Atrial Aneurysm Research Articles

TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PATIENTS WITH CRYPTOGENIC STROKE: DOES IT ALTER THEIR MANAGEMENT? A 3-year retrospective study in a single non-referral centre

Background: Cardiac embolism is estimated to be the aetiology of ischemic cerebral-vascular insults (CVI) in 25% of cases. Transesophageal echocardiography (TEE) is a reliable and widely used examination in the diagnostic work-up of stroke. TEE is superior to transthoracic echocardiography (TTE) in the search of minor sources of cardiac embolism but it is time consuming and has its inherent risks.Aim: The aim of this study was to determine whether in patients younger than 65 years of age with CVI our TEE-findings would alter their management. Only patients in whom nor the medical record, nor TTE, nor Carotid Ultrasonography could establish an aetiology, were included.Methods: A 3-year retrospective study was done in patients admitted to the stroke unit of a regional medical centre covering 110,000 inhabitants. The TEE-database was reviewed and all TEE’s performed in eligible patients were selected. Minor and major sources of cardiac embolism were listed. The impact of TEE-findings on the management of CVI was evaluated.Results: Fifty-four patients fulfilled the criteria for this study. The mean age was 52 years (range 18 - 65). A major source of cardiac embolism was seen in 6 cases (11.1%). Four patients (7.4%) had infective endocarditis (IE) with vegetations. A small apical thrombosis in a patient with isolated left ventricular non-compaction was noted and in 1 patient dysfunction of a mechanical prosthetic valve was documented.The most frequently encountered minor source of cardiac embolism was a patent foramen ovale (PFO) or small atrial septal defect (ASD) with documented right-to-left shunt during Valsalva manoeuvre (15 patients, 27.8%). Of these 15 patients, an atrial septum aneurysm(ASA) was seen in 7 patients (13%).Our TEE-findings altered the management of CVI substantially in 21 cases (38.9%). The 4 patients with IE and the patient with mechanical valve dysfunction had cardiac surgery. Twelve patients (22.2%) were referred for percutaneous closure of the PFO/ASD. Three patients with PFO/ASD and the patient with IVNC were treated with maintenance therapy of oral anticoagulation.Conclusion: In 1 out of 3 patients, younger than 65 years, suffering from CVI in whom nor medical history, nor TTE, nor Carotid Ultrasound could reveal the cause of the CVI our TEE-findings altered their management.

Giant right atrial aneurysm: Case report

A 15-month-old boy with atrial fibrillation was found to have gross cardiomegaly on a chest radiography; further evaluation by echocardiography showed a giant right atrial aneurysm which is in the form of a cyst like lesion. The patient underwent successful surgical reduction of the right atrium converting his heart rythym to normal. The operative measure was taken to prevent thrombus formation in the right atrium and lower the risk of atrial arrhythmias. The morphologic features of the resected atrial tissue showed a thin wall with a central aneurysm and focal endocardial fibrosis without inflammatory response consistent with a diagnosis of idiopathic dilatation of the right atrium.

Giant congenital intrapericardial left atrial aneurysm diagnosed by contrast-enhanced computed tomography

A left atrial aneurysm is a rare cardiac anomaly. The etiology is usually congenital, but it can also occur as an acquired pathology secondary to mitral valve disease or a degenerative process. We report a case which, on routine PA chest radiography, presented as cardiomegaly with a bulge on the left cardiac contour. Further evaluation by contrast-enhanced computed tomography proved it to be caused by a large left atrial aneurysm.

Echocardiographic Diagnosis of a Case with Giant Right Atrial Aneurysm

Right atrial aneurysm (RAA) is a very rare anomaly. Rarer still is its association with atrial septal defect (ASD). We reported a case of a 42-year-old woman with giant RRA and secundum type ASD detected by means of transthoracic echocardiography.

Atrial flutter with right atrial aneurysm—Late presentation of Cardiac Trauma—Case report

Atrial flutter with right atrial aneurysm—Late presentation of Cardiac Trauma—Case report

Right atrial aneurysm treated with atrioplasty without using cardiopulmonary bypass in an infant

A 7-month-old female child was diagnosed to have a massive right atrial aneurysm, presented with arrhythmias. She was treated by restorative right atrioplasty without using cardiopulmonary bypass. She had good postoperative outcome and a 5-month follow-up remains uneventful. In the absence of major congenital heart defects, aneurysm of right atrium can be treated without using cardiopulmonary bypass.

