Atrial septal aneurysm what is

Discussion Atrial septal aneurysm is a congenital cardiac abnormality that is characterized by saccular formation of the interatrial septum. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: Report of 80 consecutive cases. J Am Coll Cardiol. Atrial septal aneurysms: A new classification in two-hundred five adults.

J Am Soc Echocardiogr. Interatrial septal abnormalities and stroke: A meta-analysis of case control studies. Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study. Eur Heart J. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. Patent foramen ovale in cryptogenic stroke: Current understanding and management options.

Arch Intern Med. Frequency of atrial septal aneurysm in patients with recent stroke: Preliminary results from a multicenter study. Clin Cardiol. Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement. Hemogram, serum lipids, kidney function tests and liver function test results are within normal range. Chest X-ray shows normal cardiac size and clear lungs.

Computerised tomography of the brain is normal and shows no evidence of hemorrhage. Transthoracic echocardiography reveals normal-size chambers, valves, and a prominent moderator band in right ventricle.

Intraventricular septum is intact. Intra-atrial septum shows a large bulge in fossa ovalis area towards right atrium with limited excursions of this part of the atrial septum.

No evidence of thrombus in any chamber or atrial appendage nor evidence of shunt Figures 1, 2, 3. Carotid Doppler and ultrasound studies are normal. Patient has ischemic cerebrovascular embolic stroke with left side hemiparesis, atrial fibrillation with atrial septal aneurysm fossa ovalis.

The ischemic cerebrovascular incident is most likely a cardioembolic stroke. Atrial septal aneurysm is rare ASA and is most often an accidental finding. However it could be a contributing factor to cardioembolic stroke even though no thrombus in aneurysm or left atrium can be seen in transthoracic echo.

Patient was started on anticoagulants and rate control for atrial fibrillation. Although exact definitions of ASA vary according to size 2, 3, 7 , and stage mobility of the aneurysm 17, 18 , atrial septal aneurysm is a localised 'saccular' deformity, generally at the level of the fossa ovalis, which protrudes to the right or left atrium, or on both sides.

Albeit rare, atrial septal aneurysm is a well recognised cardiac abnormality. Previously diagnosed during autopsy only, it is now frequently picked up on routine echocardiography or during evaluation of ischemic stroke. Studies link it with peripheral embolism and cardioembolic stroke, pulmonary embolism and atrial arrhythmias, even though clinical significance is uncertain. Further, it can be secondary to interatrial pressure difference or may be the result of a primary malformation involving the fossa ovalis region or the entire septum 1.

In patients with chronically elevated atrial pressures, as in mitral stenosis, atrial septal aneurysms are also rare: therefore acquired origin seems unlikely. Congenital malformation of the atrial septum probably contributes to development of ASA, as was suggested by Hanley PC and colleagues 2.

Atrial septal aneurysm may be isolated or associated with another anomaly. Commonest association is patent foramen ovale PFO. Silver and Dorsy found patent foramen ovale in eight out of 16 patients 3.

Other associations are atrial septal defect 2 , mitral valve prolapsed 4,5 tricuspid valve prolapse, marfans syndrome, sinus of valsalva aneurysm and aortic dissection 1.

Shunt across ASA is more frequently detected with transesophageal echocardiography than with transthoracic echocardiography 1. Association with mitral and tricuspid valve prolapse and other abnormalities, such as Marfan's syndrome and sinus of valsalva aneurysm may point to common inherent connective tissue deficiency 6. Familial clustering of ASA has also been reported Manifestations attributed to ASA are 1 atrial arrhythmias and 2 arterial embolisms.

Interatrial septal aneurysm can act as an arrhythmic focus, generating focal atrial tachycardias. Hanley et al. Mugge A. Schneider B. Mechanism of increased prevalence of atrial tachyarrhythmia in ASA is not clear, though redundancy of atrial septum could be responsible for pathogenesis of arrhythmia. Arterial embolism is another complication associated with ASA. Presence of ASA tends to aggravate stasis of left arterial LA blood flow and predispose to minute LA clots and systemic thrombo embolisms.

A retrospective study by Mugge A. Atrial septal aneurysm was often the only source of embolism, as judged by transesophageal echocardiography 1. Salmasi A. Mechanism of cardioembolic stroke could be right to left shunting, as detected in most cases of ASA or in the thrombogenic properties of aneurysm itself. Echocardiography is used to diagnose ASA, either during routine echocardiography or in cases of cardioembolic cerebrovascular stroke and peripheral embolism.

Compared with transthoracic echo, transesophageal echo is more sensitive in picking up ASA 1, 7. Cardiac computed tomography and magnetic resonance imaging are also useful for diagnosis of ASA 14, Conclusion: The report looks at the chances of finding atrial septal aneurysm in a case of cerebral embolism. Although atrial fibrillation is a well known cause of stroke, presence of atrial septal aneurysm needs some attention as it could be contributory.

There is a possibility that atrial septal aneurysm could be a culprit for strokes. Main text 1. Summary and related texts. Related genes. Clinical signs. To get in touch with the Orphanet team, please contact Information provided in your contribution including your email address will be stocked in. Check this box if you wish to receive a copy of your message. Disease definition A rare congenital non-syndromic heart malformation characterized by an abnormal protrusion of the interatrial septum into the right or left atrium, or both, during the cardiorespiratory cycle.

Additional information Further information on this disease Classification s 2 Gene s 0 Other website s 0. Patient-centred resources for this disease Expert centres Networks of expert centre 5 Diagnostic tests 0 Patient organisations 40 Orphan designation s and orphan drug s 0.