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(Circulation. 2006;114:e607-e608.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Giant Atrial Septal Aneurysm in a 25-Year-Old Woman

M. Osranek, MD, MSc; F. Bursi, MD, MSc; J.B. Seward, MD

From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Correspondence to M. Osranek, MD, MSc, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail osranek.martin{at}mayo.edu

A 25-year-old physical fitness trainee was referred to receive an echocardiogram after being told that her ECG was mildly abnormal. She had experienced no symptoms apart from occasional deep, sighing breathing and rare vasovagal spells during adolescence. On physical examination, her second heart sound was somewhat more widely split with inspiration, and a grade 1/6 systolic ejection murmur was heard at the pulmonic region. The echocardiogram showed a huge fenestrated atrial septal aneurysm with marked mobility into the right atrium prolapsing into the tricuspid orifice (Figure 1 and Movie I). There was mild to moderate enlargement of the right ventricle and right atrium with a borderline decrease of right ventricular systolic function. Right ventricular systolic pressure was calculated to be 41 mm Hg. After saline contrast injections from an antecubital vein in the standing position and with Valsalva release, a significant but transient right-to-left shunt at the atrial level was consistently observed (Figure 1, middle panel, and Movie II). In view of an enlarged right ventricle and a redundant aneurysm that transiently obstructed the tricuspid valve, surgical repair was recommended and performed a week later. The aneurysm was excised and the resulting atrial septal defect was closed with a bovine pericardial patch (Figure 2). The removed tissue measured 4.5x3.4 cm and contained multiple small fenestrations 2 mm in size. After surgery, there was no residual shunt seen by echocardiography. Of note, the patient’s mother had also been diagnosed with a small atrial septal aneurysm.

View larger version (33K): [in this window] [in a new window]   Figure 1. Transthoracic apical four-chamber view (left). Arrows outline the atrial septal aneurysm prolapsing into the tricuspid orifice during diastole. LV indicates left ventricle; LA, left atrium; VS, ventricular septum; RA, right atrium; and RV, right ventricle. Venous saline contrast (middle) demonstrates opacification of right atrium and right ventricle, small right-to-left shunt, and moderately enlarged right ventricle. Color flow Doppler (right) shows flow from the right upper pulmonary vein deflected into the large atrial septal aneurysm.

View larger version (67K): [in this window] [in a new window]   Figure 2. Intraoperative transesophageal 4-chamber view after excision of the aneurysm and closure of the atrial defect with a bovine pericardial patch. LV indicates left ventricle; LA, left atrium; RA, right atrium; and RV, right ventricle.

	Acknowledgments

 
Disclosures

None.

	Footnotes

 
The online-only Data Supplement, which contains movies, can be found at http://circ.ahajournals.org/cgi/content/full/114/22/e607/DC1.

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Issue Highlights
Circulation 2006 114: 2305. [Full Text]

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Osranek, M. Articles by Seward, J.B. Search for Related Content PubMed PubMed Citation Articles by Osranek, M. Articles by Seward, J.B. Related Collections Echocardiography Related Article