What isAtrial Septal Aneurysm | Verywell Health
An atrial septal aneurysm (ASA) occurs when a bulge forms in the atrial septum, the membrane separating the heart’s upper left and upper right chambers (atria). The atrial septum usually is relatively immobile, but it can sometimes enlarge, become hypermobile, and protrude into the left or right atrium.
Atrial septal aneurysms are relatively rare but can cause a stroke, a potentially life-threatening blockage of blood flowing to the brain. However, many people with ASA have everyday lives, mainly if the aneurysm is small.
This article discusses atrial septal aneurysms. It explains how an ASA is linked to a stroke and other health issues. It also describes how atrial septal aneurysms are diagnosed and treated.
What Are the Symptoms of an Atrial Septal Aneurysm?
An atrial septal aneurysm does not typically cause any symptoms. It is often only detected during routine echocardiography or evaluation of ischemic stroke.1
An echocardiogram often shows evidence of paroxysmal supraventricular arrhythmias (abnormal heart rhythms) in people with ASA.2
ASA is also commonly associated with congenital heart defects, such as atrial septal defects (ASD) or patent foramen ovale (PFO).3
If you have related heart problems, you may also experience the following symptoms:4
- Fatigue
- Reduced exercise tolerance
- Shortness of breath
Complications
Atrial septal aneurysm is linked to other heart defects and can increase your risk of ischemic stroke.5
A 2021 review of 12 studies evaluating different atrial septal abnormalities found atrial septal aneurysm was associated with higher stroke rates. However, the study authors stressed that while atrial weakness may be a factor for stroke, the results are not definitive.6
Stroke symptoms are different from those of ASA and include the following:7
Centers for Disease Control and Prevention. Signs and symptoms of a stroke.
- Facial drooping
- Speech changes
- Difficulty moving or walking
- Vision changes
- Change in mental status
- Headaches
These are signs that immediate medical help is needed.
Tests That Determine Your Stroke Risk
What Causes an Atrial Septal Aneurysm?
An atrial septal aneurysm is a type of heart defect present at birth. In utero, we all have a hole along the atrial septum dividing the left and right atria. The hole is known as patent foramen ovale (PFO).5
The fetus obtains its blood supply from its mother, and this blood enters the right heart and shunts across the PFO to supply oxygenated arterial blood to the fetus’s body.
Most of the time, the PFO closes after delivery upon spontaneous air breathing. However, in about a quarter of the population, the PFO doesn’t close.
Most of the time, PFO does not cause any further problems. Sometimes, though, arterial pressure can cause a bulge to form in the atrial septum near the PFO. This is known as an atrial septal aneurysm.3
How Is an Atrial Septal Aneurysm Diagnosed?
Imaging is vital to an ASA diagnosis. An ASA appears as an extensive and bulging membrane that moves between the two atria.
In many cases, a complete echocardiogram of the heart may be done if a person has a related congenital heart condition.
It also may be done if someone has a stroke and doctors are trying to find out why. They may look for blood clots in the left atrium, a PFO, a mitral valve prolapse, or the ASA.
A person’s overall health and family history also are needed for a complete diagnosis. That’s especially true if there is a personal history of strokes, TIAs, or other cardiovascular issues.
How Is an Atrial Septal Aneurysm Treated?
The vast majority of ASAs which are identified on echocardiography incidentally are benign, and no treatment is warranted.
If an ASA with an associated PFO or ASD is identified in the process of evaluating a patient with a stroke, then a complete workup is needed to ascertain the likelihood that the PFO or ASD might have contributed to the stroke.
Medication is another treatment approach. If a person with an ASA is at high risk for stroke, or if one has already occurred, they may be given drugs that prevent blood clots along with other strategies to limit stroke risk.8
Does Closing a Patent Foramen Ovale Prevent Strokes?
All of us once had a hole in our heart. Blood flows very differently through the body of a fetus compared to an adult’s. For one, blood flows through an opening between the left and right side of the heart through an opening called the foramen ovale.
With our first breath of air, though, the pressure gradient between the left and right side of the heart changes, and a flap of tissue seals the foramen ovale. From then on, the blood flows in a pattern common to almost all adults.
Sometimes, though, the foramen ovale doesn’t seal completely, leaving what is called a patent foramen ovale, or PFO. This is actually pretty common and has been said to affect about one in five people.
As alarming as it sounds to have this connection between the two sides of the heart, most research suggests that PFOs are harmless most of the time. Some physicians, however, believe that a PFO can increase the risk of stroke.
How Does It Work?
The theory goes like this: a blood clot forms in the legs and travels through the venous system up to the heart. Blood is usually sent from the right side of the heart to the lungs to drop off carbon dioxide and load up on oxygen. The blood vessels where this gas exchange occurs are very small, and any clots traveling through the veins (emboli) will likely be filtered out in the lungs.
This natural filter may be bypassed, though, if the blood is able to travel from the right to the left side of the heart without going through the lungs. It may do this if there is a hole between the sides of the heart such as a PFO, and if the pressure gradient is sometimes higher on the right side of the heart than the left (which is generally uncommon).
Under these circumstances, a blood clot may travel to the left side of the heart, where it is pumped out into the body, including the brain, where the clot occludes further blood flow and leads to an embolic stroke. A clot that travels in such a fashion is called a paradoxical embolus, from para (two) and doxical (sided).
