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

Rajendra Kumar Jatav, Mamta B. Kumbhare, T. Surender, Ch. Rachan, T. V. Vamshi Krishna


An atrial septal aneurysm is a rare but well recognized cardiac abnormality of uncertain clinical relevance. ASA is definitively associated with congenital and acquired heart diseases but also can be presented as an isolated and totally asymptomatic entity. On the basis of our TTE finding we are proposing a new classification of ASA. We have classified ASA in to two major types: (A) Localized, and (B) Generalized. Both major types are further Sub-classified into 5 possible types on the basis of movements of ASA. New classification of ASA is as follows (1) A/B Type 1R: if the bulging is in the RA only (2) A/B  Type 2L: if the bulging is in the LA only (3) A / B  Type 3RL : if the major excursion bulges to the RA and lesser excursion bulges toward LA (4) A/B Type 4LR: if the maximal excursion of the atrial septal aneurysm is toward the LA with a lesser excursion toward the RA (5) A / B Type 5: if the atrial septal aneurysm movement is bidirectional and equidistant to both atria during the cardiorespiratory cycle. We found higher prevalence (2.24%) of ASA. A/B Type 2L and A/B Type 4LR were most common types. All type of ASA had particular clinical and echocardiographic characteristics. Mobile ASA and ASA with >10 mm excursion are associated with a higher risk of stroke.


Atrial septal aneurysm, Embolism, Echocardiography

Full Text:



Silver MD, Dorsey JS. Aneurysm of the septum Primum in the adults. Arch Path lab Med. 1978;102:62-5.

Peter C. Hanely, A. Jamil Tajik, John K. Hynes et al. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol. 1985;6(6):1370-82.

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.

Wilson JH, Lever HM, Moodie DS. Aneurysm of the interatrial septum. Cleve Clin Q. 1986;53:105-8.

Roudant R, Gosse R, Chague E, Dehant P, Choussat A, Dallochio M. Clinical and echocardiographic feature of the aneurysm on the atrial septum in infants and adults: experiences with 44 cases. Echocardiography. 1989;6:357-62.

Bewick DJ, Montague TJ. Atrial septal aneurysm: spectrum of clinical and echocardiographic presentation. Canadian Med Assoc J. 1987;136:609-11.

Gallet B, Malergue Mc, Adam C, Saudemont JP, Collot AM, Druon MC et al. Atrial septal aneurysm: a potential cause of systemic embolism. Br Heart J. 1985;53:292-7.

Schneider B, Hanrath P, Vogel P, Meinertz T. Improved morphologic characterization of atrial septal aneurysm by transesophageal echocardiography: relation to cerebrovascular events. J Am Coll Cardiol. 1990;16:1000-9.

Hanley PC, Tajik AJ, Hynes JK, Edwads WD, Reeder GS, Hagker DJ et al. Diagnosis and classification of atrial septal aneurysm by two-dimensiona echocardiography: report of 80 consecutive cases. J Am coll cardiol. 1985;6:1370-82.

Belkin RN, Hurwitz BJ, Kisslo J. Atrial septum aneurysm: associated with cerebrovascular and peripheral embolic events. Stroke. 1987;18:856-62.

Longhini C, Brunazzi MC, Musacci G, Caneva M, Bandello A, Bolomini L et al. Atrial septal aneurysm: echocardiographic study. Am J cardiol. 1985;56:653-67.

Ongelia C, Faggiano P, Sabatini T, Ghizzoni G, Rusconi C. Aneurisma del setto ed anomalie associate. Esperienza personale su 38 casi. Minerva Cardioangiol. 1993;41:95-100.

Zabalgoitia-Reyes M, Herrera C, Ghandi DK, Mehlman DJ, Mc Pherson DD, Talano JV. A possible mechanism for neurological ischemic events in patients with atrial septal aneurysm. Am J cardiol. 1990;66:761-4.

Katayama H, Mitamura H, Mitani K, Nakagawa S, Ui S, Kimura M. Incidence of atrial septal aneurysm: echocardiographic and pathologic analysis. J Cardiol. 1990;20:411-21.

Siostrzonek P, Lang W, Zangeneh M, Gossinger H, Stumpflen A, Rosenmayr G et al. Significance of left-sided heart disease for the detection of patent foramen ovale by transesophageal contrast echocardiography. J Am Coll Cardiol. 1992;19:1192-6.

Mirode A, Tribouilloy C, Boey S, Hadj Kacem L, Choqut D, Lesbre JP. Aneurysmes du septum interauriculaire. Apport de l’echographie transoesophagienne. Rlation avec les accidents systemiques emboliques. Ann Cariol Angeiol. 1993;42:7-12.

