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Atrial septal aneurysm

MedGen UID:
488911
•Concept ID:
C0521533
•
Disease or Syndrome
SNOMED CT: Atrial septal aneurysm (95440004)

Definition

A rare congenital non-syndromic heart malformation characterized by an abnormal protrusion of the interatrial septum into the right or left atrium, or both, during the cardiorespiratory cycle. The defect may be limited to the fossa ovalis or involve the entire septum. It can present as an isolated finding but is more often associated with interatrial shunts, in particular patent foramen ovale. Clinically it increases the risk of peripheral arterial embolism and stroke. [from ORPHANET]

Professional guidelines

PubMed

Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE
JAMA 2021 Dec 14;326(22):2277-2286. doi: 10.1001/jama.2021.20956. PMID: 34905030Free PMC Article
Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: An Update.
Abdelghani M, El-Shedoudy SAO, Nassif M, Bouma BJ, de Winter RJ
Cardiology 2019;143(1):62-72. Epub 2019 Jul 15 doi: 10.1159/000501028. PMID: 31307049
Neurologic complications of congenital heart disease and its treatment.
de Los Reyes E, Roach ES
Handb Clin Neurol 2014;119:49-59. doi: 10.1016/B978-0-7020-4086-3.00005-9. PMID: 24365288

Recent clinical studies

Etiology

Stroke in the Young: a Global Update.
Hathidara MY, Saini V, Malik AM
Curr Neurol Neurosci Rep 2019 Nov 25;19(11):91. doi: 10.1007/s11910-019-1004-1. PMID: 31768660
Identification of High-Risk Patent Foramen Ovale Associated With Cryptogenic Stroke: Development of a Scoring System.
Nakayama R, Takaya Y, Akagi T, Watanabe N, Ikeda M, Nakagawa K, Toh N, Ito H
J Am Soc Echocardiogr 2019 Jul;32(7):811-816. Epub 2019 May 23 doi: 10.1016/j.echo.2019.03.021. PMID: 31130417
Patent foramen ovale and stroke.
Miranda B, Fonseca AC, Ferro JM
J Neurol 2018 Aug;265(8):1943-1949. Epub 2018 Apr 21 doi: 10.1007/s00415-018-8865-0. PMID: 29680895
Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial.
Lee PH, Song JK, Kim JS, Heo R, Lee S, Kim DH, Song JM, Kang DH, Kwon SU, Kang DW, Lee D, Kwon HS, Yun SC, Sun BJ, Park JH, Lee JH, Jeong HS, Song HJ, Kim J, Park SJ
J Am Coll Cardiol 2018 May 22;71(20):2335-2342. Epub 2018 Mar 12 doi: 10.1016/j.jacc.2018.02.046. PMID: 29544871
Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke.
Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Béjot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guérin P, Piot C, Rossi R, Dubois-Randé JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G; CLOSE Investigators
N Engl J Med 2017 Sep 14;377(11):1011-1021. doi: 10.1056/NEJMoa1705915. PMID: 28902593

Diagnosis

Wide-ranging clinical spectrum of paradoxical embolism.
Jolobe O
Postgrad Med J 2022 Dec;98(1166):958-966. Epub 2021 May 18 doi: 10.1136/postgradmedj-2020-139691. PMID: 34006630
Association between atrial septal aneurysm and arrhythmias.
Yetkin E, Ileri M, Korkmaz A, Ozturk S
Scand Cardiovasc J 2020 Jun;54(3):169-173. Epub 2019 Sep 23 doi: 10.1080/14017431.2019.1667525. PMID: 31544553
Stroke in the Young: a Global Update.
Hathidara MY, Saini V, Malik AM
Curr Neurol Neurosci Rep 2019 Nov 25;19(11):91. doi: 10.1007/s11910-019-1004-1. PMID: 31768660
Patent foramen ovale and stroke.
Miranda B, Fonseca AC, Ferro JM
J Neurol 2018 Aug;265(8):1943-1949. Epub 2018 Apr 21 doi: 10.1007/s00415-018-8865-0. PMID: 29680895
The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review.
Agrawal A, Palkar A, Talwar A
Respir Med 2017 Aug;129:31-38. Epub 2017 May 31 doi: 10.1016/j.rmed.2017.05.016. PMID: 28732833

Therapy

Pearls and Pitfalls in the Transesophageal Echocardiographic Diagnosis of Patent Foramen Ovale.
Song JK
J Am Soc Echocardiogr 2023 Sep;36(9):895-905.e3. Epub 2023 May 15 doi: 10.1016/j.echo.2023.05.004. PMID: 37196905
Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE
JAMA 2021 Dec 14;326(22):2277-2286. doi: 10.1001/jama.2021.20956. PMID: 34905030Free PMC Article
Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial.
Lee PH, Song JK, Kim JS, Heo R, Lee S, Kim DH, Song JM, Kang DH, Kwon SU, Kang DW, Lee D, Kwon HS, Yun SC, Sun BJ, Park JH, Lee JH, Jeong HS, Song HJ, Kim J, Park SJ
J Am Coll Cardiol 2018 May 22;71(20):2335-2342. Epub 2018 Mar 12 doi: 10.1016/j.jacc.2018.02.046. PMID: 29544871
Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke.
Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Béjot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guérin P, Piot C, Rossi R, Dubois-Randé JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G; CLOSE Investigators
N Engl J Med 2017 Sep 14;377(11):1011-1021. doi: 10.1056/NEJMoa1705915. PMID: 28902593
Mechanisms of cardioembolic stroke.
Di Tullio MR, Homma S
Curr Cardiol Rep 2002 Mar;4(2):141-8. doi: 10.1007/s11886-002-0027-3. PMID: 11827638

