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Diagnostic value of transesophageal echocardiography in atrial septal aneurysm

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Abstract

Transthoracic and transesophageal echocardiography was performed in 40 consecutive adult patients with an atrial septal aneurysm. In 11 (27%) of 40 patients transthoracic echocardiography failed to demonstrate the lesion and the diagnosis was established by the transesophageal approach only. Interatrial shunting, assessed by echocardiographic contrast study and/or color flow mapping, was detected in 13 (54%) of 24 patients on transthoracic imaging and in 29 (76%) of 38 patients during transesophageal echocardiography. Identification of multiple fenestrations (n=9) and thrombi within the aneurysm (n=2) could be achieved only by transesophageal ultrasound. A cerebrovascular event of suspected embolic origin occurred in 20 (50%) of 40 patients; 11 (55%) of the 20 patients had repeated cerebral events. Except for mitral valve prolapse in 2 patients and spontaneous left atrial contrast phenomenon in 1 patient no other potential cardiac source of embolism could be identified by transesophageal echocardiography. A marked thickening of the aneurysm was present in 14 (70%) of 20 patients with a cerebrovascular event versus only 4 (20%) of 20 patients without a cerebrovascular event (p<0,01). The mechanism of embolization may be both primary thrombus formation within the aneurysm and paradoxical embolization through an interatrial communication as suggested by the findings on transesophageal ultrasound in 2 patients. Although the patients of this study represent a highly selected group it may be concluded that atrial septal aneurysm is a cardiac abnormality with embolic potential. Transesophageal echocardiography has to be regarded the imaging method of choice for evaluation of this lesion.

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Authors and Affiliations

  1. II. Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Lohmühlenstr. 5, 2000, Hamburg 1, Germany

    Birke Schneider, Thomas Hofmann & Thomas Meinertz

  2. Medizinische Klinik I, Rheinisch-Westfälische Technische Hochschule, Pauwelsstr. 30, 5100, Aachen, Germany

    Peter Hanrath

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  1. Birke Schneider
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  2. Thomas Hofmann
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  3. Thomas Meinertz
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  4. Peter Hanrath
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Schneider, B., Hofmann, T., Meinertz, T. et al. Diagnostic value of transesophageal echocardiography in atrial septal aneurysm. Int J Cardiac Imag 8, 143–152 (1992). https://doi.org/10.1007/BF01137535

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