Options
There are two courses of action when someone with a PFO has a stroke with no clear cause. The first approach, as recommended by the 2012 American College of Chest Physicians (ACCP) guidelines, is to use antiplatelet therapy like aspirin. If a thrombus is present in the legs, anticoagulation with an agent like heparin or warfarin is preferred.
The second approach is to seal the PFO. This is very appealing to patients who have just had a stroke and who receive the alarming news that there’s a “hole in their heart.” Under those conditions, a person may want to do everything possible to keep from having another, potentially even more serious, stroke.
The problem is that while sealing the PFO would seem to be a sensible thing to do, extensive research has shown no conclusive benefit to this invasive procedure.
The most popular way of sealing a patent foramen ovale is with a percutaneous procedure. A trained physician threads a catheter through the veins of the body into the heart, where a device is used to seal the PFO. Another method involves more invasive surgery.
Large studies of PFO closure in stroke show no benefit to either procedure. One of the best trials, appropriately named CLOSURE 1, looked at people under the age of 60 with a PFO who had suffered a stroke or transient ischemic attack. Not only was there no benefit after two years, but people who had the procedure done were more likely to have major vascular complications or atrial fibrillation than those who just received medical therapy.
Their results were frustrating to people who had observed that in other, weaker studies the device closure had seemed to work. Like any trial, CLOSURE 1 had flaws. Critics suggested that perhaps a better device could have reduced the risk of complications, or that the sample size wasn’t large enough. That said, CLOSURE 1 has the best evidence of any previous trial, and the results are more conclusive. while some have argued that advances in the techniques used in PFO closure may now justify its use, the counterargument is that medical management is also advancing, and could still out-compete closure of the PFO.
Conclusions
The American Academy of Neurology and more have concluded there is no benefit to the procedure in PFO, though percutaneous closure is probably still merited in less common and more severe forms of communication between the left and right sides of the heart. Such cases include a large atrial septal defect.
There are still physicians around who are willing to do this procedure for those who insist on having a patent foramen ovale closed. Some people cannot bear the thought that there is a hole in the heart, even if it is a hole that we have all had, and many people continue to have without problems. For those who remain interested despite the lack of proven benefit, it is important to get an opinion from a doctor who has no financial stake in doing the procedure.
Sources
By Peter Pressman, MD
Peter Pressman, MD, is a board-certified neurologist developing new ways to diagnose and care for people with neurocognitive disorders.
Summary
Most ASAs are incidentally found on an echocardiogram performed for other reasons. Thus, most patients with ASA have no symptoms, and the ASA is benign.
Small atrial level shunts are associated with ASA; in rare cases, these can be related to stroke. People may not even know that they have an ASA for a long time or possibly ever. But it increases the chance of a stroke, so knowing the signs and symptoms is essential.
If you have concerns about a congenital heart problem and its risks, talk to your healthcare provider.
8 Sources
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By Jose Vega MD, PhD
Jose Vega MD, PhD, is a board-certified neurologist and published researcher specializing in stroke.
Atrial Septal Aneurysm Life Expectancy | AI Generated Answer
Patients with migraine, patent foramen ovale (PFO), and atrial septal aneurysm (ASA) have more frequent ischemic brain lesions, migraine with aura, and larger PFO sizes than patients with migraines and PFO without ASA, according to the results of a recent study.PFO is an interatrial opening that did not close up during infancy, and although the occurrence of PFO is not rare in the general population (27%), its prevalence is nearly doubled in patients with migraine with aura (48%). ASA is another heart deformity where the atrial septum bulges into the right or left atrium. The prevalence of ASA is rare (2%-3%) but occurs significantly more frequently in the presence of PFO.Although the effects of ASA are not fully understood, its incidence has been identified as one of the risk factors for cryptogenic stroke. Because patients with migraine are more predisposed to PFO, their risk of ASA also increases. To analyze this connection further, researchers conducted a retrospective study on patients with migraine and PFO and its association with ASA.In this study, patients with migraine and PFO were divided into 2 groups: group A for patients with ASA and group B for patients without ASA. Baseline characteristics were similar between the 2 groups; however, patients in group A had increased frequency of ischemic brain lesions (11.3% vs 6.2%, P = .038), migraines with aura (32.5% vs 21.1%, P = .040), and significantly larger PFO size (median size; 2.6 mm vs 2.1 mm, P = .007).All patients underwent PFO closure either through Cardi-O-Fix PFO occluder or Amplatzer PFO occluder. The procedure was successful in all the patients, with no patients experiencing transient ischemic attacks or stroke afterward. Two patients did develop paroxysmal atrial fibrillation: 1 reverted spontaneously and 1underwent pharmacological conversion.To analyze the differences in migraine severity, investigators used the headache impact test-6 (HIT-6). Prior to surgery, baseline HIT-6 scores were 61 and 63 for groups A and B, respectively. At the 1-year follow up, the average HIT-6 scores were 36 were both groups, indicating a drastic decrease from baseline. No significant differences before and at the 1-year follow up after the PFO closure were seen between the 2 groups.Based on the findings, investigators concluded that the prevalence of ASA in patients with migraines and PFO is associated with silent stroke, larger PFO size, and migraines with aura. However, due to similar HIT-6 scores between the 2 groups, there does not seem to be differences in the severity of the migraines.Reference:He L, Cheng G, Du Y, Zhang Y. Clinical relevance of atrial septal aneurysm and patent foramen ovale with migraine. World J Clin Cases. 2018;6(15):916-921. doi: 10.12998/wjcc.v6.i15.916.
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