Congenital right atrial diverticulum, atrial septal defect within the oval fossa, and complex pulmonary valvar obstruction in an infant with chromosome 8(p23.1) deletion

We describe an unusual right atrial aneurysm, occurring with progressive obstruction of the right ventricular outflow tract and increasing cyanosis, in a nine-month-old boy with chromosome 8(p23.1) deletion. Surgical resection of the diverticulum, and relief of the right ventricular obstruction, was successful, although impairment of right ventricular compliance persists after 19 months follow-up.

Giant left atrial aneurysm secondary to mitral stenosis

Giant left atrial aneurysm secondary to mitral stenosis

塞栓源究明のための心エコー図

Echocardiography is a noninvasive and useful tool to detect cardiovascular source of cerebral embolism. Although transthoracic echocardiography is easy to detect cardiovascular abnormalities, transesophageal echocardiography is superior to transthoracic approach in terms of the image quality. We should use both of transthoracic and transesophageal echocardiography in a complementary way. Left ventricular thrombus is occasionally found in patients with myocardial infarction and dilated cardiomyopathy and is usually well ob-served by transthoracic echocardiography. Left atrial thrombus is a major source of embolism and trans-esophageal echocardiography is indispensable to detect it. Transesophageal echocardiography is also useful to detect aortic atheroma and vegetation in infective endocarditis. Atrial aneurysm is associated with paradoxical embolism. The presence of right-to-left shunting can be confirmed by contrast echocardiography and the Valsalva maneuver. Therefore, if a patient has stroke of unknown origin, this procedure should be done. Cardiac tumors also cause cerebral embolism. Myxoma is most common among cardiac tumors and soft and polypoid one with irregular surface is at a high risk of embolism. Papillary fibroelastoma incidentally found on the mitral or aortic valve in asymptomatic aged people may also be a source of cerebral embolism.

Minimal invasive endoscopic resection of a giant left atrial appendage aneurysm

We report a case of a 35-year-old male patient who presented with chronic atrial fibrillation secondary to a massive congenital left atrial appendage aneurysm. Minimal invasive endoscopic resection of the left atrial aneurysm with cryoablation was performed. The patient was discharged home in sinus rhythm.

Infectious endocarditis of a Chiari network

We present the case of a 62-year-old man with infectious endocarditis in a Chiari network. Chiari networks are present in 1.5% to 3% of the population. Although Chiari networks are usually clinically insignificant, they are associated with a number of conditions, including patent foramen ovale, thromboembolism, atrial aneurysm, and cardiac arrhythmias. Although there are rare reports of patients with a Chiari network who had endocarditis develop, this is the first report of a patient who had endocarditis develop solely within a Chiari network.

Resection of Congenital Intrapericardial Right Atrial Aneurysm

A 16-year-old male was investigated for exercise-induced dyspnea and paroxysmal palpitations. There was no prominent right heart border in a chest radiograph. A congenital intrapericardial right atrial aneurysm was diagnosed from 2-dimensional echocardiographic findings of a large echo-free space close to the right atrium, and confirmed by magnetic resonance imaging and surgical pathology. Successful repair was achieved on a beating heart with a brief period of on-pump support. Postoperatively, the symptoms disappeared completely.

Congenital Intrapericardial Left Atrial Aneurysm

A 14-year-old boy with sudden onset of palpitations and dyspnea was found to have an intrapericardial left atrial aneurysm (15 × 12 cm). Left atrial aneurysmectomy was carried out under cardiopulmonary bypass. The patient has been symptom-free during a 1-year follow-up.

Left atrial aneurysm

Aneurysms of the left atrium are rare abnormalities. They can be congenital or acquired. Whereas a true congenital aneurysm presents as isolated pathology, inflammatory or degenerative processes involving the endocardium are associated with the acquired type. The clinical records of 2 patients with the diagnosis of left atrial aneurysm were reviewed, along with the surgical strategies, current literature, and patient outcomes. Because of the risk of life-threatening complications, surgery is recommended even in asymptomatic cases. Resection and mitral valvuloplasty should be the treatment of choice.

Defeito do anel fibroso mitral posterior com aneurisma de átrio esquerdo e insuficiência mitral: tratamento cirúrgico com sucesso

Atrial aneurysm is a rare condition and can be found on the atrial appendage or on the atrial wall. Most patients are asymptomatic, but arrhythmias, thromboembolism, and heart failure are common complications. We present a 39 years old female patient with posterior mitral ring defect causing a great aneurysm of the left posterior atrial wall with mitral insufficiency. The diagnosis was achieved by chest roentgenogram (marked prominence of the upper left heart border) and echocardiography (great left atrial aneurysm behind the left posterior ventricular wall with mitral insufficiency). Left ventricular cineangiogram suggested the presence of a false aneurysm of the left ventricle. The patient subsequently underwent surgical treatment with cardiopulmonary bypass. Posterior mitral valve annuloplasty was performed with aneurysm exclusion and posterior left atrial wall reconstruction using a bovine pericardial patch. The postoperative course was uneventful, and the patient was discharged sympton-free on the eighth postoperative day.

