Interatrial septal aneurysm
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- updated 11 May 2022:
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Interatrial septal aneurysm or atrial septal aneurysm (ASA) is defined as an abnormal protrusion of the interatrial septum. The exact length of the protrusion that defines an interatrial septal aneurysm varies in the literature, ranging from >11 mm to >15 mm beyond normal excursion in adults 4,5 and 5 mm in children.
It can be limited to the fossa ovale or involve the entire inter-atrial septum.
Epidemiology
It is encountered in approximately 1% of the paediatric population.
Pathology
Associations
Interatrial septal aneurysm is associated with an increased incidence of peripheral arterial embolism and increased stroke risk.
It is known to be associated with the following:
Classification
Several classification systems have been proposed, on system is as 1:
- type 1R: bulging is in the right atrium only
- type 2L: bulging is in the left atrium only
- type 3RL: major excursion bulges to the right atrium and the lesser excursion bulges toward the left
- type 4LR: maximal excursion of the atrial septal aneurysm is toward the left atrium with a lesser excursion toward the right atrium
- type 5: atrial septal aneurysm movement is bidirectional and equidistant to both atria during the cardiorespiratory cycle
Complications
-
cryptogenic stroke
- some consider an aneurysm of more than 10 mm excursion to be associated with markedly increased risk (odds ratio 8) 8
- the concurrent presence of a patent foramen ovale is thought to have a synergistic effect on stroke 8
Differential diagnosis
On imaging consider:
-<p><strong>Interatrial septal aneurysm</strong> or<strong> atrial septal aneurysm (ASA)</strong> is defined as an abnormal protrusion of the interatrial septum. The exact length of the protrusion that defines an interatrial septal aneurysm varies in the literature, ranging from >11 mm to >15 mm beyond normal excursion in adults <sup>4,5</sup> and 5 mm in children.</p><p>It can be limited to the <a href="/articles/fossa-ovale">fossa ovale</a> or involve the entire inter-atrial septum.</p><h4>Epidemiology</h4><p>It is encountered in approximately 1% of the paediatric population.</p><h4>Pathology</h4><h5>Associations</h5><p>Interatrial septal aneurysm is associated with an increased incidence of peripheral arterial embolism and increased stroke risk.</p><p>It is known to be associated with the following:</p><ul>-<li><a href="/articles/atrial-septal-defect-2">atrial septal defect</a></li>-<li><a href="/articles/patent-foramen-ovale">patent foramen ovale</a></li>-</ul><h5>Classification</h5><p>Several classification systems have been proposed, on system is as <sup>1</sup>:</p><ul>-<li>-<strong>type 1R</strong>: bulging is in the right atrium only</li>-<li>-<strong>type 2L</strong>: bulging is in the left atrium only</li>-<li>-<strong>type 3RL</strong>: major excursion bulges to the right atrium and the lesser excursion bulges toward the left</li>-<li>-<strong>type 4LR</strong>: maximal excursion of the atrial septal aneurysm is toward the left atrium with a lesser excursion toward the right atrium</li>-<li>-<strong>type 5</strong>: atrial septal aneurysm movement is bidirectional and equidistant to both atria during the cardiorespiratory cycle</li>-</ul><h4>Complications</h4><ul><li>-<a href="/articles/cryptogenic-stroke">cryptogenic stroke</a><ul>-<li>some consider an aneurysm of more than 10 mm excursion to be associated with markedly increased risk (odds ratio 8) <sup>8</sup>-</li>-<li>the concurrent presence of a <a href="/articles/patent-foramen-ovale">patent foramen ovale</a> is thought to have a synergistic effect on stroke<sup> 8</sup>-</li>-</ul>- +<p><strong>Interatrial septal aneurysm</strong> or<strong> atrial septal aneurysm (ASA)</strong> is defined as an abnormal protrusion of the interatrial septum. The exact length of the protrusion that defines an interatrial septal aneurysm varies in the literature, ranging from >11 mm to >15 mm beyond normal excursion in adults <sup>4,5</sup> and 5 mm in children.</p><p>It can be limited to the <a href="/articles/fossa-ovalis">fossa ovale</a> or involve the entire inter-atrial septum.</p><h4>Epidemiology</h4><p>It is encountered in approximately 1% of the paediatric population.</p><h4>Pathology</h4><h5>Associations</h5><p>Interatrial septal aneurysm is associated with an increased incidence of peripheral arterial embolism and increased stroke risk.</p><p>It is known to be associated with the following:</p><ul>
- +<li><a href="/articles/atrial-septal-defect-2">atrial septal defect</a></li>
- +<li><a href="/articles/patent-foramen-ovale">patent foramen ovale</a></li>
- +</ul><h5>Classification</h5><p>Several classification systems have been proposed, on system is as <sup>1</sup>:</p><ul>
- +<li>
- +<strong>type 1R</strong>: bulging is in the right atrium only</li>
- +<li>
- +<strong>type 2L</strong>: bulging is in the left atrium only</li>
- +<li>
- +<strong>type 3RL</strong>: major excursion bulges to the right atrium and the lesser excursion bulges toward the left</li>
- +<li>
- +<strong>type 4LR</strong>: maximal excursion of the atrial septal aneurysm is toward the left atrium with a lesser excursion toward the right atrium</li>
- +<li>
- +<strong>type 5</strong>: atrial septal aneurysm movement is bidirectional and equidistant to both atria during the cardiorespiratory cycle</li>
- +</ul><h4>Complications</h4><ul><li>
- +<a href="/articles/cryptogenic-stroke">cryptogenic stroke</a><ul>
- +<li>some consider an aneurysm of more than 10 mm excursion to be associated with markedly increased risk (odds ratio 8) <sup>8</sup>
- +</li>
- +<li>the concurrent presence of a <a href="/articles/patent-foramen-ovale">patent foramen ovale</a> is thought to have a synergistic effect on stroke<sup> 8</sup>
- +</li>
- +</ul>
Images Changes:
Image 4 Ultrasound (Transverse) ( create )
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