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Improved morphologic characterization of atrial septal aneurysm by transesophageal echocardiography: relation to
B Schneider1, P Hanrath, P Vogel
1Medical Clinic II, St. Georg Hospital, Hamburg, Federal Republic of Germany.
Insights
Atrial septal aneurysm is a cardiac issue linked to stroke. Transesophageal echocardiography aids in diagnosing this condition and identifying thrombus, suggesting anticoagulant therapy for affected patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Atrial septal aneurysm (ASA) is a rare cardiac anomaly.
- The association between ASA and cerebrovascular events (CVEs) is not fully understood.
Purpose of the Study:
- To evaluate the diagnostic utility of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in patients with ASA.
- To investigate the mechanisms of embolization and identify risk factors for CVEs in patients with ASA.
Main Methods:
- 23 adult patients with ASA underwent TTE and TEE.
- Echocardiographic contrast imaging and Doppler color mapping were used to detect interatrial shunting.
- Patients were assessed for CVEs and other potential cardiac sources of embolism.
Main Results:
- TEE identified interatrial shunting in 83% of patients, significantly higher than TTE (41%).
- TEE enabled the first-time echocardiographic identification of multiple fenestrations (4) and thrombus (2) within ASAs.
- Aneurysmal membrane thickening (≥5 mm) was significantly associated with a history of CVEs (75% vs 27%, p<0.05).
- CVEs occurred in 52% of patients, with 43% deemed thromboembolic.
Conclusions:
- ASA is a cardiac abnormality with significant thromboembolic potential.
- TEE is superior to TTE for diagnosing interatrial shunting and detecting intracardiac findings in ASA.
- Long-term anticoagulant therapy is indicated for patients with ASA and a history of embolic events.
Abstract:
Transthoracic and transesophageal echocardiography was performed in 23 consecutive adult patients with an atrial septal aneurysm. In three patients with a cerebrovascular event the diagnosis was established by the transesophageal approach only. Interatrial shunting on transthoracic imaging with use of echocardiographic contrast imaging or Doppler color mapping, or both, was detected in 7 (41%) of 17 patients. On performing contrast imaging in combination with color flow mapping during transesophageal echocardiography, positive shunting was demonstrated in 15 (83%) of 18 patients. Echocardiographic identification of multiple fenestrations (n = 4) and thrombus within the aneurysm (n = 2) could be achieved for the first time by transesophageal ultrasound application. Cerebrovascular events occurred in 12 (52%) of 23 patients and were regarded as being definitely thromboembolic in 10 (43%); 8 (67%) of the 12 patients had repeated cerebral events. Except for mitral valve prolapse in one patient, no other potential cardiac source of embolism could be identified despite the use of transesophageal echocardiography. A thickening of the aneurysmal membrane greater than or equal to 5 mm was found in 9 (75%) of 12 patients with versus 3 (27%) of 11 patients without a cerebrovascular event (p less than 0.05); this proved to be the only significant difference between the two patient groups. The mechanism of embolization may be both primary thrombus formation within the aneurysm and paradoxic embolization through an interatrial communication as demonstrated by the findings in two patients. It is concluded that atrial septal aneurysm is a cardiac abnormality with thromboembolic potential. In patients with this lesion and a history of an embolic event, long-term anticoagulant therapy is indicated.