American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2016, 4(3), 111-114
DOI: 10.12691/ajmcr-4-3-10
Open AccessCase Report

Huge Interatrial Septum Aneurysm

Pramod Theetha Kariyanna1, , Apoorva Jayarangaiah2, Robert Adrah3 and Abhishek Sharma4

1Department of Internal Medicine, State University of new York, Downstate Medical Center, U.S.A.

2Department of Internal Medicine, Marshfield Clinic- St Joseph Hospital, Marshfield, Wisconsin, U.S.A.

3Department of Internal Medicine, Brookdale University Hospital and Medical center, Brooklyn, New York, U.S.A.

4Division of Cardiology, Department of Internal Medicine, State University of New York, Downstate Medical center, Brooklyn, New York, U.S.A.

Pub. Date: April 18, 2016

Cite this paper:
Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Robert Adrah and Abhishek Sharma. Huge Interatrial Septum Aneurysm. American Journal of Medical Case Reports. 2016; 4(3):111-114. doi: 10.12691/ajmcr-4-3-10


Atrial septum aneurysm (ASA) is a saccular aneurysm of the interatrial septum, bulging into either atrium during the cardiac cycle. It is mostly congenital in natures and is often associated with patent foramen ovale (PFO). ASA is increasingly gaining attention as a possible cause of cryptogenic stroke. We here present a case of ASA in an elderly female in whom ASA possibly contributed to atrial fibrillation and mitral valvular prolapse; she denied any thromboembolic event. Transesophageal echocardiography remains the imaging modality of choice for diagnosis of ASA. Management guidelines for initiation of antiplatelet therapy, anticoagulation and the need for endovascular or surgical closure of associated PFO are lacking.

atrial septum aneurysm patent foramen ovale stroke transesophagel echocardiography

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[1]  Lang FJ, Posselt A. Aneurrysmatische vorwolburg der fossa ovalis in den linken vorhof, Wiener Medizinische Wochenschrift. 1934; 84:392-396.
[2]  Olivares-Reyes A, Chan S, Lazar EJ. Atrial septal aneurysms: A new classification in two-hundred five adults. J Am Soc Echocardiogr. 1997;10: 644-656.
[3]  Hanley PC, Tajik AJ, Hynes JK, Edwards WD, Reeder GS, Hagler DJ, Seward JB. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol. 1985;6:1370-1382.
[4]  Silver MD, Dorsey JS. Aneurysms of the septum primum in adults. Arch Pathol Lab Med. 1978;102:62-65.
[5]  Iliceto S, Papa A, Sorino M, Rizzon P. Combined atrial septal aneurysm and mitral valve prolapse: detection by two-dimensional echocardiography. Am J Cardiol. 1984;54:1151-1154.
[6]  Rahko PS, Xu QB. Increased prevalence of atrial septal aneurysm in mitral valve prolapse. Am J Cardiol. 1990;66:253-257.
[7]  Mugge A, Daniel WG, Angermann C, Spes C, Khandheria BK, Kronzon I, Freedberg RS, Keren A, Denning K, Engberding R. Atrial septal aneurysm in adult patients: A multicenter study using transthoracic and transesophageal echocardiography. Circulation. 1995;91(11): 2785-92.
[8]  Mattioli AV, Aquilina M, Oldani A, et al. Frequency of atrial septal aneurysm in patients with recent stroke: Preliminary results from a multicenter study. Clin Cardiol.2001;24:297-300.
[9]  Morelli S, Voci P, Morabito G, et al. Atrial septal aneurysm and cardiac arrhythmias.Int J Cardiol. 1995;49:257-265.
[10]  Belkin RN, Kisslo J. Atrial septal aneurysm: Recognition and clinical relevance. Am Heart J. 1990;120:948-957
[11]  Carerj S, Narborne MC, Zito C, et al. Prevalence of atrial septal aneurysm in patients with migraine: An echo cardiographic study. Headache. 2003;43:725-728.
[12]  Cabanes L, Mas JL, Cohen A, et al. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography. Stroke.1993;24:1865-1873.
[13]  Mas J, Arquizan C, Lamy C, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. 2001;345:1740-1746.
[14]  Lamy C, Giannesini C, Zuber M, et al. Clinical and Imaging findings in cryptogenic stroke patients with and without patent foramen ovale: The PFO-ASA Study. Stroke. 2002;33:706-711.
[15]  Ewert P, Berger F, Vogel M, et al. Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement. Heart. 2000;84:327-331.
[16]  M. Janion and J. Kurzawski, “Atrial fibrillation in patients with atrial septal aneurysm,” Cardiology Journal. 2-7; 14(6),. 580–584..
[17]  Wilmhurst PT, Nightingale S, Walsh KP, Morrison WL. Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons. Lancet. 2000;356:1648-1651.
[18]  Pearson AC, Nagelhout D, Castello R, Gomez CR, Labovitz AJ. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol. 1991;18:1223-1229.
[19]  Hur J, Kim YJ, Lee HJ, Ha JW, Heo JH, Choi EY, Shim CY, Kim H, Nam JE, Choe KO. Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients, Stroke. 2009; 40(6): 2073-2078.
[20]  Saremi F, Channual S,Raney A, Gurudevan SV, Narula J, S. Fowler, A. Abolhoda, and J. C. Milliken. Imaging of Patent Foramen Ovale with 64-Section Multidetector CT Radiology, November 1, 2008; 249(2): 483-492.
[21]  Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van Melle G. Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group, Neurology. 1996; 46(5):1301-5.
[22]  Martin F, Sanchez P L, Doherty E. et al Percutaneous transcatheter closure of foramen ovale in patients with paradoxical embolism, Circulation. 2002;106:1121-1126.
[23]  Rao PS, Berger F, Rey C, for the International Buttoned Device Trial Group et al Results of transvenous occlusion of secundum atrial septal defects with the fourth generation buttoned device: comparison with first, second, third generation devices. J Am Coll Cardiol. 200;36:583-592.
[24]  Hung J, Landzberg MJ, Jenkins KJ. Closure of patent foramen ovale for paradoxical emboli: intermediate‐term risk of recurrent neurological events following transcatheter device placement. J Am Coll Cardiol. 2000;35:1311-1316.
[25]  Homma S, Di Tullio MR, Sacco RL. Surgical closure of patent foramen ovale in cryptogenic stroke patients. Stroke 1997;28:2376-2381.
[26]  Orgera M A, O'Malley PG, Taylor A J. Secondary prevention of cerebral ischaemia in patent foramen ovale: systemic review and meta‐analysis. South Med J. 2001;94:699-703.703.
[27]  Devuyst G, Bogousslavsky J, Ruchat P. Prognosis after stroke followed by surgical closure of patent foramen ovale: a prospective follow‐up study with brain MRI and simultaneous transesophageal and transcranial Doppler ultrasound. Neurology. 1996;47:1162-1166.