Giant right atrial aneurysm: case report

A 15-month-old boy with atrial fibrillation was found to have gross cardiomegaly on a chest radiography; further evaluation by echocardiography showed a giant right atrial aneurysm which is in the form of a cyst like lesion. The patient underwent successful surgical reduction of the right atrium converting his heart rhythm to normal. The operative measure was taken to prevent thrombus formation in the right atrium and lower the risk of atrial arrhythmias. The morphologic features of the resected atrial tissue showed a thin wall with a central aneurysm and focal endocardial fibrosis without inflammatory response consistent with a diagnosis of idiopathic dilatation of the right atrium.     

Atrial septal aneurysm: a report of three cases

Three cases of isolated atrial septal aneurysm are reported. Case 1: A 66-year-old man visited our hospital for detailed examination and evaluation of premature ventricular contractions and left ventricular hypertrophy previously detected. Echocardiography revealed an atrial septal aneurysm protruding into the left atrium in the early systolic phase and into the right atrium during the mid-systolic to diastolic phase. Subxiphoid M-mode echocardiography showed triphasic movement of the wall of the atrial septal aneurysm toward the left atrium during the end-diastolic to systolic phase, which was enhanced during inspiration. No abnormalities were found by Doppler echocardiography. Cardiac catheterization revealed normal intracardiac pressures and oxygen saturations, but a right arteriogram revealed a defect in the right atrium. Case 2: A five-month-old male infant was referred to our hospital for detailed examination and evaluation of a heart murmur. Echocardiography revealed an atrial septal aneurysm in which a part of the interatrial septum protruded into the right atrium. Case 3: A one-day-old female infant was admitted to our hospital for detailed cardiac examination. Echocardiography revealed that the entire interatrial septum protruded into the right atrium. In Cases 2 and 3 the morphology of the aneurysms did not show cyclic or respiratory change. These two cases had no other abnormalities on echocardiography or Doppler echocardiography. The mechanism of the wall movement in Case 1 seemed to be attributed to differences in pressures between the right and left atria and in properties of the aneurysmal walls. Enhancement of the protrusion of the aneurysmal wall toward the left atrium during inspiration was considered due to inspiratory increase of right atrial pressure.     

False aneurysm of the right atrium.

A false aneurysm of the right atrium is described. The false aneurysm appeared after open-heart surgery and was probably related to loosening of a right atrial suture. Because of the low pressure in the right atrium, the danger of rupture seemed to be low, and conservative therapy was chosen.     

Echocardiographic diagnosis of atrial septal aneurysm in an infant with hypoplastic right heart syndrome

Echocardiographic findings are described in a patient with hypoplastic right heart syndrome (pulmonary atresia type with intact ventricular septum and small right ventricular cavity) who had an associated atrial septal aneurysm. An unusual appearance of echoes behind the aorta bulging into the left atrium in diastole on both the M-mode and cross-sectional echo suggested this diagnosis prior to cardiac catheterization. The angiographic findings confirmed the diagnosis of right ventricular hypoplasia, pulmonary atresia and the large atrial septal aneurysm. The infant died after surgery and the atrial septal aneurysm was observed at autopsy. The importance of the diagnosis of the atrial septal aneurysm and its association with restriction of right-to-left atrial shunting prompts this report.     

Diagnosis of atrial septal aneurysm by two-dimensional echocardiography--a case report.

A patient who was evaluated for a syncopal episode was found by two-dimensional (2D) echocardiography to have an aneurysm of the atrial septum. The atrial septal aneurysm appeared as a localized outpouching of the atrial septum that protruded into the left atrium during systole and into the right atrium during early diastole. The 2D echocardiography permits the definitive diagnosis of this condition by a noninvasive technique.     

Rare case of heart failure caused by compression of the left atrium by a thoracic aortic aneurysm

A 61 year old patient was found to have an aneurysm extending from the aortic root to the suprarenal region. He underwent first stage surgery with aortic root and arch replacement, prosthetic aortic valve replacement, and coronary artery bypass grafting. Four weeks later, he presented with breathlessness and signs of heart failure and pleural effusion. Computed tomography showed that the left atrium was compressed between the aortic aneurysm posteriorly and the left ventricle and sternum anteriorly. Obstruction of the superior vena cava, bronchus, oesophagus, and rarely right atrium by an aortic aneurysm has been described before but presentation with left atrial compression has not been reported.     

Partial resection of atrial septal aneurysm with multiple fenestrations--a case report

Aneurysms of the interatrial septum are uncommon lesions that are often accompanied by other cardiac anomalies or systemic thrombosis. The authors report 1 case of atrial septum aneurysm that was diagnosed by two-dimensional contrast echocardiography. At surgery a membrane-like, fenestrated aneurysmal protrusion to the right atrium without thrombosis was seen. The atrial septum was closed without using an artificial patch after some of the aneurysm with fenestrations was resected.     

