Atrial septal aneurysm: association with cerebrovascular and peripheral embolic events.

Belkin, Robert N.; Hurwitz, Barrie J.; Kisslo, Joseph

doi:10.1161/01.str.18.5.856

Cited by 120 publications

(42 citation statements)

References 27 publications

(16 reference statements)

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“…It has been suggested that ASA, isolated or in association with other cardiac abnormalities, may cause arterial embolism [17, 18, 19]. Potential mechanisms of stroke in patients with ASA included embolization from thrombi formed within the aneurysm and the formation of thrombus as a result of atrial arrhythmias [17, 20].…”

Section: Discussionmentioning

confidence: 99%

Association between Atrial Septal Aneurysm and Patent Foramen ovale in Young Patients with Recent Stroke and Normal Carotid Arteries

et al. 2003

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Background: Atrial septal aneurysm (ASA) has been considered a potential source of cardiogenic embolism for many years. The ASA Multicenter Italian (ASA-MI) Study evaluated the prevalence and characteristics of ASA in patients with stroke and normal carotid arteries compared with control patients without stroke. The purpose of the present study was to evaluate the frequency of ASA and the association with patent foramen ovale (PFO) in the subgroup of younger patients (aged less than 55 years) included in the ASA-MI Study. Methods: The ASA-MI Study included 606 patients, enrolled between November 1990 and December 1996: 245 patients with a previous cerebral embolic attack and normal carotid study and a control group of 316 patients. They all underwent transthoracic and transesophageal echocardiography. The subgroup of younger patients aged less than 55 years included 90 patients (61 men and 29 women of mean age 49 ± 5 years) (group AY). This group was evaluated and compared with an age- and sex-matched control population (61 men; of mean age 48 ± 6 years) (group BY). Results: The prevalence of ASA was 48.8% (95% confidence interval 40–61) in group AY and 22.2% in the group BY (95% confidence interval 18–33) (χ² = 5.968; p = 0.01). Morphological features were similar in the 2 groups of patients. ASA involved the entire septum in 52% of patients of group AY, and in 47.2% of group BY. The prevalence of PFO was 58.8% (95% confidence interval 43–62) in group AY and 28.8% in group BY (95% confidence interval 17–35) (χ² = 5.811; p = 0.01). A strong association was found between ASA and PFO. Of the 90 younger patients with stroke, 39 of 44 (88.6%) with ASA also had PFO, compared with 14 of 46 (30.4%) without ASA (χ² = 7.370; p = 0.007). Conclusion: We found that ASA and PFO were independent predictive factors for stroke in younger patients with stroke and normal carotid arteries and that the association between ASA and PFO bore an increased odds risk.

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Section: Discussionmentioning

confidence: 99%

Association between Atrial Septal Aneurysm and Patent Foramen ovale in Young Patients with Recent Stroke and Normal Carotid Arteries

et al. 2003

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“…88 Although attached thrombi have been suggested as a cause of these events, a high proportion of patients with atrial septal aneurysms have intra-atrial shunting, suggesting paradoxical emboli as a probable causative factor.…”

Section: Paradoxical Embolimentioning

confidence: 99%

Cardiac evaluation of the patient with stroke.

Sirna

Biller

Skorton

et al. 1990

Stroke

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Coronary artery disease and ischemic cerebrovascular disease are leading causes of morbidity and mortality in the United States. Coronary artery disease often coexists with asymptomatic carotid artery atherosclerosis, transient ischemic attacks, or ischemic stroke. Numerous studies have shown that mortality from all forms of ischemic cerebrovascular disease is primarily due to coronary artery disease. Thus, there is increasing interest in identifying coronary artery disease in patients with cerebrovascular disease, including those without clinical manifestations of heart disease. We review the use of current noninvasive techniques to detect coronary artery disease and present practical approaches to screen for ischemic heart disease. Current diagnostic imaging methods for potential cardioembolic sources of cerebral infarction are also discussed.

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“…This anomaly has been related to systolic click, atrioventricular valve prolapse, atrial septal defect or patent foramen ovale, and arterial embolism [1, 2, 3, 4, 5, 6, 7, 8]. ASA has also been described in association with ventricular arrhythmias [9, 10]and supraventricular arrhythmias both in neonates [11, 12, 13]and adults [3, 10, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23].…”

Section: Introductionmentioning

confidence: 99%

Is There an Association of Atrial Septal Aneurysm with Arrhythmias?

Hofmann¹,

Meinertz²

1999

Cardiology

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An association of atrial septal aneurysm (ASA) with cardiac arrhythmias has been described, and it has been suggested that undulating movements of the aneurysm initiate these arrhythmias, thereby causing arterial embolism. In this prospective study, all available electrocardiograms were reviewed and Holter monitoring was performed in 50 consecutive patients with echocardiographic diagnosis of ASA in order to assess the relationship between the occurrence of arrhythmias, morphologic characteristics of ASA and arterial embolism. Significant arrhythmias were identified in 26 (52%) patients (supraventricular n = 15, ventricular n = 6, both n= 5). Patients with arrhythmias were older (65 ± 12 vs. 54 ± 13 years, p = 0.005), frequently had palpitations (21/26 vs. 1/24, p < 0.0001) and an abnormal resting electrocardiogram (18/26 vs. 5/24, p < 0.001). By echocardiography, patients with arrhythmias had a larger left atrial (42.8 ± 7.4 vs. 35.3 ± 4.6 mm, p < 0.0001) and left ventricular enddiastolic diameter (53.8 ± 5.6 vs. 49.7 ± 4.1, p < 0.01) and a higher prevalence of associated mitral valve prolapse (12/26 vs. 4/24, p = 0.05). Potential cardiovascular causes for arrhythmia other than ASA were present in the great majority of patients with documented arrhythmias (24/26 vs. 7/24, p < 0.0001). The base diameter of ASA was larger in patients with arrhythmias (25.5 ± 6.2 vs. 21.4 ± 3.4, p < 0.01) and correlated with a larger left atrial diameter (r = 0.72, p < 0.0001). Concerning the mobility of ASA (maximal protrusion or phasic excursion), there was no significant difference between the two patient groups. Arterial embolism, however, predominantly occurred in ASA patients without arrhythmias (16/24 vs. 9/26, p < 0.05). In conclusion, the majority of patients with ASA and arrhythmias has underlying structural heart disease other than ASA which may be responsible for the arrhythmias observed. Arrhythmias in association with ASA do not play a major role as a mechanism for arterial embolism.

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Atrial septal aneurysm: association with cerebrovascular and peripheral embolic events.

Cited by 120 publications

References 27 publications

Association between Atrial Septal Aneurysm and Patent Foramen ovale in Young Patients with Recent Stroke and Normal Carotid Arteries

Association between Atrial Septal Aneurysm and Patent Foramen ovale in Young Patients with Recent Stroke and Normal Carotid Arteries

Cardiac evaluation of the patient with stroke.

Is There an Association of Atrial Septal Aneurysm with Arrhythmias?

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