Prognosis

Pearls and Pitfalls in the Transesophageal Echocardiographic Diagnosis of Patent Foramen Ovale.
Song JK
J Am Soc Echocardiogr 2023 Sep;36(9):895-905.e3. Epub 2023 May 15 doi: 10.1016/j.echo.2023.05.004. PMID: 37196905
Atrial Septal Aneurysm may Cause In-Hospital Recurrence of Cryptogenic Stroke.
Kuriki A, Ueno Y, Kamiya Y, Shimizu T, Doijiri R, Tateishi Y, Kikuno M, Shimada Y, Takekawa H, Yamaguchi E, Koga M, Ihara M, Ono K, Tsujino A, Hirata K, Toyoda K, Hasegawa Y, Hattori N, Urabe T
J Atheroscler Thromb 2021 May 1;28(5):514-523. Epub 2020 Jul 17 doi: 10.5551/jat.56440. PMID: 32684557Free PMC Article
Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial.
Lee PH, Song JK, Kim JS, Heo R, Lee S, Kim DH, Song JM, Kang DH, Kwon SU, Kang DW, Lee D, Kwon HS, Yun SC, Sun BJ, Park JH, Lee JH, Jeong HS, Song HJ, Kim J, Park SJ
J Am Coll Cardiol 2018 May 22;71(20):2335-2342. Epub 2018 Mar 12 doi: 10.1016/j.jacc.2018.02.046. PMID: 29544871
Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke.
Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Béjot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guérin P, Piot C, Rossi R, Dubois-Randé JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G; CLOSE Investigators
N Engl J Med 2017 Sep 14;377(11):1011-1021. doi: 10.1056/NEJMoa1705915. PMID: 28902593
Management of cryptogenic stroke.
Finsterer J
Acta Neurol Belg 2010 Jun;110(2):135-47. PMID: 20873443

Clinical prediction guides

Transcatheter closure of fenestrated atrial septal aneurysm in children: Feasibility and long-term results.
Mahmoud HT, Gaio G, Giordano M, Pizzuto A, Cuman M, Abdel Wahab MAK, Palladino MT, Russo MG, Santoro G
Catheter Cardiovasc Interv 2022 Jun;99(7):2043-2053. Epub 2022 Apr 14 doi: 10.1002/ccd.30191. PMID: 35420259
Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE
JAMA 2021 Dec 14;326(22):2277-2286. doi: 10.1001/jama.2021.20956. PMID: 34905030Free PMC Article
Atrial Septal Aneurysm may Cause In-Hospital Recurrence of Cryptogenic Stroke.
Kuriki A, Ueno Y, Kamiya Y, Shimizu T, Doijiri R, Tateishi Y, Kikuno M, Shimada Y, Takekawa H, Yamaguchi E, Koga M, Ihara M, Ono K, Tsujino A, Hirata K, Toyoda K, Hasegawa Y, Hattori N, Urabe T
J Atheroscler Thromb 2021 May 1;28(5):514-523. Epub 2020 Jul 17 doi: 10.5551/jat.56440. PMID: 32684557Free PMC Article
Identification of High-Risk Patent Foramen Ovale Associated With Cryptogenic Stroke: Development of a Scoring System.
Nakayama R, Takaya Y, Akagi T, Watanabe N, Ikeda M, Nakagawa K, Toh N, Ito H
J Am Soc Echocardiogr 2019 Jul;32(7):811-816. Epub 2019 May 23 doi: 10.1016/j.echo.2019.03.021. PMID: 31130417
Patent foramen ovale and stroke.
Miranda B, Fonseca AC, Ferro JM
J Neurol 2018 Aug;265(8):1943-1949. Epub 2018 Apr 21 doi: 10.1007/s00415-018-8865-0. PMID: 29680895

Recent systematic reviews

Atrial septal aneurysm contribution to the risk of cryptogenic stroke in patients with patent foramen ovale: A brief updated systematic review and meta-analysis.
Rigatelli G, Zuin M, Bilato C
Trends Cardiovasc Med 2023 Aug;33(6):329-333. Epub 2022 Feb 15 doi: 10.1016/j.tcm.2022.02.006. PMID: 35181471
The diagnostic yield of transesophageal echocardiography in patients with cryptogenic cerebral ischaemia: a meta-analysis.
Katsanos AH, Giannopoulos S, Frogoudaki A, Vrettou AR, Ikonomidis I, Paraskevaidis I, Zompola C, Vadikolias K, Boviatsis E, Parissis J, Voumvourakis K, Kyritsis AP, Tsivgoulis G
Eur J Neurol 2016 Mar;23(3):569-79. Epub 2015 Nov 19 doi: 10.1111/ene.12897. PMID: 26918744
Transesophageal echocardiography in patients with cryptogenic ischemic stroke: a systematic review.
McGrath ER, Paikin JS, Motlagh B, Salehian O, Kapral MK, O'Donnell MJ
Am Heart J 2014 Nov;168(5):706-12. Epub 2014 Jul 30 doi: 10.1016/j.ahj.2014.07.025. PMID: 25440799
Systematic review of percutaneous closure versus medical therapy in patients with cryptogenic stroke and patent foramen ovale.
Spencer FA, Lopes LC, Kennedy SA, Guyatt G
BMJ Open 2014 Mar 7;4(3):e004282. doi: 10.1136/bmjopen-2013-004282. PMID: 24607561Free PMC Article
Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation.
Holmes M, Rathbone J, Littlewood C, Rawdin A, Stevenson M, Stevens J, Archer R, Evans P, Wang J
Health Technol Assess 2014 Mar;18(16):1-176. doi: 10.3310/hta18160. PMID: 24602782Free PMC Article

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