From the Guidelines
Atrial septal aneurysm (ASA) diagnosis is typically made incidentally during echocardiography, and treatment should be individualized based on symptoms and risk factors, with a focus on preventing thromboembolic events and managing associated arrhythmias, as recommended by the most recent guidelines 1.
Diagnosis and Treatment Considerations
The diagnosis of ASA is often made during routine echocardiography, and most patients are asymptomatic. However, patients with ASA who have experienced a stroke or transient ischemic attack (TIA) may benefit from antiplatelet therapy or anticoagulation.
- The decision between antiplatelet therapy and anticoagulation should be individualized based on risk factors, with consideration of the patient's history of paradoxical embolism or atrial fibrillation 1.
- For patients with ASA and a patent foramen ovale (PFO) who have had cryptogenic stroke, percutaneous closure may be considered, especially in those under 60 years old with no other identifiable stroke cause.
- Regular cardiac monitoring is recommended for all ASA patients due to the increased risk of atrial arrhythmias, and symptomatic rhythm disorders can be treated conservatively or with EP intervention 1.
Treatment Options
Treatment options for ASA include:
- Conservative therapy to alleviate symptoms temporarily and create a beneficial basis for the following operation 1.
- Oral anticoagulation for patients with a history of paradoxical embolism or atrial fibrillation, with consideration of the patient's increased thrombo-embolic risk or presence of an R-L shunt 1.
- Percutaneous closure of the atrial communication, which may be considered in isolation, but requires careful evaluation and consultation with interventional cardiologists, especially in cases with a large septal aneurysm or multifenestrated atrial septum 2, 3. The most effective treatment approach for ASA should prioritize the prevention of thromboembolic events and management of associated arrhythmias, with a focus on individualized care based on the patient's symptoms, risk factors, and medical history, as supported by the most recent guidelines 1.
From the Research
Diagnosis of Atrial Septal Aneurysm (ASA)
- Atrial septal aneurysm (ASA) is a congenital malformation of the atrial septum characterized by bulging of the septum overlying the fossa ovalis region into either atrium 4.
- The diagnosis of ASA can be established using transesophageal echocardiography (TEE) 4, 5, 6, 7.
- TEE is superior to transthoracic echocardiography in diagnosing ASA, with a higher detection rate 7.
- ASA can be classified into different types based on its pathogenesis, including Type I, Type II, and Type III 4.
Treatment of Atrial Septal Aneurysm (ASA)
- The treatment of ASA depends on the presence of associated abnormalities, such as interatrial shunts, and the risk of embolic events 4, 5, 6, 7.
- Patients with ASA and a high risk of embolic events may require long-term antiplatelet or anticoagulation therapy 4, 8.
- Surgical correction of the defect may be necessary in some cases, particularly those with embolic complications or significant shunting 6.
- The surgical procedure involves excising the aneurysmal part of the interatrial septum and replacing it with a pericardial patch 6.
Associated Abnormalities and Risk Factors
- ASA is often associated with other cardiac abnormalities, such as patent foramen ovale or mitral valve prolapse 4, 5, 7.
- Interatrial shunts, particularly patent foramen ovale, are common in patients with ASA and may increase the risk of embolic events 7.
- The presence of thrombi attached to the ASA is rare, but may increase the risk of embolic events 7.
- Patients with ASA and a history of stroke or transient ischemic attack may require careful evaluation and management to prevent further embolic events 4, 5, 6, 7.