Presentation
Cough, dyspnea on mild exertion and paroxysmal nocturnal dyspnea. No known comorbids. LBBB on ECG. Sinus tachycardia with a heart rate of 106 bpm.
Patient Data
there is a large bulge of the interatrial septum overlying the fossa ovalis region
the bulge is approximately 18 mm beyond the plane of the interatrial septum towards the right atrium only throughout the cardiorespiratory cycle (type 1R)
no evidence of thrombus in any chamber or atrial appendage
no atrial septal defect, no patent foramen ovale
moderate mitral regurgitation, dilated left atrium
the left ventricle is dilated, with impaired systolic function, paradoxical interventricular septum movement and hypokinesia of the remaining wall segem
Case Discussion
An atrial septal aneurysm is a rare cardiac anomaly that is typically discovered during routine echocardiography or an assessment of an ischemic stroke. It can occur in isolation or in combination with other defects, the most common of which is patent foramen ovale.
An atrial septal aneurysm can be caused by interatrial pressure differences producing a bulging septal shift towards the low-pressure side, but it can also be a primary malformation involving the fossa ovalis region or the entire septum.
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