A Picture Is Worth a Thousand Words

Abstract

A 70-year-old man was referred to our hospital to receive a transthoracic echocardiogram because of atrial fibrillation. Physical examination, chest X-ray, and electrocardiogram were normal. When performing the echocardiography, an image compatible with a huge aneurysm of the interatrial septum was found (A and B, Online Videos 1 and 2). Color-flow Doppler demonstrated the existence of a little left-to-right shunt in the anterior junction of the aneurysm with the interatrial septum with Qp/Qs ratio of 1.2. Agitated saline contrast injection opacified the right chambers, and no passage of agitated saline across the shunt was demonstrated (C). Transesophageal echocardiography showed the same findings (D to F, Online Videos 3, 4, and 5). Surgery for aneurysm resection was decided on. A large whitish membrane, with a small rounded orifice in its anterior side, was resected, and the atrial septal defect was closed with a pericardial patch (G to I). The patient was discharged 8 days after an uneventful post-operative period.