https://doi.org/10.4081/acbr.2021.101
Atrial septal aneurysm in Sub-Saharan Africa: From an asymptomatic incidental echocardiographic finding to a potential cause of cardio embolic stroke
Submitted: 17 August 2020
Accepted: 14 December 2020
Published: 22 February 2021
Accepted: 14 December 2020
Abstract Views: 1941
PDF: 220
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Atrial Septal Aneurysm (ASA) is an abnormality of the interatrial septum that has continued to generate interest because of its rarity, asymptomatic presentation and possibility to cause cardioembolic stroke. There are many published accounts of atrial septal aneurysm in USA, Europe and Asia but very few published reports from sub-Saharan Africa. Our first case is a 48 years old female patient with type 1 ASA presented as an incidental finding during echocardiographic investigative procedures for other cardiac diagnosis. The second case is a 58 years old female with type 2L ASA, who presented with transient loss of consciousness lasting for 5 minutes. Our third case is a 25 years old male with type 5 ASA with heart failure who presented with exertional dyspnoea for 3 years. In this presentation, we ask questions about the reason for rare presentations and or publications of atrial septal aneurysm from Africa. We also re-examined the different associations of ASA as well as clinical presentations. ASA is an often asymptomatic but treatable cause of cardiovascular disease that includes cardioembolic stroke. A high index of suspicion is required to make the diagnosis during routine trans thoracic echocardiography and the availability of transesophageal echocardiography will definitely improve diagnosis and management of cases in sub-Saharan Africa.
Silvestry FE, Cohen MS, Armsby LB, et al. Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 2015;28:910-58.
DOI: https://doi.org/10.1016/j.echo.2015.05.015
Griffin BP, Topol EJ. Manual of Cardiovascular Medicine. 3° edition. Lippincott Williams and Wilkins; 2008. pp. 444.
Lesson P, Augustine D, Mitchell ARJ, Becher H. Transthoracic anatomy and pathology: chambers and vessels. In: Lesson P, Augustine D, Mitchell ARJ,Becher H (eds). Echocardiography (OSHs in Cardiology). 2 edition. Oxford University Press; 2012. pp. 191-341.
DOI: https://doi.org/10.1093/med/9780199591794.003.0004
Pearson AC, Nagelhout D, Castello R, et al. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol 1991;18:1223-9.
DOI: https://doi.org/10.1016/0735-1097(91)90539-L
Gallet B, Malergue MC, Adam C, et al. Atrial septal aneurysm: a potential cause of systemic embolism. Br Heart J 1985;53:292-297.
DOI: https://doi.org/10.1136/hrt.53.3.292
Longhini C, Brunazzi MC, Musacci G, et al. Atrial septal aneurysm: echopolycardiographic study. Am J Cardiol 1985;56:653-6.
DOI: https://doi.org/10.1016/0002-9149(85)91029-X
Lin CS, Chen HY, Jan YI. The interatrial septal echocardiogram: relationship to left atrial volume change in the normal and diseased heart. Am Heart J 1984;107:519-25.
DOI: https://doi.org/10.1016/0002-8703(84)90094-2
Chiappa EM, Cook AC, Botta G, Silverman NH. Echocardiographic anatomy in the fetus. Springer; 2008.
DOI: https://doi.org/10.1007/978-88-470-0573-0
Necas M. Redundant septum primum flap in fetus with premature atrial contractions. OBGYN.net. April 2000. Available from: https://www.contemporaryobgyn.net/view/redundant-septum-primum-flap-fetus-premature-atrial-contractions
Armstrong WF, Ryan T. Contrast echocardiography. In: Armstrong WF, Ryan T (eds). Feigenbaum’s Echocardiography. Wolters Kluwer; 2010. pp. 67-90.
Olivares-Reyes A, Chan S, Lazar E, et al. Atrial septal aneurysm: a new classification in 205 adults. J Am Soc Echocardiogr 1997;10:644-56.
