Real time three‐dimensional transesophageal echocardiography imaging of crescent‐shaped superior sinus venosus atrial septal defect

Multi‐imaging modalities should be considered in patients with atrial septal defects (ASDs) in which the degree of right ventricular enlargement is not fully explained by the small size of ASD found on conventional transthoracic echocardiography. We report a case of crescent‐shaped superior sinus venosus ASD discriminated using real‐time three‐dimensional transesophageal echocardiography. MDCT confirmed its relationship with the superior vena cava and the absence of combined anomalies, such as the pulmonary venous return anomaly.     

A rare giant congenital left atrial appendage aneurysm in a 1‐day‐old newborn

Congenital left atrial appendage aneurysm (LAAA) is a very rare condition and occurs as a result of congenital dysplasia of musculi pectinate. These patients may be asymptomatic and/or may present with dyspnea, and thromboembolic events. The most common complications are life‐threatening thromboembolic events and supraventricular tachyarrhythmias. Transthoracic echocardiography plays a very important role in the diagnosis of LAAA. Herein, we present a rare case of giant congenital LAAA.     

A patient with an unusual cyst of the inter‐atrial septum and atrial sepal defect

Hepatic and renal cysts are relatively common among healthy people, but there are few published reports of primary cysts of the atrial septum. Here, we report a case of an unusual cyst of the atrial septum accompanied by atrial septal defect (ASD) in a 42‐year‐old woman. Microscopic examination showed the deposition of calcium salts within the tissue mass and an organized thrombus surrounded by a fibrous capsule. The case was discussed with reference to the relevant published literature and compared to other documented types of atrial septal cysts. The final diagnostic conclusion was a primary atrial septal cyst.     

Big thrombus “sitting” in an atrial septal aneurysm

A 79 year‐old‐man presented three episodes of upper gastrointestinal bleeding and weight loss. Endoscopy revealed bleeding and extrinsic compression at the pyloric region. Computed tomography scan showed a pancreatic tumor, peritoneal carcinomatosis, vascular infiltration, and incidentally found a partially calcified hypodense lesion of 35 mm in the left atrium, suggesting a myxoma or a thrombus. Echocardiography revealed moderate left atrium enlargement, dilated left atrial appendage with spontaneous echo contrast, moderate dilatation and dysfunction of the left ventricle, ejection fraction was 39%, and an atrial septal aneurysm in which a piriform, mass of 35×33×25 mm, was “sitting,” suggesting an organized thrombus.     

Observer Variation in the Echocardiographic Measurement of Maximum Atrial Septal Excursion: A Comparison of M‐Mode with Two‐Dimensional or Transesophageal Echocardiography

Background: Atrial septal aneurysm is typically diagnosed by transthoracic two‐dimensional or transesophageal echocardiography (2DE or TEE). Such techniques are highly dependent on visual inspection which predisposes to observer variation. This study compares inter‐ and intraobserver variations in the measurement of maximum atrial septal excursion (MASE) obtained using transthoracic M‐mode echocardiography (MME) with that obtained using 2DE or TEE. Methods: Consecutive patients with highly mobile atrial septal motion by visual inspection during 2DE or TEE were studied. MASE was estimated visually on 2DE or TEE. MME tracings were obtained with the cursor bisecting the parabola formed by the atrial septum at its maximum deviation from the midline. Electronic calipers were used to measure MASE for all echocardiographic techniques. Two observers provided two measurements each. Observer variation was determined by assessing standard deviation and confidence intervals of inter‐ and intraobserver differences. Results: Interobserver analysis showed standard deviations of 0.077 cm (95% CI 0.065–0.094) for MME and 0.280 cm (95% CI 0.242–0.334) for 2DE or TEE. Intraobserver analysis showed standard deviations of 0.08 cm (95% CI 0.068–0.101) for MME and 0.318 cm (95% CI 0.274–0.381) for 2DE or TEE. The mean magnitude of measured MASE was 0.44 cm higher with MME than with 2DE or TEE (95% CI 0.068–0.101). Conclusions: MME assessment of MASE is associated with substantially lower inter‐ and intraobserver variation than 2DE or TEE assessment. The magnitude of MASE is substantially higher with MME than with 2DE or TEE. (ECHOCARDIOGRAPHY, Volume **, ********)