Echocardiographic Evaluation of the Left Atrium and Left Atrial Appendage Function in Patients with Atrial Septum Aneurysm - Implications for Thromboembolic Complications

Abstract

(1) Atrial septum aneurysm impairs left atrium systolic function. (2) In patients with atrial septum aneurysm, left atrium appendage function changes; its systolic as well as a reservoir function improve. (3) The enhancement of LAA function in ASA may be a compensatory mechanism for LA systolic function deterioration. (4) As LAA systolic function is enhanced, it is rather unlikely that LAA is the place of origin of thrombi, which occur relatively frequently (according to the literature) in patients with ASA. The thrombi seem to be formed in the bulging sack of ASA, i.e., in the part of the LA whose systolic function is depressed.

Incomplete Aneurysm Coverage after Patent Foramen Ovale Closure in Patients with Huge Atrial Septal Aneurysm: Effects on Left Atrial Functional Remodeling

“…On the basis of these considerations, it is likely that some degree of LA dysfunction, such as impairment of active or passive emptying or perhaps conduit function might be present in patients with PFO, in particular in those with large ASA, as a mechanical effect caused by the association of aneurysm excursion and shunt flow within the left atrium. Our study further confirmed the previous studies 5,6 suggesting that, after percutaneous closure, these functional aberrations return to levels of healthy subjects also in patients in whom an incomplete coverage of the ASA was observed.…”

“…Our study suggests a favorable remodeling of the left atrium after closure in patients with PFO and large ASA, even when only an incomplete ASA coverage was obtained with the device‐based closure using the Amplatzer ASD Cribriform Occluder (AGA Medical Corp.). A positive shrinkage of the uncovered portion of ASA during the device fibrotic process with stabilization of the interatrial septum was confirmed by the normalization of LA parameters of active and passive emptying, as well ejection fraction, which, as previously investigated, 5,6 are clearly altered in PFO patients with ASA. The role of LA function in the modulation of left ventricular diastolic filling is well described 17 .…”

“…The use of a single moderately small device, theoretically preferable in every patient, may avoid the risk of arrhythmias, thrombosis, and erosion potentially related to large devices, but the incomplete coverage of the ASA, often achieved with small device is considered not the ideal technique by most operators for the fear of residual shunt and potential thrombosis caused by platelet and blood sequestration on the surface of uncovered ASA. Recent reports 5,6 suggested that in patients with large PFO and ASA, a left atrial dysfunction may be present as compared as normal or PFO alone patients, and that this kind of dysfunction may regress after device closure of PFO. Our study is aimed to assess the impact on left atrium functional remodeling and clinical outcomes of a partial ASA coverage approach based on maximum ratio device/interatrial septum length = 0.8 using the Amplatzer ASD Cribriform Occluder (AGA Medical Corp., Plymouth, MN, USA) in patients with large PFOs and large ASA.…”

Left Atrial Dysfunction in Patients with Patent Foramen Ovale and Atrial Septal Aneurysm Scheduled for Transcathter Closure May Play a Role in Aura Genesis

“…Migraine affects up to 10% of the population, accounting for significant morbidity, lost productivity, and health care expenditures 1 . Although the pathophysiology of migraine is not fully understood, patent foramen ovale (PFO) has been reported with greater prevalence in patients with migraine with aura, as compared to those without 2–4 . Recent studies 5,6 suggested that in patients with large PFO and atrial septal aneurysm (ASA), dysfunction of the left atrium may be present, as compared with normal or PFO alone patients.…”

72-letnia pacjentka z kryptogennym udarem niedokrwiennym mózgu z towarzyszącym tętniakiem przegrody międzyprzedsionkowej i drożnym otworem owalnym

“…Finally, the coexistence of PFO and ASA change the geometry, shape and hemodynamics of the atria, and affects the coordinated cooperation of atria, left atrial appendage and the other chambers of the heart. This is why coexistence of PFO and ASA is believed to promote similar conditions as in atrial fibrillation (AF) with left atrial dysfunction, which promotes thrombus formation [7]. Available data on the correlation between cryptogenic ischemic stroke and PFO with concomitant ASA are limited [3,8,9].…”