Morphometric analysis of the fossa ovalis in human cadaveric hearts

Abstract

Coronary artery disease (CAD) is highly prevalent in the United States, leading to an increased need for interventions such as mitral valve replacement via transseptal puncture (TSP). TSP utilizes the fossa ovalis (FO), a remnant of the foramen ovale located between the right and left atria. However, detailed normative data describing FO anatomy remain limited. Inadequate understanding of FO morphology during TSP may result in serious complications, including cardiac tamponade caused by misdirected puncture. Accurate measurement of the FO is therefore essential for clinical decision-making during left-sided cardiac interventions. This study aimed to develop a comprehensive understanding of FO anatomy by investigating its morphological features in relation to surrounding cardiac structures and donor demographics. Thirty-six hearts from donors in the Willed Body Program at the John A. Burns School of Medicine were examined using a standardized method to measure and quantify FO morphology. Measurements of FO area, circularity, and aspect ratio were analyzed in relation to donor demographics, including age, sex, height, body weight, body mass index, body surface area, heart weight, and heart circumference. Additional anatomical characteristics, such as the presence of a patent foramen ovale, quality of the limbus, presence of the right septal pouch, and presence of the valve of the foramen ovale, were also evaluated. Analysis revealed significant correlations between FO morphology, heart weight, heart circumference, and donor demographics. Notably, sex-based differences were observed, with females demonstrating a significantly larger FO area when normalized using the heart weight and circumference. These findings enhance the current knowledge of FO anatomy and may contribute to improving the safety and efficacy of TSP during cardiac interventions.