Low incidence of embolic strokes with atrial septal aneurysms: A prospective, long-term study

Previous retrospective studies have suggested that atrial septal aneurysms (ASA) are associated with embolic strokes. The purpose of this study was to evaluate prospectively the embolic potential of ASA.

Of 846 consecutive patients undergoing cardiac surgery from December 1990 to March 1993, we identified 42 patients who had ASA as an incidental finding on intraoperative transesophageal echocardiography. Patency was determined by color and/or contrast echocardiography. The majority of patients were given aspirin postoperatively. Patients were monitored by personal and/or telephone interviews, and their clinical conditions were confirmed by their personal physicians. Any patient with any question of a neurologic event had a detailed neurologic history, examination, and computed tomographic or magnetic resonance imaging scan.

The incidence of ASA in our population was 4.9%; there were 22 men and 20 women with a mean age of 72 years. Oscillating ASA were present in 28 patients and fixed aneurysm in 10. The mean diameter of the ASA was 21 +/- 4 mm. Eighteen (56%) of 32 patients had a patent ASA. Patients were monitored for a mean period of 69.5 months (56 to 85 months). No patient had a cerebrovascular event or systemic embolization.

The risk of cerebrovascular events or embolic strokes in our patient population with incidental ASA was low. If treatment is needed for this condition, aspirin appears to be effective therapy.