos (18%). As indicações mais frequentes foram: insuficiência cardíaca refratária em 10 casos (35,7%) e choque cardiogênico em 9 casos (32,1%). A valvuloplastia foi bem sucedida em 57.1% dos casos. 19 pacientes morreram (67,8%). A mediana de sobrevivência é de 59 dias (IQ 5-412). 6 pacientes receberam tratamento definitivo (4 implantes percutâneos e 2 por cirurgia cardíaca aberta). A mediana do tempo de valvoplastia aórtica percutânea para implante de valva aórtica percutânea foi de 233 dias e cirurgia aberta de 47 dias. Conclusões: as indicações mais frequentes para valvoplastia aórtica percutânea foram a terapia ponte para tratamento e para decisão definitiva. A valvoplastia aórtica percutânea foi bem sucedida em mais de 50%. As complicações principais marcaram o prognóstico. A mortalidade foi alta no follow-up. Um pequeno número concordou com o tratamento definitivo (predominantemente implante percutâneo).

Prevalencia de septal pouch en una cohorte derivada para ecocardiograma transesofágico / Prevalence of septal pouch in a cohort derived for transesophageal echocardiography / Prevalência da bolsa septal em uma coorte derivada para ecocardiografia transesofágica

Resumen: Introducción: los defectos del septum interauricular (SIA) son frecuentes. En los últimos años se ha identificado una nueva entidad conocida comoseptal pouch (SP). Los datos sobre su prevalencia son escasos, estimándose entre 30%-50% en la población general. El rol como fuente de cardioembolia es discutido. Objetivos: el objetivo primario es determinar la prevalencia y caracterizar el SP; en forma secundaria, definir la variabilidad interobservador para su diagnóstico. Material y método: estudio observacional, descriptivo y analítico. Se reclutaron en forma prospectiva pacientes consecutivos derivados para ecocardiograma transesofágico (ETE) entre el 20 de abril de 2018 y el 30 de agosto de 2018. Se registraron datos patronímicos, antecedentes personales de accidente cerebrovascular (ACV), ritmo cardíaco y motivo del estudio. Se evaluó la presencia de SP y se caracterizó como left-sided septal pouch (LSSP) o rigth-sided septal pouch (RSSP); se midió profundidad, presencia de trombo en su interior y se completó el estudio ecocardiográfico. Las imágenes fueron evaluadas por dos ecocardiografistas ciegos entre sí. Las variables cualitativas se presentan en frecuencia relativa (FR); las cuantitativas en mediana e intervalo intercuartilo. Se realizó test de chi cuadrado para evaluar la asociación entre la presencia de SP y la presencia de ACV o de FA. La reproducibilidad del diagnóstico de SP fue evaluada por índice Kappa. Resultados: se incluyeron 50 sujetos. La prevalencia de SP fue de 0,5 (FR), 0,46 LSSP y 0,04 RSSP. El índice Kappa interobservador para el diagnóstico fue 0,68, error estándar 0,14, con 84% de acuerdo. Catorce sujetos tenían antecedente de ACV, en nueve de ellos se diagnosticó SP (chi cuadrado p=0,21); 18 pacientes tenían fibrilación auricular/flutter, la mitad de ellos tenía SP (chi cuadrado p=1). Conclusión: la prevalencia de SP fue de la mitad de la población, predominando ampliamente el LSSP, con buena reproducibilidad en su diagnóstico. Se trata de un hallazgo subdiagnosticado; interesa continuar investigando su posible asociación con ACV.

Summary: Introduction: the interatrial septum defects are frequent. A new entity has recently been identified, known as septal pouch. Prevalence data in general population is scarce, and is estimated between 30%-50%. The role as a source of cardioembolism is unclear. Objectives: the primary objective is to determine the prevalence and characterize the septal pouch; secondarily to define the interobserver variability for the diagnosis. Material and methods: observational, descriptive and analytical study. Consecutive patients were recruited for transesophageal echocardiography between 4/20/2018 and 8/30/2018. We recorded patronymic data, personal history of stroke, heart rate, and the reason for the study. The presence of septal pouch was defined and characterized as left-sided septal pouch or rigth-sided septal pouch; depth was measured, presence of thrombus inside and echocardiographic study measures were completed. The images were evaluated by two blind echocardiographers. The qualitative variables are presented in relative frequency (RF), the quantitative variables in median and interquartile interval. Chi square test was carried out. The reproducibility of the diagnosis of septal pouch was evaluated by Kappa index. Results: 50 subjects were included. The prevalence of septal pouch was 0.5 (RF), 0.46 left-sided septal pouch and 0.04 rigth-sided septal pouch. The interobserver Kappa index for diagnosis is 0.68, standard error 0.14, with 84% agreement. 14 subjects had stroke, in 9 of them septal pouch was diagnosed (chi square p=0.21); 18 patients had atrial fibrillation or flutter, half of them had septal pouch (chi square p=1). Conclusion: the prevalence of septal pouch was half of the population, predominantly the left-sided septal pouch, with good reproducibility in diagnosis. It is an underdiagnosed finding; further investigation is necessary to assess its relation to stroke.

Resumo: Introdução: os defeitos do septo interatrial são freqüentes. Nos últimos anos, uma nova entidade conhecida como bolsa septal foi identificada. Dados sobre prevalência são escassos, estimados em 30%-50% na população geral. O papel como fonte de cardioembolismo é discutido. Objetivos: o objetivo primário é determinar a prevalência e caracterizar a bolsa septal; secundariamente definir a variabilidade interobservador para o seu diagnóstico. Material e métodos: estudo observacional, descritivo e analítico. Consecutivos pacientes foram recrutados para ecocardiograma transesofágico entre 20/4/2018 e 30/08/2018. Registramos dados patronímicos, histórico pessoal de acidente vascular cerebral, frequência cardíaca e o motivo do estudo. A presença de bolsa septal foi definida e caracterizada como bolsa septal esquerda ou bolsa septal direita; a profundidade foi medida, a presença de trombo no interior e o estudo ecocardiográfico foram concluídos. As imagens foram avaliadas por dois ecocardiografistas cegos. As variáveis qualitativas são apresentadas em frequência relativa (FR); os quantitativos em mediana e interquartil intervalo. O teste do qui quadrado foi realizado. A reprodutibilidade do diagnóstico de bolsa septal foi avaliada pelo índice Kappa. Resultados: 50 sujeitos foram incluídos. A prevalência de bolsa septal foi de 0,5 (FR), 0,46 bolsa septal esquerda e 0,04 bolsa septal direita. O índice Kappa interobservador para diagnóstico é 0,68, erro padrão 0,14, com 84% de concordância. 14 sujeitos apresentaram acidente vascular cerebral, em 9 deles foi diagnosticada bolsa septal (qui-quadrado p=0,21); 18 pacientes apresentaram fibrilhação auricular / flutter, metade deles com bolsa septal (qui quadrado p=1). Conclusão: a prevalência de bolsa septal foi metade da população, predominantemente a bolsa septal esquerda, com boa reprodutibilidade em seu diagnóstico. É um achado subdiagnosticado; é interessante para continuar investigando sua possível associação com acidente vascular cerebral.