Shiraishi I, Hamaoka K, Hayashi S, Koh E, Onouchi Z, Sawas T. Atrial septal aneurysm in infancy. Pediatr Cardiol. 1990;11:82-5.

Pearson AC, Nagelhout D, Castello R, Gomez CR, Labovitz AJ. Atrial septal aneurysm and stroke. A transesophageal echocardiographic study. J Am Coll Cardiol. 1991;18:1223-9.

Brand A, Keren A, Branski D, Abrahamov A, Stern S. Natural course of atrial septal aneurysm in children and the potential for spontaneous closure of associated septal defect. Am J Cardiol. 1989;64:996-1001.

Wolf WJ, Casta A, Sapire DW. Atrial septal aneurysm in infants and children. Am Heart J. 1987;113:1149-53.

Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP. Echocardiographic criteria for left ventricular hypertrophy: the Framingham heart study. Am J Cardiol. 1987;59:956-60.

Alexander Olivares-Reyes, Samuel Chan, Eliot J. Lazer, Kishore Bandlamudi et al. Atrial septal aneurysm: a new classification in two hundred five adults. J Am Soci Echocardiography. 1997 July;6:644-56.

Hauser AM, Timmis GC, Stewart JR, Ramos RG, Gangadharan V, Westveer DC, Gordon S. Aneurysm of the atrial septum as diagnosed by echocardiography: analysis of 11 patients. Am J Cardiol. 1984;53:1401-2.

Gondi B, Nanda NC. Two dimensional Echocardiographic features of atrial septal aneurysm. Circulat. 1981;63:452-7.

Roberts WC. Aneurysm (redundancy) of the atrial septum (fossa ovalis membrane) and prolapse (redundancy) of the mitral valve. Am J Cardiol. 1984;54:1153-4.

Belkin RN, Waugh RA, Kisslo J. Interatrial shunting in atrial septal aneurysm. Am J Cardiol. 1986;57:310-2.

Topaz O, Feigl A, Edwards JE. Aneurysm of the fossa ovalis in infants: a pathological study. Pediatr cardiol. 1985;6:65-8.

Burstow DJ, Mc Eniery PT, Stafford EG. Fenestrated atrial septal aneurysm: diagnosed by transesophageal echocardiography. J Am So Echocardiog. 1990;3:499-501.

Rice MJ, Mc Donald RW, Reller MD. Fetal atrial septal aneurysm. A cause of fetal arrhythmias. J Am Coll Cardiol. 1988;12:1292-7.

Ong LS, Nanda NC, Falkoff MD, Barold SS. Interatrial septum aneurysm, systolic click and atrial tachyarrhythmia’s-a new syndrome?. Ultrasound Biol. 1982;8:691-3.

Pernot G, Cloez JL, Khalife K, Had A, Marcon F. Dysrythemies supraventriculaires du nouveau-ne et aneurisme du septum interauricularie. Arch Fr Pediatr. 1984;41:21-5.

Toro L, Weintraub RG, Shiota T, Sahn DJ, Shan C, Mc Donald RW et al. Relation between persistent atrial arrhythmias and redundant septum Primum flap (atrial septal aneurysm) in fetuses. Am J Cardiol. 1994;73:711-3.

Cabanes L, Mas JL, Cohen A, Amarenco P, Cabanes PA, Oubary P et al. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age: a study using transesophageal echocardiography. Stroke. 1993;24:1865-73.

Mas JL, Arquizen C, Lamy C et al. Patent foramen ovale, and atrial septal aneurysm study group. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. 2001;345:1740-6.

Rahko PS, Xu QR. Increased prevalence of atrial septal aneurysm in mitral valve prolapse. Am J cardiol. 1990;66:235-7.

Barbosa MM, Pene JL, Motta MM, Fortes PR. Aneurysm of the atrial septum diagnosed by echocardiography and their associated cardiac abnormalities. Int J Cardiol. 1990;29:71-8.

Andreas Mugge, Werner G. Daniel, Christiane Angermann, Christoph Spes et al. atrial septal aneurysm in adults patients: a multicenter study using transthoracic and transesophageal echocardiography. Circulat. 1995;91:2785-92.

Lang FJ, Posselt A. Aneurrysmatische vorwolburg der fossa ovalis in den linken vorhof. Wiener Medizinische Wochenschrift. 1934;84:392-6.

Mugge A, Daniel WG, Angermann C, Spes C, Khandheria BK et al. Atrial septal aneurysm in adults patients: a multicenter study using transthoracic and transesophageal echocardiography. Circulat. 1995;19:2785-92.

Schneider B, Hofmann T, Meinertz T. Atrial septal aneurysm: is there an association between arrhythmias and stroke? Circulat. 1993;88(Suppl):1222.