Dramatic Aneurysmal Atrial Septum Identified with Intracardiac Echo Complicating Transseptal Puncture

Figures

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  Figure 1. TTE, four-chamber view in early diastole, showing no obvious abnormalities of the intra-atrial septum. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

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  Figure 2. ICE, home view, showing large intra-atrial septal aneurysm (arrow). This is a diffuse aneurysm with dimensions of 2.4 cm × 3.0 cm. There is no visible thrombus attached to the aneurysm. Ao, Aortic outflow; LA, left atrium; RA, right atrium; RV, right ventricle.

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  Figure 3. ICE, home view with color Doppler, showing large intra-atrial septum aneurysm (arrow) and the absence of atrial septal defect or patent foramen ovale. Ao, Aortic outflow; LA, left atrium; RA, right atrium; RV, right ventricle.

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  Figure 4. ICE, home view, clockwise rotated compared with Figures 2 and 3, showing another view of the large intra-atrial septum (arrow) in dynamic motion, bowing towards the RA (A) and then the LA (B). LA, Left atrium; LAA, left atrial appendage; RA, right atrium.

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  Figure 5. ICE, home view, showing the introducer and dilator (arrow) engaging the intra-atrial septum and the dynamic movements of the septum. LA, Left atrium; LV, left ventricle; RA, right atrium.

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  Figure 6. Computed tomography angiography of the chest, multiplanar reconstruction—horizontal long-axis view of the heart with four chambers (A) and short-axis view of the heart at the atrial level (B)—showing intra-atrial septum bulging into the right atrium cavity (arrows). Aneurysm measures 20 mm × 17 mm. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.