DOI: https://doi.org/10.1016/S0894-7317(97)70027-0
Tamatey MN, Sereboe LA, Tettey MM et al. Twenty-two years of repair of atrial septal defects in Ghana. Postgraduate Med J Ghana 2015;4:2.
Ker J. The enigma of bulging to the left—a case report of an unusual atrial septal aneurysm. J Clinic Experiment Cardiol 2012,3:2.
DOI: https://doi.org/10.4172/2155-9880.1000175
Brown S, Buys D. Percutaneous closure of patent foramen ovale and atrial septal aneurysm using the Atriasept™ II PFO occluder: clinical and technical implications. Cardiovasc J Afr 2011:22:274-7.
Yuko-Jowi C, Okello C. Left ventricular inflow obstruction by giant atrial septal aneurysm in a neonate with hypoplastic right heart syndrome: case report. East Afri Med J 2013;90:67-71.
Danbauchi SS, Alhassan SS, Oyati IA, Onyemelukwe GC. Atrial septal aneurysm in an 80 year old woman: A case report and review of literature. Ann Afr Med 2002;1:31-4.
Oyedeji AT, Okunola O, Sani MU. Atrial septal aneurysm mimicking a cor triatriatum sinister: a case report and review of the literature. Clin Med Insights Case Rep 2012;5:143–7.
DOI: https://doi.org/10.4137/CCRep.S10447
Odetunde OI, Ekwochi U, Chinawa J. Conducting defect with atrial septal aneurysm in a preterm neonate: A case report from resource limited setting. Niger J Paed 2015;42:64-7.
Rodriguez CJ, Homma S, Sacco RL, Di Tullio MR. Race-ethnic differences in patent foramen ovale, atrial septal aneurysm, and right atrial anatomy among ischemic stroke patients. Stroke 2003;34:2097-102.
DOI: https://doi.org/10.1161/01.STR.0000085828.67563.42
Salmasi AM, Salmasi H, Rawilins S, et al. Atrial septal aneurysm and patent foramen ovale are less prevalent in the Indo-Asian than in the Caucasian or Afro-Caribbean population. Angiology 2009;61:205-10.
DOI: https://doi.org/10.1177/0003319709339590
Silver MD, Dorsey JS. Aneurysms of the septum primum in adults. Arch Pathol Lab Med 1978; 102:62-5.
Brand A, Keren A, Branski D, et al. Natural course of atrial septal aneurys m in children and the potential for spontaneous closure of associated septal defects. Am J Cardiol 1989;64:996-1001.
DOI: https://doi.org/10.1016/0002-9149(89)90797-2
Mügge A, Daniel WG, Angermann C, et al. Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography. Circulation 1995;91:2785–92.
DOI: https://doi.org/10.1161/01.CIR.91.11.2785
Falanga G, Carerj S, Oreto G, et al. How to understand patent foramen ovale clinical significance, Part I. J Cardiovasc Echogr 2014;24:114-21.
DOI: https://doi.org/10.4103/2211-4122.147202
Snijder RJ, Luermans JG, de Heij AH, et al. Patent foramen ovale with atrial septal aneurysm is strongly associated with migraine with aura: A large observational study. J Am Heart Assoc 2016;5:e003771.
DOI: https://doi.org/10.1161/JAHA.116.003771
Hanley PC, Tajik AJ, Hynes JK, et al. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol 1985;6:1370-82.
DOI: https://doi.org/10.1016/S0735-1097(85)80228-X
Iliceto S, Papa A, Sorino M, Rizzon P. Combined atrial septal aneurysm and mitral valve prol apse: detection by two-dimensional echocardiography. Am J Cardiol 1984;54:1151-4.
DOI: https://doi.org/10.1016/S0002-9149(84)80171-X
Roberts WC. Aneurysm (redundancy) of the atrial septum (fossa ovale membrane) and prola pse (redundancy) of the mitral valve. Am J Cardiol 1984;54:1153-4.
