Document Detail

Improved morphologic characterization of atrial septal aneurysm by transesophageal echocardiography: relation to cerebrovascular events.
MedLine Citation:
PMID:  2212349     Owner:  NLM     Status:  MEDLINE    
Transthoracic and transesophageal echocardiography was performed in 23 consecutive adult patients with an atrial septal aneurysm. In three patients with a cerebrovascular event the diagnosis was established by the transesophageal approach only. Interatrial shunting on transthoracic imaging with use of echocardiographic contrast imaging or Doppler color mapping, or both, was detected in 7 (41%) of 17 patients. On performing contrast imaging in combination with color flow mapping during transesophageal echocardiography, positive shunting was demonstrated in 15 (83%) of 18 patients. Echocardiographic identification of multiple fenestrations (n = 4) and thrombus within the aneurysm (n = 2) could be achieved for the first time by transesophageal ultrasound application. Cerebrovascular events occurred in 12 (52%) of 23 patients and were regarded as being definitely thromboembolic in 10 (43%); 8 (67%) of the 12 patients had repeated cerebral events. Except for mitral valve prolapse in one patient, no other potential cardiac source of embolism could be identified despite the use of transesophageal echocardiography. A thickening of the aneurysmal membrane greater than or equal to 5 mm was found in 9 (75%) of 12 patients with versus 3 (27%) of 11 patients without a cerebrovascular event (p less than 0.05); this proved to be the only significant difference between the two patient groups. The mechanism of embolization may be both primary thrombus formation within the aneurysm and paradoxic embolization through an interatrial communication as demonstrated by the findings in two patients. It is concluded that atrial septal aneurysm is a cardiac abnormality with thromboembolic potential. In patients with this lesion and a history of an embolic event, long-term anticoagulant therapy is indicated.
B Schneider; P Hanrath; P Vogel; T Meinertz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  16     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1990 Oct 
Date Detail:
Created Date:  1990-11-21     Completed Date:  1990-11-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1000-9     Citation Subset:  AIM; IM    
Medical Clinic II, St. Georg Hospital, Hamburg, Federal Republic of Germany.
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MeSH Terms
Echocardiography / methods*
Heart Aneurysm / complications,  epidemiology,  ultrasonography*
Heart Diseases / ultrasonography
Heart Septum
Intracranial Embolism and Thrombosis / etiology*
Middle Aged
Retrospective Studies
Thrombosis / ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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