A “Teapot” Atrial Septal Aneurysm with Spontaneous Thrombus in an Asymptomatic Patient

Abstract

An 84-year-old woman with a history of hypertension, mild aortic stenosis, coronary artery bypass grafting, and a known atrial septal aneurysm (ASA) came to the cardiac clinic for a routine follow-up. She had no history of stroke or systemic embolism. Cardiovascular examination was notable for a grade 2/6 holosystolic murmur at the cardiac apex and a grade 3/6 mid-peaking crescendo/decrescendo murmur at right upper sternal border with radiation to bilateral carotids. The rest of the systemic examination was normal. She was noted to be in sinus rhythm. A follow-up transthoracic echocardiogram for her valvular heart disease revealed normal left ventricular (LV) chamber size with low normal LV systolic function. LV ejection fraction by biplane Simpson’s method was calculated to be 53%. LV wall thickness was increased with the presence of moderate concentric LV hypertrophy. There was the presence of moderate aortic stenosis and mild mitral regurgitation. The left atrium was severely enlarged with an indexed left atrial volume of 84 …