Atrial Septal Aneurysm Does Not Predispose to Stroke in the Immediate Postoperative Period Following Cardiac Surgery

The postoperative period following cardiac surgery is associated with an increased incidence of cerebrovascular events. Previous retrospective studies have suggested that atrial septal aneurysms (ASAs) are associated with embolic strokes ranging in incidence from 20%–52%. The purpose of the study was to investigate whether patients with ASA undergoing cardiac surgery have increased risk for strokes in the immediate postoperative period. Of 1626 consecutive patients undergoing transesophageal echocardiography during cardiac surgery over a 44-month period, 80 patients were identified to have ASA (incidence 4.9%). Patients were followed during their entire hospital stay for development of any neurological event. Any patient with a suspicion of neurological event had a detailed neurological history, examination, and, if necessary, a CT scan or MRI study. Most patients were started on aspirin postoperatively. None of the patients experienced a cerebrovascular event or systemic embolization during this period. Thus, the presence of isolated ASA may not pose an additional risk for cerebrovascular events during postoperative period.     

Low Incidence of Cerebrovascular Events in Patients with Incidental Atrial Septal Aneurysm

Objectives: The purpose of our investigation was to describe the echocardiographic characteristics of an atrial septal aneurysm (ASA) and associated cardiac abnormalities, to determine whether any echocardiographic characteristics are associated with cerebrovascular events, and to compare the cerebrovascular risk of ASA when it is an isolated and incidental finding with ASA associated with other cardiac abnormalities and diagnostic indications, including a cardiac source of embolus. Methods: In 1605 consecutive patients referred for transesophageal echocardiography during open heart surgery, we identified 78 patients with ASA as an incidental finding (Group I). During the same period, this anomaly was found in 39 of 8014 consecutive patients referred to the echocardiographic laboratory for various diagnostic reasons (Group II). The frequency of cerebrovascular events and ASA characteristics was compared between these two groups. Results: A total of 117 patients with ASA was included in the study: 60 males and 57 females with a mean age of 66.7 ± 9.1 years. There were no significant differences in the echocardiographic characteristics of ASA or associated cardiac abnormalities between these two groups; no intracardiac or ASA associated thrombi were detected in either group. While only 6.4% of Group I had a clinical event, 23% of patients in Group II had a stroke or transient ischemic abnormality. Conclusions: The morphological characteristics of ASA and associated cardiac abnormalities do not distinguish patients at risk for cerebrovascular events. Although the presence of ASA may be a risk factor for embolic strokes, this risk is lower than previously thought .     

房间隔瘤与反常性栓塞

房间隔瘤是一种少见的心脏结构畸形,其临床价值并不十分确切.房间隔常常并发房内分流,特别是在合并卵圆孔未闭时更容易发生.房间隔瘤病人有较高的脑卒中发生率.大量的研究结果表明,反常性栓塞是房间隔瘤病人发生脑卒中的主要机制.现就房间隔瘤与反常性栓塞相关性研究的新进展作一综述.     

Transesophageal Echocardiographic Identification of Atrial Septal Aneurysm

This case illustrates the usefulness of biplane transesophageal echocardiography in the diagnosis of an atrial septal aneurysm, which in some views, mimicked a mass lesion in the left atrium. (ECHOCARDIOGRAPHY, Volume 8, July 1991)     

Percutaneous Catheter Closure of Atrial Septal Defect and an Atrial Septal Aneurysm: One Case Report

We describe a 56-yr-old female presented with palpitation and shortness of breath on exertion and intracardiac echocardiography showed atrial septal defect and an atrial septal aneurysm. She was underwent successfully percutaneous catheter closure with Amplatzer occluder devices.     

房间隔膨胀瘤在脑卒中患者中的超声特征及临床意义

目的探讨房间隔膨胀瘤（ASA）在颈动脉正常脑卒中患者中的临床意义。方法选择有脑中风病史颈动脉正常的ASA病例36例作为A组，性别年龄相匹配的非脑中风病例68例作为B组，应用经胸超声心动图（TTE）获取心尖四腔心和大血管短轴切面，观察ASA最大膨出深度、膨出方向，随正常呼吸，循环周期膨胀瘤的运动，ASA瘤壁厚度，是否存在血栓，以及有无其他心脏异常。结果按ASA的膨出方向和运动情况分型，两组病例均以IB型居多，两组病例的各类型间差异无统计学意义；A组的瘤体深度及瘤壁厚度均较B组明显增加；A组ASA合并PFO的比例（10／36）高于B组（8／68）。结论ASA在颈动脉正常脑卒中患者的发病中扮演着重要的角色，超声心动图可以对ASA的特征作出准确的诊断，为临床提供更为有价值的信息。     

Paradoxical embolism with a patent foramen ovale and atrial septal aneurysm.

Patent foramen ovale (PFO) and atrial septal aneurysm have been cited as potential risk factors for cryptogenic stroke. We present two cases which we propose to directly illustrate paradoxical embolisation as a mechanism of cerebrovascular accident. The diagnosis of PFO is discussed and the literature reviewed.     

Long-Term Results after Percutaneous Closure of Atrial Septal Defect: Cardiac Remodeling and Quality of Life

Background:

Atrial septal defect (ASD) represents a common congenital heart malformation, cause of right ventricle (RV) volume overload, pulmonary hypertension, atrial arrhythmias, and paradoxical emboli. Percutaneous closure represents the treatment of choice for ASD. However, it is still difficult to associate symptoms to the success of ASD treatment.

Objective:

To investigate any possible correlation between transthoracic echocardiography (TTE) findings and patients’ symptoms after ASD treatment.

Materials and Methods:

Thirty patients (mean age 49 ± 17 years; 10 younger ≤40 years and 20 > 40 years) underwent percutaneous closure of ASD type ostium secundum. Every patient underwent clinical examination, electrocardiogram (ECG) and TTE before procedure and at 1, 6, and 12 months after procedure and a multichoice questionnaire to collect patients’ symptoms and complain severity.

Statistical analysis:

Continuous variables were summarized by means and standard deviation. Estimates of occurrence of events were expressed as percentages. Comparison between mean follow-ups was achieved using paired t-test sample.

Results:

At end of follow-up, TTE showed a decrease of RV dimensions (34.4 vs 37.5 mm preclosure; P = 0.01), pulmonary artery systolic pressure (PAPs 28.4 vs 39.5 mmHg; P = 0.00003), atrial dimensions (51 vs 56 mm; P = 0.085), and of right myocardial performance index (MPI; 0.39 vs 0.42; P = 0.05). PAPs was significantly reduced in group more than 40-years-old (P = 0.00004), while the reduction was not significant in the less or equal than 40 years of age (P = 0.08) group because the baseline value was significantly lower. Many patients after procedure complained headache, insomnia, palpitations, fatigue, and dyspnea; but no cardiac morphological abnormalities related to symptoms were found.

Conclusions:

Our data showed a great improvement in symptoms and positive cardiac remodeling after closure of ASD, more effective in elderly patients compared to younger patients. The symptoms are not correlated with the principal disease or procedure.     

Atrial Septal Aneurysm and Dilated Sinus of Valsalva in a Patient with Wolff-Parkinson-White Syndrome

Atrial septal aneurysm and a dilated sinus of Valsalva were noted on echocardiography in a 30-year-old male with Wolff-Parkinson-White syndrome. The relative low probability of all three coexisting by chance alone suggests the possibility of a common developmental origin.