Giant interatrial septal aneurysm mimicking a right atrial tumor

We report the case of a patient with a giant interatrial septum aneurysm who was admitted to our hospital for analysis of palpitations. Transthoracic echocardiography was not contributive and cardiac magnetic resonance imaging demonstrated a small interatrial septal aneurysm. In our study, only transesophageal echocardiography provided the correct diagnosis, showing a giant interatrial septal aneurysm protruding far away into the right atrium and mimicking a right atrial cystic tumor.     

Aorto-right artrial fistula: a rare complication of aortic dissection

We describe the successful surgical repair of an acute aortic dissection that had caused an aorto-right atrial fistula in a 67-year-old man. The patient was admitted to the hospital on an emergency basis because of severe heart failure. The diagnosis of acute aortic dissection with rupture into the right atrium was confirmed by use of intraoperative transesophageal echocardiography, although rupture of a sinus of Valsalva aneurysm into the right atrium had been suggested initially by 2-dimensional and Doppler transthoracic echocardiography. At surgery, we found the patient to have aortic arch dissection with complete separation of the right coronary artery from the sinus of Valsalva and a false lumen that had ruptured into the right atrium. The aortic arch was repaired directly. The ascending aorta was successfully replaced with a composite graft. Aortic dissection with rupture into the right atrium is extremely rare and leads to death rapidly. As shown in this case, such a condition might be mistaken for an aneurysmal rupture of the sinus of Valsalva, with use of transthoracic echocardiography alone. Transesophageal echocardiography is a useful noninvasive method to further define or confirm the diagnosis. Early surgical intervention is necessary in patients with this condition to prevent profound shock and end-organ failure.     

Aneurysm of the interatrial septum occurring as an isolated anomaly

We report a case of aneurysm of the atrial septum occurring as an isolated abnormality in a patient with atypical chest pain. Apical two-dimensional echocardiography demonstrated phasic bulging of the fossa ovalis region of the atrial septum into the right atrium. Biplane cineangiography confirmed the presence of a large septal aneurysm in an otherwise normal heart. The incidence, pathogenesis, and complications of this unusual anomaly are briefly discussed.     

Anévrysme isolé du septum interauriculaire : cause exceptionnelle d’ischémie digitale

An atrial septal aneurysm (ASA) is a rare but well recognized entity characterized by saccular deformity of the atrial septum that bulges into the right or left atrium. Diagnosis can be established using transthoracic and transesophageal echocardiography. Although this abnormality is considered clinically benign, it has been independently associated with systemic or cerebral embolism. We present a unique case of isolated atrial septal aneurysm complicated by digital ischemia in a 51 years old woman.     

Aneurysm of atrial septum associated with rheumatic mitral stenosis simulating tumour of right atrium

We present a case of aneurysm of interatrial septum associated with rheumatic mitral stenosis, which supports the theory that claims that the pressure gradient between the atriums plays an important part in its aetiology. The angiographic image of a filling defect in the right atrium may cause an erroneous diagnosis of atrial tumour. The levophase of right angiography and cross-sectional echocardiography confirmed the diagnosis of aneurysm of interatrial septum.     

Saphenous vein graft aneurysm masquerading as a right atrial mass

We report a case of a large saphenous vein graft (SVG) aneurysm masquerading as a right atrial mass on transesophageal echocardiogram. Cardiac magnetic resonance angiography reliably made a diagnosis of SVG aneurysm extrinsically compressing right atrium. This case illustrates the importance of using combined imaging modalities for the diagnosis and management of cardiac masses.     

Two-dimensional and Doppler echocardiographic diagnosis of an aortic to right atrial fistula complicating aortic dissection

A 60 year old woman presented with massive aortic root dilation and sudden cardiovascular collapse 10 years after aortic valve replacement. An aortic to right atrial fistula was diagnosed by echocardiographic imaging and Doppler ultrasound. At operation, the patient was found to have chronic aortic dissection with aneurysm formation. Rupture of the aneurysm into the right atrium was confirmed.     

The echocardiographic features of an aneurysm of the inter-atrial septum

The echocardiographic features of a surgically confirmed case of an aneurysm of the inter-atrial septum presenting as a persistent right atrial lesion were described. The lesion appeared cystic and could be differentiated from solid tumours. In contrast to other reported cases of smaller aneurysms, the lesion in this patient remained in the right atrium and did not show any phasic variation during the respiratory cycle because of its larger size. A review of the reported echocardiographic features of intra-cavitary right atrial tumours and pseudotumours was made. This highlighted distinguishing features that could be used in the differential diagnosis of space-occupying lesion within the right atrium.     

Percutaneous Closure of a Fistulous Giant Coronary Aneurysm

Giant coronary artery aneurysms larger than 50 mm are rare and associated with important complications: namely, rupture. Its workup requires comprehensive imaging and standard treatment is surgical exclusion. We present a 60-year-old patient with previous ostium secundum atrial septal defect surgical closure diagnosed with a giant proximal right coronary artery aneurysm (70 x 62 mm) fistulizing into the right atrium. Percutaneous closure of its aortic origin with an atrial septal occluder was successfully performed, and thrombosis of the aneurysm confirmed on angiography and echocardiogram. This case depicts an innovative, minimally invasive approach to this worrisome entity.     

