From the Research
Management of a patient with an aneurysmal atrial septum typically involves monitoring and addressing any associated complications rather than treating the aneurysm itself, with a focus on individualized care based on patient-specific factors including age, comorbidities, and presence of associated cardiac abnormalities. Most aneurysmal atrial septa are benign findings that require no specific intervention. Regular cardiac follow-up with echocardiography every 1-2 years is recommended to monitor for changes in size or development of complications, as suggested by the latest studies 1, 2.
Key Considerations
- If the patient has associated atrial septal defects, these may require closure depending on size and hemodynamic significance.
- For patients with cryptogenic stroke and patent foramen ovale (PFO) with aneurysmal atrial septum, PFO closure may be considered as this combination increases stroke risk, with recent evidence suggesting that atrial septal aneurysm (ASA) is a more important predictor of recurrent stroke than shunt size 2.
- Antiplatelet therapy with aspirin 81-325 mg daily is often prescribed if there is concern for thromboembolic risk, particularly in patients with history of stroke or TIA, although the use of single antiplatelet therapy with aspirin has been shown to be as safe and effective as dual antiplatelet therapy with aspirin and clopidogrel after device closure 3.
- Anticoagulation with direct oral anticoagulants or warfarin may be considered in cases with documented thrombus formation or recurrent embolic events despite antiplatelet therapy, with studies suggesting that anticoagulants may be more effective than antiplatelet therapy in preventing embolisms in certain patient populations 4.
Patient Education
Patients should be educated about symptoms that warrant immediate medical attention, such as palpitations, chest pain, shortness of breath, or neurological symptoms. The management approach is individualized based on patient-specific factors, including age, comorbidities, and presence of associated cardiac abnormalities, with a focus on minimizing morbidity, mortality, and improving quality of life.