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Mammoth interatrial septal aneurysm in the ICE age
Cardiovascular Ultrasound volume 5, Article number: 30 (2007)
Abstract
Background
Intracardiac echocardiography (ICE) is a useful imaging modality that is now being used more widely to assist in the percutaneous closure of atrial septal defects (ASD) and patent foramen ovales (PFO).
Case presentation
A 42 year old lady with a history of transient ischaemic attacks and migraine underwent percutaneous closure of an ASD. Intraprocedural ICE demonstrated a mammoth billowing multiperforated interatrial septal aneurysm in association with a secondum ASD.
Conclusion
ICE provides excellent adjuvant imaging during percutaneous closure of intracardiac shunts, in this case demonstrating a 'mammoth' interatrial septal aneurysm.
Background
Intracardiac echocardiography (ICE) is a useful imaging modality that is now being used more widely to assist in the percutaneous closure of atrial septal defects (ASD) and patent foramen ovales (PFO).
Case presentation
A 42 year old lady with a history of previous transient ischemic attacks and migraines was found to have a secundum ASD and an aneurysmal interatrial septum on contrast transthoracic echocardiography. She then went on to undergo percutaneous closure of the ASD, during which ICE demonstrated a dramatic giant multiperforated aneurysmal interatrial septum with a secundum ASD on Doppler flow imaging (Figures 1, 2, 3).
Image obtained using intracardiac echocardiography (ICE): Demonstrating a large interatrial aneurysm (arrow) billowing into the right atrium (RA) with an excursion of over 22 mm.
Image obtained using intracardiac echocardiography (ICE): With colour flow mapping (arrow) of the interatrial septum demonstrating a large ASD with shunting.
Image obtained using intracardiac echocardiography (ICE): With colour flow mapping of the interatrial septum demonstrating 2 jets (arrows) across the septum.
Discussion
An aneurysmal interatrial septum is thought to be the harbinger of potential embolic thrombus and its presence increases the risk of a stroke significantly particularly in association with a PFO and is thus of clinical importance [1]. Adjuvant ICE imaging has permitted such cases to be performed as a same day discharge procedure without the need for general anaesthesia and provides detailed imaging to enable rapid, accurate closure of intracardiac lesions.
Conclusion
This case demonstrates a "mammoth" billowing multiperforated interatrial septal aneurysm in association with a secondum ASD and illustrated elegantly by ICE.
References
Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J: Patent Foramen Ovale and Atrial Septal Aneurysm Study Group: Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001, 345: 1740-6. 10.1056/NEJMoa011503
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Bhindi, R., Timperley, J. & Ormerod, O.J. Mammoth interatrial septal aneurysm in the ICE age. Cardiovasc Ultrasound 5, 30 (2007). https://doi.org/10.1186/1476-7120-5-30
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DOI: https://doi.org/10.1186/1476-7120-5-30
Keywords
- Migraine
- Atrial Septal Defect
- Transient Ischaemic Attack
- Flow Imaging
- Atrial Septal Defect