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European Heart Journal 2001 22(3):261-268; doi:10.1053/euhj.2001.2293
Copyright © 2001 by the European Society of Cardiology.
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Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study

A.V Mattiolia,f1, M Aquilinab, A Oldanib, C Longhinic and G Mattiolia

a Department of Cardiology, University of Modena, Modena, Italy
b Department of Cardiology, Pierantoni Hospital, Forli', Italy
c School of Medicine, University of Ferrara, Ferrara; Italy

revised April 21, 2000; accepted May 24, 2000

Abstract

Background Atrial septal aneurysm has been considered a potential source of cardiogenic embolism for many years. The present study evaluated the prevalence and characteristics of atrial septal aneurysm in a patient population with stroke and normal carotid arteries compared to a control population without stroke.

Methods A total of 606 patients were enrolled between November 1990 and December 1996. The study group included 245 patients who had experienced cerebral ischaemic attack but had normal carotid arteries. The control group included 316 age- and sex-matched patients undergoing transoesophageal echocardiography for indications other than a search for a cardiac source of embolism. The prevalence and morphological characteristics of atrial septal aneurysm were evaluated and compared.

Results We reported a higher prevalence of atrial septal aneurysm in the group with cerebral ischaemia; 68 patients (27·7%) vs 36 patients (9·9%) from the control group;P<0·001. A patent foramen ovale was detected with contrast injection in 69·2% of the patients with atrial septal aneurysm. Atrial septal aneurysm predicted the presence of a patent foramen ovale (odds ratio of patent foramen ovale 4·2; 95% CI 1·03–9·8). Multivariate analysis showed that atrial septal aneurysm was an independent predictor of an embolic event. In the 95% of patients with atrial septal aneurysm and cerebral ischaemia aged less than 45 years, transoesophageal echocardiography did not detect a source of embolism other than an associated patent foramen ovale.

Conclusions The prevalence of atrial septal aneurysm in patients with cerebral ischaemia and normal carotid arteries was 27·7%, higher than the control group. Atrial septal aneurysm was frequently associated with patent foramen ovale. In patients less than 45 years old, atrial septal aneurysm was the only potential cardiac source of embolism detected with transoesophageal echocardiography.

Key Words: Stroke, atrial septal aneurysm, transoesophageal echocardiography, carotid ultrasound

f1 Correspondence: Anna Vittoria Mattioli, MD, Department of Cardiology, University of Modena, Via del pozzo, 71, 41100 Modena, Italy.

