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Atrial Septal Aneurysm Is Always Linked To Right-Left Shunt and Cardio embolic Risk

Received: 13 May 2013    Accepted:     Published: 20 June 2013
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Abstract

Atrial septal aneurysm when associated to other cardiac abnormalities, such as patent foramen ovale, Chiari network or Eustachian Membrane, is a well-known recognised risk factor for cerebral embolism. Aim of study is to assess if isolated atrial septal aneurysm could be considered statistically related to cryptogenic stroke, considering the strong clinical impact that this association could have on these patients outcome. 579 patients were investigated for a suspected patent foramen ovale using transthoracic echocardiography, in order to evaluate the presence of atrial septal aneurysm and to identify other potential cardiac embolic sources. The patients with atrial septal aneurysm underwent transcranic echodoppler and transoesophageal echocardiography examination with contrast solution during Valsalva manoeuvre.209/579 (36%) patients where we made diagnosis of atrial septal aneurysm. In this cohort of patients transcranic echodoppler showed a patent foramen ovale in 114/209 (54%), whereas transoesophageal echocardiography in 111/209 (53%); 6/114 (5%) pa-tients with a positive transcranic echodoppler had a normal transoesophageal echocardiography examination and 3/95 (3%) with normal transcranic echodoppler had a positive transoesophageal echocardiography. Transcranic echodoppler vs. transoesophageal echocardiography sensibility was 97% and specificity 94%. Only 13/98 (13%) of patients with isolated atrial septal aneurysm and 23/111 (26%) with patent foramen ovale had history of cryptogenic stroke. According to our data, isolated atrial septal aneurysm could not be considered an independent risk factor for cryptogenic stroke.

DOI 10.11648/j.cmr.20130204.12
Published in Clinical Medicine Research (Volume 2, Issue 4, July 2013)
Page(s) 48-52
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Atrial Septum Aneurysm, Stroke, Echocardiography

References
[1] Silver MD, Dorsey JS. Aneurysms of the septum primum in adults. Arch Pathol Lab Med 1978;102:62–5.
[2] Gondi B, Nanda NC.Two dimensional echocardiographic features of atrial septal aneurysms. Circulation 1981; 63: 452–457
[3] Belkin RN, Kisslo J. Atrial septal aneurysm: recognition and clinical relevance. Am Heart J 1990; 120: 948–957
[4] Pearson AC, Labovitz AJ, Tatineni S, Gomez CR. Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol 1991; 17: 66–72
[5] Ghosh S, Ghosh AK, Ghosh SK. Patent foramen ovale and atrial septal aneurysm in cryptogenic stroke. Postgrad Med J 2007; 83: 173–177
[6] Davison P, Clift PF, Steeds RP. The role of echocardiography in diagnosis, monitoring closure and post-procedural assessment of patent foramen ovale. Eur J Echocardiogr 2010; 11 (10): i27-34
[7] Mattioli AV, Aquilina M, Oldani A, Longhini C, Mattioli G. Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid artery. A multicentre study. Eur Heart J 2001; 22: 261–268
[8] Gallet B, Malergue MC, Adams C, Saudemont JP, Collot AM, Druon MC, Hiltgen M. Atrial septal aneurysm a potential cause of systemic embolism. Br Heart J 1985; 53: 292–297
[9] Razaq M, Pariar RK, Saini G. Atrial septal aneurysm and stroke Ann Pediatr Cardiol 2012; 5 (1): 98–99
[10] Force M, Massabuau P, Larrue PV. Prevalence of atrial septal abnormalities in older patients with cryptogenic ischemic stroke or transient ischemic attack. Clin Neurol Neurosurg 2008; 110 (8): 779-783
[11] Pepi M, Evangelista A, Nihoyannopoulos P, Flachskampf FA, Athanassopoulos G, Colonna P, Habib G, Ringelstein E, Sicari R, Zamorano JL. Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism. Eur J Echocard 2010; 11, 461–476
[12] Blersch WK, Draganski BM, Holmer SR, Koch HJ, Schlachetzki F, Bogdahn U, Hölscher T . Transcranial Duplex Sonography in the Detection of patent foramen ovale. Radiology 2002; 225: 693-699
[13] Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001; 345: 1740–1746
[14] Schuchlenz HW, Weihs W, Beitzke A, Stein JI . Transesophageal Echocardiography for Quantifying Size of Patent Foramen. Stroke 2002; 33:293-296
[15] Mangiafico S, Scandura S, Ussia GP, Privitera A, Capodanno D, Petralia A, Tamburino C. Transesophageal echocardiography and transcranial color-doppler: indipendent or complementary diagnostic tests for cardiologists in the detection of patent foramen ovale? J Cardiovasc Med 2009; 10:143-148.
[16] Agmon Y, Khandheria BK, Meissner I, Gentile F, Whisnant JP, Sicks JD, O’Fallon M, Covalt J, Wiebers D, Seward JB . Frequency of atrial septal aneurysms in patients with cerebral ischemic events. Circulation 1999; 99: 1942–1944
[17] Ueno Y, Shimada Y, Tanaka R, Miyamoto N, Tanaka Y, Hattori N, Urabe T. Patent Foramen Ovale with Atrial Septal Aneurysm May Contribute to White Matter Lesions in Stroke Patients. Cerebrovasc Dis 2010; 30: 15–22
[18] Monte I, Grasso S, Licciardi S, Badano LP. Head-to-head comparison of real-time three-dimensional transthoracic echocardiography with transthoracic and transesophageal two-dimensional contrast echocardiography for the detection of patent foramen ovale. Eur J Echocardiogr 2010; 11: 245–249
[19] Cruz-Gonzales I, Solis J, Inglessis-Azuaije I, Palacios IF. Patent Foramen Ovale: current state of art. Rev Esp. Cardiol 2008; 61 (7): 738-751
Cite This Article
  • APA Style

