Atrial septal aneurysm and stroke--a report of two cases

Atrial septal aneurysm (ASA) is an uncommon lesion which often associates other cardiac abnormalities such as patent foramen ovale or mitral valve prolapse. More than half of the cases with ASA associate an interatrial shunt which can explain cerebral embolism and consecutive ischemic stroke.

We present two cases which were admitted to our hospital with minor complaints. Personal histories excluded cardiac disease, high blood pressure, smoking, and included ischemic stroke in both cases. Physical examination revealed no abnormalities. Electrocardiogram showed right bundle branch block in one case, lab findings were in normal limits. Cardiac ultrasound (transthoracic and transesophageal) revealed in both cases an ASA, one with bidirectional equidistant excursion without visible interatrial shunt, and one with unilateral excursion and a small shunt.

The ASA diagnosis should be remembered as an alternative cause in a patient with a history of stroke, or with developing stroke, and without risk factors for cerebrovascular disease.