Key result
Embolic stroke evaluation is linked to ~4-fold higher TEE detection of atrial septal aneurysms.
Why the study?
This study sought to describe the prevalence and morphologic characteristics of atrial septal aneurysms identified by transesophageal echocardiography in patients evaluated for a potential source of embolus versus other indications.
Does transesophageal echocardiography improve detection of atrial septal aneurysms and identify morphological differences in patients referred for evaluation of a potential embolic source/stroke compared to patients referred for other reasons?
Observational (n=410)
Does transesophageal echocardiography improve detection of atrial septal aneurysms and identify morphological differences in patients referred for evaluation of a potential embolic source/stroke compared to patients referred for other reasons?
Atrial septal aneurysms are more frequently detected by transesophageal echocardiography than surface echocardiography, occur significantly more often in patients with unexplained stroke (15% vs. 4%), and are commonly associated with right-to-left atrial shunting.
TEE-detected atrial septal aneurysms are associated with stroke; leaves open causal role and need for targeted intervention.
The prevalence and morphologic characteristics of atrial septal aneurysms identified by transesophageal echocardiography in 410 consecutive patients are described. Two groups of patients were compared: Group I consisted of 133 patients referred for evaluation of the potential source of an embolus and Group II consisted of 277 patients referred for other reasons. An atrial septal aneurysm was diagnosed by transesophageal echocardiography in 32 (8%) of the 410 patients. Surface echocardiography identified only 12 of these aneurysms. Atrial septal aneurysm was significantly more common in patients with stroke (20 [15%] of 133 vs. 12 [4%] of 277) (p less than 0.05); right to left shunting at the atrial level was demonstrated in 70% of patients in Group I and 75% of patients in Group II by saline contrast echocardiography. Four patients in Group I had an atrial septal defect with additional left to right flow. There was no difference between the two groups in aneurysm base width, total excursion or left atrial or right atrial excursion. However, Group I patients had a thinner atrial septal aneurysm than did Group II patients. It is concluded that an atrial septal aneurysm occurs commonly in patients with unexplained stroke, is more frequently detected by transesophageal echocardiography than by surface echocardiography and is usually associated with right to left atrial shunting. Treatment (anticoagulant therapy vs. surgery) of atrial septal aneurysm identified in stroke patients can be determined only by long-term follow-up studies.
No takes yet. Share an insight, caveat, or question.
Pearson et al. (1991) conducted an observational in Atrial septal aneurysm and stroke / suspected embolic source (n=410). Referral for evaluation of potential source of embolus (stroke) vs. Referral for other reasons was evaluated on Prevalence of atrial septal aneurysm diagnosed by transesophageal echocardiography (p=<0.05). Transesophageal echocardiography detected atrial septal aneurysms more often in patients evaluated for embolic stroke vs other reasons (15% vs 4%; P<0.05).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: