Atrial septal aneurysm. Morphological characteristics in a large population: pathological associations. A French multicenter study on 259 patients investigated by transoesophageal echocardiography.
A strong association between interatrial septal aneurysm (IASA) and stroke has recently led many authors to consider IASA as a potential cardiac source of embolism. We studied the morphological characteristics and main associations of IASA in a large cooperative study based on transoesophageal echocardiographic examinations; 259 IASA were studied in 134 men and 125 women with a mean age of 59 +/- 15 years. Fifty-five percent of IASA were found to overlap the commonly described fossa ovalis region. IASA protruded into the right atrium in 90% of the cases. They appeared thin in 81% of the patients and highly mobile in 79%. Fifty-eight percent of patients had a history of systemic embolic events, while an atrial septal shunt was detected in 61% of the patients. In patients with an embolic event, only the mobility of IASA was significantly higher than in those with no embolic event. In nine cases a pulmonary embolism was associated with arterial embolism. Furthermore, we reported three cases of paradoxical embolism. However, the true demonstration of a thrombus within the IASA was quite rare.


CONCLUSIONS
IASA is probably an important risk factor for stroke. In patients with IASA and a history of embolic events, IASA may enhance migration of a thrombus constituted in situ or transiting through it. Marked mobility of IASA may also increase the risk of peripheral embolus.
Marazanof
M
M
Hôpital Cardiologique du Haut-Lévêque, Pessac, France.
Roudaut
R
R
Cohen
A
A
Tribouilloy
C
C
Malergues
M C
MC
Halphen
C
C
Bussiere
J L
JL
Schultz
R
R
Marcaggi
X
X
Lardoux
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D017548:Echocardiography, Transesophageal; D005260:Female; D005602:France / Q000453:epidemiology; D006322:Heart Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors