Citation, DOI, disclosures and article data
Citation:
St-Amant M, Feger J, Machang'a K, et al. Interatrial septal aneurysm. Reference article, Radiopaedia.org (Accessed on 20 Apr 2024) https://doi.org/10.53347/rID-23958
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 ovalis or involve the entire interatrial septum.
It is encountered in approximately 1% of the pediatric population.
Associations
Interatrial septal aneurysms are associated with an increased incidence of peripheral arterial embolism and increased stroke risk.
They are also known to be associated with the following:
Classification
Several classification systems have been proposed, one of them is as follows 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
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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
On imaging consider:
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7. Mügge A, Daniel W, Angermann C et al. Atrial Septal Aneurysm in Adult Patients. A Multicenter Study Using Transthoracic and Transesophageal Echocardiography. Circulation. 1995;91(11):2785-92. doi:10.1161/01.cir.91.11.2785 - Pubmed
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8. Cabanes L, Mas J, Cohen A et al. Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age. A Study Using Transesophageal Echocardiography. Stroke. 1993;24(12):1865-73. doi:10.1161/01.str.24.12.1865 - Pubmed
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9. Wahl A, Krumsdorf U, Meier B et al. Transcatheter Treatment of Atrial Septal Aneurysm Associated with Patent Foramen Ovale for Prevention of Recurrent Paradoxical Embolism in High-Risk Patients. J Am Coll Cardiol. 2005;45(3):377-80. doi:10.1016/j.jacc.2004.10.043 - Pubmed
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10. Olivares-Reyes A, Chan S, Lazar E, Bandlamudi K, Narla V, Ong K. Atrial Septal Aneurysm: A New Classification in Two Hundred Five Adults. J Am Soc Echocardiogr. 1997;10(6):644-56. doi:10.1016/s0894-7317(97)70027-0 - Pubmed
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