Aneurysm of the left atrial appendage.

A 2-year old asymptomatic girl is presented in whom the chest x-ray film led to the discovery of a grossly distorted cardiac shadow. Angiocardiography showed a giant aneurysm originating from the left atrium. At operation an intrapericardial aneurysm of the left atrial appendage, measuring 12 X 4 X 4 cm, was found. It communicated with the left atrium through an orifice measuring 3 cm. The aneurysm was excised.     

Atrial septal aneurysm--a potential cause of systemic embolism. An echocardiographic study

Atrial septal aneurysm is an uncommon condition. Between 1981 and 1984 10 cases of atrial septal aneurysm were diagnosed by real time cross sectional echocardiography performed in 4840 patients. The aneurysm was associated either with mitral valve prolapse (three patients) or with atrial septal defect (three patients) or occurred in isolation (four patients, two of whom had had a previous embolic event leading to the diagnosis of atrial septal aneurysm by cross sectional echocardiography). During cross sectional echocardiography the aneurysm appeared as a localised bulging of the interatrial septum, which was best seen in the subcostal four chamber view and in the parasternal short axis view at the level of the aortic root. The aneurysm either protruded into only the right atrium (five patients) or moved backwards and forwards between the right and the left atria during the cardiac cycle (five patients). This motion pattern might be related to changes in the interatrial pressure gradient. The two patients who had had a systemic embolism were given anticoagulant treatment, but none underwent surgery. It is concluded that the true prevalence of atrial septal aneurysm might have been underestimated before the routine use of cross sectional echocardiography, that cross sectional echocardiography enables definitive diagnosis of this condition by a non-invasive technique, and that an atrial septal aneurysm should be suspected and looked for by cross sectional echocardiography after an unexplained systemic embolism.     

Atrial septal aneurysm--a potential cause of systemic embolism. An echocardiographic study.

Atrial septal aneurysm is an uncommon condition. Between 1981 and 1984 10 cases of atrial septal aneurysm were diagnosed by real time cross sectional echocardiography performed in 4840 patients. The aneurysm was associated either with mitral valve prolapse (three patients) or with atrial septal defect (three patients) or occurred in isolation (four patients, two of whom had had a previous embolic event leading to the diagnosis of atrial septal aneurysm by cross sectional echocardiography). During cross sectional echocardiography the aneurysm appeared as a localised bulging of the interatrial septum, which was best seen in the subcostal four chamber view and in the parasternal short axis view at the level of the aortic root. The aneurysm either protruded into only the right atrium (five patients) or moved backwards and forwards between the right and the left atria during the cardiac cycle (five patients). This motion pattern might be related to changes in the interatrial pressure gradient. The two patients who had had a systemic embolism were given anticoagulant treatment, but none underwent surgery. It is concluded that the true prevalence of atrial septal aneurysm might have been underestimated before the routine use of cross sectional echocardiography, that cross sectional echocardiography enables definitive diagnosis of this condition by a non-invasive technique, and that an atrial septal aneurysm should be suspected and looked for by cross sectional echocardiography after an unexplained systemic embolism.     

Incidence of atrial septal aneurysm: echocardiographic and pathologic analysis

We prospectively studied the echocardiographic findings of an atrial septal aneurysm (ASA) to estimate its incidence and to clarify its clinical characteristics and significance. Post-mortem examination was also performed in three patients. Echocardiographically, ASA was defined as a bulging segment of the atrial septum localized in the fossa ovalis, either fixed in one direction or oscillating between the atria. It was classified in three types according to Hanley et al., i.e., Type 1A, protruding into the right atrium without oscillation; Type 1B protruding into the right atrium with oscillation, and Type 2, protruding into the left atrium with oscillation. Among 2,074 consecutive subjects in the echocardiographic study population, ASA was diagnosed in 26 patients (1.2%). This figure was slightly higher than those previously reported (0.6% to 1.0%). The extent of protrusion of the aneurysm was 8 mm or more in all patients, regardless of its direction, and it was assumed that this is a reasonable echocardiographic diagnostic criterion in the apical four-chamber view. All patients were over 51 years in age, with a mean of 71 years. Most patients (96%) had oscillation of their aneurysms. Twenty-one patients (81%) were of Type 2; one was Type 1A, and four were Type 1B. Post-mortem examination of three patients revealed septal protrusion toward the right atrium in all, and patent foramina ovale in two of them. Among the 26 patients, two (8%) had systemic embolic complications; one, cerebellar infarction, the other, cerebral infarction and mesenteric artery embolism. In conclusion, atrial septal aneurysm was observed in 1.2% of subjects undergoing routine echocardiography, with a distinctive distribution among patients over 51 years of age. Characteristically, it protrudes into the left atrium 8 mm or more, and it is sometimes associated with patent foramen ovale. Systemic embolism is a possible complication of this anomaly.