Opinion: I discovered a new structure in the heart — just by looking closely — SkimNews
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- Dr. Subramaniam C. Krishnan, a cardiac electrophysiologist at Sutter Health in Sacramento, discovered the left atrial septal pouch (LASP) — an 8-11 millimeter pouch opening into the left atrium — while studying preserved hearts at the Jesse E. Edwards Registry of Cardiac Disease in St. Paul, Minn., beginning in 2004.
- Krishnan and a colleague published the first formal description of the LASP in 2010; subsequent studies have since identified the structure in approximately one-third of adult hearts.
- Investigators at Fuwai Hospital in Beijing recently reported the first randomized trial evaluating transcatheter elimination of the pouch, using a septal occluder device originally built for PFO closure, and found a marked reduction in recurrent MRI-detected ischemic brain lesions compared with medical therapy alone.
- Unlike the left atrial appendage — where atrial fibrillation is typically needed for clot formation — the LASP can allow blood to stagnate and clot even in a perfectly normal heart rhythm, making it a candidate explanation for unexplained cryptogenic strokes.
- Krishnan's subsequent work on an implant-free PFO closure strategy grew directly out of studying the pouch, after he recognized that a LASP is essentially an incompletely fused PFO tunnel that nature might be coaxed into sealing biologically.
- The author argues the discovery required only preserved specimens and careful observation — no AI, genomic sequencing, or billion-dollar technology — and positions the finding as a rebuke to the assumption that gross anatomy is a completed science.
Why it matters: Roughly one-third of adults carry an anatomical variant unrecognized until 2010 that observational studies have tied to cryptogenic strokes. If the Fuwai Hospital randomized trial is replicated, it could open a device-based treatment pathway for stroke patients whose cause has gone undiagnosed — and vindicate a low-tech, observation-driven model of discovery.
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