    Sarah Mangiafico, Ines Paola Monte, Vincenzo Lavanco, Lucio Raffaello Tropea, Antonio Andrea Arcidiacono, et al. (2013). Atrial Septal Aneurysm Is Always Linked To Right-Left Shunt and Cardio embolic Risk. Clinical Medicine Research, 2(4), 48-52. https://doi.org/10.11648/j.cmr.20130204.12

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    ACS Style

    Sarah Mangiafico; Ines Paola Monte; Vincenzo Lavanco; Lucio Raffaello Tropea; Antonio Andrea Arcidiacono, et al. Atrial Septal Aneurysm Is Always Linked To Right-Left Shunt and Cardio embolic Risk. Clin. Med. Res. 2013, 2(4), 48-52. doi: 10.11648/j.cmr.20130204.12

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    AMA Style

    Sarah Mangiafico, Ines Paola Monte, Vincenzo Lavanco, Lucio Raffaello Tropea, Antonio Andrea Arcidiacono, et al. Atrial Septal Aneurysm Is Always Linked To Right-Left Shunt and Cardio embolic Risk. Clin Med Res. 2013;2(4):48-52. doi: 10.11648/j.cmr.20130204.12

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  • @article{10.11648/j.cmr.20130204.12,
      author = {Sarah Mangiafico and Ines Paola Monte and Vincenzo Lavanco and Lucio Raffaello Tropea and Antonio Andrea Arcidiacono and Maria Concetta di Pasqua and Letizia Santonoceto and Giovanni Millan and Corrado Tamburino},
      title = {Atrial Septal Aneurysm Is Always Linked To Right-Left Shunt and Cardio embolic Risk},
      journal = {Clinical Medicine Research},
      volume = {2},
      number = {4},
      pages = {48-52},
      doi = {10.11648/j.cmr.20130204.12},
      url = {https://doi.org/10.11648/j.cmr.20130204.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20130204.12},
      abstract = {Atrial septal aneurysm when associated to other cardiac abnormalities, such as patent foramen ovale, Chiari network or Eustachian Membrane, is a well-known recognised risk factor for cerebral embolism. Aim of study is to assess if isolated atrial septal aneurysm could be considered statistically related to cryptogenic stroke, considering the strong clinical impact that this association could have on these patients outcome. 579 patients were investigated for a suspected patent foramen ovale using transthoracic echocardiography, in order to evaluate the presence of atrial septal aneurysm and to identify other potential cardiac embolic sources. The patients with atrial septal aneurysm underwent transcranic echodoppler and transoesophageal echocardiography examination with contrast solution during Valsalva manoeuvre.209/579 (36%) patients where we made diagnosis of atrial septal aneurysm. In this cohort of patients transcranic echodoppler showed a patent foramen ovale in 114/209 (54%), whereas transoesophageal echocardiography in 111/209 (53%); 6/114 (5%) pa-tients with a positive transcranic echodoppler had a normal transoesophageal echocardiography examination and 3/95 (3%) with normal transcranic echodoppler had a positive transoesophageal echocardiography. Transcranic echodoppler vs. transoesophageal echocardiography sensibility was 97% and specificity 94%. Only 13/98 (13%) of patients with isolated atrial septal aneurysm and 23/111 (26%) with patent foramen ovale had history of cryptogenic stroke. According to our data, isolated atrial septal aneurysm could not be considered an independent risk factor for cryptogenic stroke.},
     year = {2013}
    }
    

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  • TY  - JOUR
    T1  - Atrial Septal Aneurysm Is Always Linked To Right-Left Shunt and Cardio embolic Risk
    AU  - Sarah Mangiafico
    AU  - Ines Paola Monte
    AU  - Vincenzo Lavanco
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    AU  - Antonio Andrea Arcidiacono
    AU  - Maria Concetta di Pasqua
    AU  - Letizia Santonoceto
    AU  - Giovanni Millan
    AU  - Corrado Tamburino
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    JO  - Clinical Medicine Research
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    AB  - Atrial septal aneurysm when associated to other cardiac abnormalities, such as patent foramen ovale, Chiari network or Eustachian Membrane, is a well-known recognised risk factor for cerebral embolism. Aim of study is to assess if isolated atrial septal aneurysm could be considered statistically related to cryptogenic stroke, considering the strong clinical impact that this association could have on these patients outcome. 579 patients were investigated for a suspected patent foramen ovale using transthoracic echocardiography, in order to evaluate the presence of atrial septal aneurysm and to identify other potential cardiac embolic sources. The patients with atrial septal aneurysm underwent transcranic echodoppler and transoesophageal echocardiography examination with contrast solution during Valsalva manoeuvre.209/579 (36%) patients where we made diagnosis of atrial septal aneurysm. In this cohort of patients transcranic echodoppler showed a patent foramen ovale in 114/209 (54%), whereas transoesophageal echocardiography in 111/209 (53%); 6/114 (5%) pa-tients with a positive transcranic echodoppler had a normal transoesophageal echocardiography examination and 3/95 (3%) with normal transcranic echodoppler had a positive transoesophageal echocardiography. Transcranic echodoppler vs. transoesophageal echocardiography sensibility was 97% and specificity 94%. Only 13/98 (13%) of patients with isolated atrial septal aneurysm and 23/111 (26%) with patent foramen ovale had history of cryptogenic stroke. According to our data, isolated atrial septal aneurysm could not be considered an independent risk factor for cryptogenic stroke.
    VL  - 2
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Author Information
  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy

  • Dept, Cardio-Thoraco-Vascular, AOU Policlinic University of Catania, Catania, Italy; Excellence through Newest Advances (ETNA)

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