Atrial septal aneurysm and stroke: A transesophageal echocardiographic study

Abstract

The prevalence and morphologic characteristics of atrial septal aneurysms identified by transesophageal echocardiography in 410 consecutive patients are described. Two groups of patients were compared: Group I consisted of 133 patients referred for evaluation of the potential source of an embolus and Group II consisted of 277 patients referred for other reasons. An atrial septal aneurysm was diagnosed by transesophageal echocardiography in 32 (8%) of the 410 patients. Surface echocardiography identified only 12 of these aneurysms. Atrial septal aneurysm was significantly more common in patients with stroke (20 [15%] of 133 vs. 12 [4%] of 277) (p less than 0.05); right to left shunting at the atrial level was demonstrated in 70% of patients in Group I and 75% of patients in Group II by saline contrast echocardiography. Four patients in Group I had an atrial septal defect with additional left to right flow. There was no difference between the two groups in aneurysm base width, total excursion or left atrial or right atrial excursion. However, Group I patients had a thinner atrial septal aneurysm than did Group II patients. It is concluded that an atrial septal aneurysm occurs commonly in patients with unexplained stroke, is more frequently detected by transesophageal echocardiography than by surface echocardiography and is usually associated with right to left atrial shunting. Treatment (anticoagulant therapy vs. surgery) of atrial septal aneurysm identified in stroke patients can be determined only by long-term follow-up studies.

Impairment of Venous Drainage Due to Atrial Septal Aneurysm During Open-Heart Surgery

“…2 With widespread use of TTE in the 1980s, several studies found its prevalence to be ranging from 0.2% to 1.9%. 3,4 A recent study based on TEE put its prevalence at 4.3% 5 and suggests that it is a more sensitive diagnostic tool than TTE. 5,6 Although 3D TEE clearly showed the aneurysm in this case, 2D TEE is sufficient to make a diagnosis of ASA.…”

“…3,4 A recent study based on TEE put its prevalence at 4.3% 5 and suggests that it is a more sensitive diagnostic tool than TTE. 5,6 Although 3D TEE clearly showed the aneurysm in this case, 2D TEE is sufficient to make a diagnosis of ASA. Several studies have classified ASA based on morphology and movement of the aneurysm.…”

“…5,9,10 Although not definitively proven, mechanism is presumed to be due to paradoxical interatrial shunting of thrombus since a high percentage of patients with ASA has PFO. 5,6 Presence of spontaneous echo contrast in the aneurismal cavity has been previously reported and thought to be a precursor to thrombus formation. 8 In a patient who presented for routine coronary artery bypass graft surgery, massive thrombus was noted within the aneurismal cavity that subsequently caused intraoperative embolic stroke.…”

Dual-sided Infective Endocarditis due to Atrial Septal Aneurysm With Patent Foramen Ovale

“…PFO has a prevalence of up to 29% with autopsy studies [3]. PFO is a major cause of cryptogenic stroke; Mas and others have reported that a combination of PFO and ASA imparts an increased risk of stroke [4]. The presence of Staphylococcus, right-sided cardiac vegetation, a lesion greater than 10 mm, and increased mobility of the vegetation were all significant predictors of subsequent embolization [6].…”

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

“…Several studies have linked the presence of ASA to stroke. In 1 study, ASA was significantly more common in patients with stroke than in those without stroke (20 of 133 [15%] versus 12 of 277 [4%]; P <0.05) 12. The combination of a PFO and ASA has been shown to be a significant risk factor for recurrent stroke 10…”