References

  1. Manning WJ. Role of transesophageal echocardiography in the management of thromboembolic stroke. Am J Cardiol. 1997;80:19D–28D[CrossRef][Medline]
  2. Pearson AC, Labovitz AJ, Tatieni S, Gomez CR. Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol. 1991;17:66–72[Abstract]
  3. Labovitz AJ. Transesophageal Echocardiography and unexplained cerebral ischemia: a multicenter follow-up study. Am Heart J. 1999;137:1082–1087[CrossRef][Web of Science][Medline]
  4. Rahmatullah AF, Rahko PS, Stein JH. Transesophageal echocardiography for the evaluation and management of patients with cerebral ischemia. Clin Cardiol. 1999;22:391–396[Web of Science][Medline]
  5. Mugge A, Daniel WG, Angermann C. Atrial septal aneurysm in adult patients: a multicenter study using transthoracic and transesophageal echocardiography. Circulation. 1995;91:2785–2792[Abstract/Free Full Text]
  6. Agmon Y, Khandeheria BK, Meissner I. Frequency of Atrial Septal Aneurysms in Patients with Cerebral Ischemic Events. Circulation. 1999;99:1942–1944[Abstract/Free Full Text]
  7. Burger AJ, Sherman HB, Charlamb MJ. Low incidence of embolic strokes with atrial septal aneurysms: A prospective, long term study. Am Heart J. 2000;139:149–152[Web of Science][Medline]
  8. Mattioli AV, Tarabini Castellani E, Carpeggiani P, Mattioli G. Heart and brain. Cardiologia. 1994;39:487–495[Medline]
  9. Mattioli AV, Tarabini Castellani E, Mattioli G. Stroke in paced patients with sick sinus syndrome: influence of left atrial function and size. Cardiology. 1999;91:150–155[CrossRef][Web of Science][Medline]
  10. Arch Neurol. 1989;46:727–743[Abstract/Free Full Text]
  11. Seward JB, Khandheria BK, Oh JK. Transesophageal echocardiography: technique, anatomic correlation, implementations and clinical applications. Mayo Clin Proc. 1988;63:649–680[Web of Science][Medline]
  12. Hanley PC, TajiK AJ, Hynes JK. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol. 1985;6:1370–1382[Abstract]
  13. Pearson A, Nagelhout D, Castello R, Gomez CR, Labovitz AJ. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol. 199;18:1223–1229
  14. Strandness DE. Duplex Scanning in Vascular Disorders. New York: Raven Press; 1990. p. 92–120
  15. Nighoghossian N, Perinetti M, Barthelet M, Adeleine P, Trouillas P. Potential cardioembolic sources of stroke in patients less than 60 years of age. Eur Heart J. 1996;17:590–594[Abstract/Free Full Text]
  16. Meissner I, Whisnant JP, Khandheria BK. Prevalence of Potential Risk Factors for Stroke Assessed by Transesophageal Echocardiography and Carotid Ultrasonography: The SPARC Study. Mayo Clin Proc. 1999;74:862–869[Abstract]
  17. Zabalgoitia M, Herrera C, Gandhi DK, Mehlman DJ, McPherson D, Talano JV. A possible mechanism for neurologic ischemic events in patients with atrial septal aneurysm. Am J Cardiol. 1990;15:761–764[CrossRef]
  18. Belkin RN, Hurwitz BJ, Kisslo J. Atrial septal aneurysm: association with cerebrovascular and peripheral embolic events. Stroke. 1987;18:856–862[Abstract/Free Full Text]
  19. Marazanof M, Roudaut R, Cohen A. Atrial Septal Aneurysm: morphologic characteristics in a large population: pathological associations: a French multicenter study on 259 patients investigated by transesophageal echocardiography. Int J Cardiol. 1995;52:59–65[CrossRef][Web of Science][Medline]
  20. Schneider B, Harath P, Vogel P, Meinertz T. Improved morphologic characterization of atrial septal aneurysm by trasesophageal echocardiography: relation to cerebrovascular events. J Am Coll Cardiol. 1990;16:1000–1009[Abstract]
  21. Silver MD, Dorsey JS. Aneurysms of the septum primum in adults. Arch Pathol Lab Med. 1978;102:62–65[Web of Science][Medline]
  22. Grosgogeat Y, Lhermitte F, Carpentier A, Facquet J, Alhomme P, Tran TX. Aneurysme da le cloison interauriculaire revele par une embolie cerebrale. Arch Mal Coeur. 1973;66:169–177
  23. Cabanes L, Mas JL, Cohen A. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. Stroke. 1993;24:1865–1873[Abstract/Free Full Text]
  24. Lechat P, Lascault G, Mas JL. Prevalence of patent foramen ovale in young patients with ischemic cerebral complications. Arch Mal Coeur. 1989;82:847–852
  25. Iliceto S, Papa A, Sorino M, Rizzon P. Combined atrial septal aneurysm and mitral valve prolapse: detection by two-dimensional echocardiography. Am J Cardiol. 1984;54:1151–1153[CrossRef][Web of Science][Medline]
  26. Spes CH, Mugge A, Daniel WG. Follow-up of embolic events in patients afetr diagnosis of atrial septal aneurysm (abstr). J Am Coll Cardiol. 1996;27:161A
  27. Stone DA, Godard J, Corretti MC. Patent foramen ovale: association between the degree of shunt by contrast transesophageal echocardiography and the risk of future ischemic neurologic events. Am Heart J. 1996;131:158–161[CrossRef][Web of Science][Medline]
  28. Ende DJ, Chopra PS, Rao PS. Transcatheter closure of atrial septal defect or patent foramen ovale with the buttoned device for prevention of recurrence of paradoxic embolism. Am J Cardiol. 1996;78:233–236[Web of Science][Medline]

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