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Ann Thorac Surg 2009;88:1024. doi:10.1016/j.athoracsur.2008.12.075
© 2009 The Society of Thoracic Surgeons
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Tomokazu Kosuga
Shuji Fukunaga
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Images in Cardiothoracic Surgery

Atrial Septal Aneurysm Associated With Mitral Valve Disease

Shigeaki Aoyagi, MD*, Tomokazu Kosuga, MD, Shuji Fukunaga, MD, Tomohiro Ueda, MD

Department of Surgery, Kurume University School of Medicine, Kurume, Japan

* Address correspondence to Dr Aoyagi, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan (Email: aoyagi{at}med.kurume-u.ac.jp).

Atrial septal aneurysm is an infrequent anomaly that is often accompanied by other cardiac anomalies or systemic thrombosis.

A 63-year-old woman presented with decreased exercise tolerance for approximately 7 months. The patient had a history of cerebral embolism 1 year previously. Auscultation revealed an accentuated first sound, diastolic rumble, and opening snap at the apex. Transthoracic echocardiography demonstrated an atrial septal aneurysm (26 x 20 mm) bulging to the right atrium and the thickened, stenotic mitral valve. The aneurysm was clearly delineated as a thin, localized bulging of the atrial septum that protruded into the right atrium by transesophageal echocardiography; however, no intracardiac shunts and thrombi in the aneurysm or the left atrium were detected (Fig 1 [IAS = interatrial septum; LA = left atrium; RA = right atrium]).


Figure 1
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  		Fig 1.
 
At surgery, a thin-walled atrial septal aneurysm (30 x 25 mm) in size, without fenestrations, was found in the fossa ovalis at the right atrium (Fig 2). After complete excision of the aneurysm, the deformed mitral valve was replaced with a mechanical valve. Then a defect of the atrial septum was repaired using an autologous pericardial patch. Postoperative echocardiography revealed no atrial septal aneurysm and the normally functioning prosthetic valve. The patient recovered uneventfully and has remained stable 16 months after surgery.


Figure 2
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  		Fig 2.
 
Although the detailed mechanism for generation of atrial septal aneurysm is unclear, we believe that it should be surgically repaired to reduce the future risk of cerebral embolism or heart failure, even in asymptomatic patients.





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Tomokazu Kosuga
Shuji Fukunaga
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