DOI: https://doi.org/10.1016/S0002-9149(84)80172-1
Iliceto S, Papa A, Sorino M, Rizzon P. Combined atrial septal aneurysm and mitral valve prolapse: detection by two-dimensional echocardiography. Am J Cardiol 1984;54:1151-4.
DOI: https://doi.org/10.1016/S0002-9149(84)80171-X
Rahko PS, Xu QB. Increased prevalence of atrial septal aneurysm in mitral valve prolapse. Am J Cardiol 1990;66:253-7.
Werren M. Clinical implications of familial occurrence of atrial septal aneurysm. G Ital Cardiol 2008;9:579-82.
Yetkin E, Atalay H, Ileri M. Atrial septal aneurysm: prevalence and covariates in adults. Int J Cardiol 2016;223:656–9.
DOI: https://doi.org/10.1016/j.ijcard.2016.08.220
Jatav RK, Kumbhare MB, Surender T, et al. Atrial septal aneurysm in adult patients: spectrum of clinical, echocardiographic presentation and to propose a new classification on the basis of trans-thoracic-two-dimensional echocardiography. Int J Res Med Sci 2014;2:708–17.
DOI: https://doi.org/10.5455/2320-6012.ijrms20140564
Shah MD. A look at atrial septal aneurysm. e-J Cardiol Pract 2012;10:17.
Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Atrial anatomy in non-cardioembolic stroke patients: effect of medical therapy. J Am Coll Cardiol 2003;42:1066-72.
DOI: https://doi.org/10.1016/S0735-1097(03)00907-0
Wahl A, Krumsdorf U, Meier B, et al. Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism in high-risk patients. J Am Coll Cardiol 2005;45:377-80.
DOI: https://doi.org/10.1016/j.jacc.2004.10.043
Schneider B, Hofmann T, Meinertz T. Atrial septal aneurysm: is there an association between arrhythmias and stroke? Circulation 1993;88:222.
Yetkin E, Ileri M, Korkmaz A, Ozturk S. Association between atrial septal aneurysm and arrhythmias. Scand Cardiovasc J 2019:54:169-73.
DOI: https://doi.org/10.1080/14017431.2019.1667525
Morelli S, Voci P, Morabito G, et al. Atrial septal aneurysm and cardiac arrythmias. Int J Cardiol 1995:49:3.
DOI: https://doi.org/10.1016/0167-5273(95)02317-P
Gallet B, Malergue MC, Adam C, et al. Atrial septal aneurysm: a potential cause of systemic embolism. Br Heart J 1985;53:292-7.
DOI: https://doi.org/10.1136/hrt.53.3.292
Belkin RN, Hurwitz BJ, Kisslo J. Atrial septal aneurysm: association with cerebrovascular an d peripheral embolic events. Stroke 1987;18:856-62.
DOI: https://doi.org/10.1161/01.STR.18.5.856
Adauy JV, Gabrielli L, Cordava S, et al. Big thrombus “sitting” in an atrial septal aneurysm. Echocardiography 2017;34:1396-8.
DOI: https://doi.org/10.1111/echo.13574
Zabalgoitia M, Norris LP, Garcia M. Atrial septal aneurysm as a potential source of neurological ischemic events. Am J Card Imaging 1994;8:39–44
Estagnasié P, Djedaïhi K, Le Bourdellès G, et al. Atrial septal aneurysm plus a patent foramen ovale: a predisposing factor for paradoxical embolism and refractory hypoxemia during pulmonary embolism. Chest 1996;110:846–848.
DOI: https://doi.org/10.1378/chest.110.3.846
How to Cite
Anakwue, R., & Anakwue, A.-M. (2021). Atrial septal aneurysm in Sub-Saharan Africa: From an asymptomatic incidental echocardiographic finding to a potential cause of cardio embolic stroke. Annals of Clinical and Biomedical Research, 2(1). https://doi.org/10.4081/acbr.2021.101
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