Recurrent Congenital Left Atrial Aneurysm in a Newborn

Recurrent congenital left atrial aneurysm presenting in a newborn as cardiac tamponade is described. Such a presentation has not been previously reported.

The Findings of Transesophageal Echocardiography in the Evaluation of the Source of Ischemic Stroke

Background and Objectives:Intracardiac pathology results in 15-20% of ischemic stroke, but transthoracic echocardiography (TTE) has a number of limitations because of suboptimal precordial windows or ultrasound interference with prosthetic materials. Transesophageal echocardiography (TEE) provides superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purpose of this study was to describe the various TEE findings which were sources of cerebral emboli. Materials and Method:The study population was comprised of 122 patients (mean age:54.5, male 83, female 39) who were admitted to Severance Hospital because of ischemic stroke from 1991 to 1997. All patients underwent TEE with agitated saline contrast administration. Patients without a definitive cardiac source of embolism underwent Holtor monitoring, internal carotid and cerebral angiography, as well as transcranial Do-ppler. Results:1) The number of patients diagnosed as cardioembolic stroke was 55 (45.1%). Atrial fibrillation was noted in 31 patients of cardioembolic stroke and it was the most frequent finding. Among these patients, 16 did not have any other cardiac problem. 2) We were able to find the possible source of embolism in 49 (40.2%) patients with TEE. Among these patients, 12 did not have dysrhythmia or any known previous heart problem. We found spontaneous echo contrast in the left atrium and left atrial appendage in 33 cases. There were 8 patients who had intracardiac thrombus. Among these patients, 6 patients had thrombi in the left atrial appendage, 1 in left atrium and 1 in left ventricular apex. We found patent foramen ovale in 3 cases and atrial aneurysm in 1 case. We found atheromatous plaque and/or thrombi of the aorta in 16 cases, while there were 4 cases where lesions located in the ascending aorta and aortic arch and which were considered as the source of embolism. Small thrombi in the left atrial appendage and left atrium were only detectable with TEE. Conclusions:We described TEE findings in ischemic stroke patients. And we assert TEE is a useful diagnostic tool in detecting the source of cardioembolic stroke and it may be used as a primary diagnostic tool in patients who are being evaluated for ischemic stroke. (Korean Circulation J 1998;28(10):1746-1754)

Resolution of Thrombi in Left Atrial Appendage Aneurysm.

Atrial appendage aneurysm is a rare cardiac disease and may be complicated by embolic events and rhythm disturbances. We describe a case of a congenital left atrial aneurysm presenting with a cerebrovascular accident in a 57-year-old female. The diagnosis was made by transesophageal echocardiography, which revealed the presence of intraaneurysmal thrombi. The patient initially received anticoagulant therapy and the thrombi were resolved. Subsequently, she was successfully operated on and the aneurysm was removed. This is the first report of thrombi resolution in a left atrial appendage aneurysm.

Successful treatment of incessant atrial flutter with excision of congenital giant right atrial aneurysm diagnosed by transesophageal echocardiography

Successful treatment of incessant atrial flutter with excision of congenital giant right atrial aneurysm diagnosed by transesophageal echocardiography

Diagnostic problems in “clinically definite” multiple sclerosis patients with normal CSF and multiple MRI abnormalities

Among patients who underwent cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) examination during a 5-year period, we found 18 patients at the multiple sclerosis center of the University of Rome and clinically definite multiple sclerosis, MRI white matter abnormalities, normal CSF examination, a disease duration of at least 1 year and an upper age of < 45 years at onset These patients were examined again with a variety of tests screening for different diseases mimicking multiple sclerosis. Alternative diagnoses reached after laboratory tests were: Lyme disease, two cases of vasculitis, mitochondrial encephalomyopathy, multiple ischemic lesions caused by atrial septum aneurysm and olivopontocerebellar atrophy. Hence, six of these 18 patients had a final diagnosis other than multiple sclerosis, while 12 remained with a final diagnosis of "MS with normal CSF". Our study suggests that in patients with a clinical picture of multiple sclerosis and disseminated white matter MRI lesions but no CSF abnormalities, the classical clinical criteria may not be sufficiently specific, unless confirmed by a very prolonged clinical history with repeated MRI.