The surgical treatment of atrial septal aneurysm with patent foramen ovalein patients with cerebral ischemia as an alternative to life-long anticoagulant therapy: operative strategy and results in 5 cases

There is a significantly higher incidence of cerebral ischemia among patien ts with an atrial septal aneurysm and/or a patent foramen ovale. According to the information provided by modern diagnostic procedures - and in partic ular by transesophageal echocardiography - two pathogenic mechanisms should be considered as possible causes of the cerebral ischemia. Thrombi may dev elop locally in the left atrium or atrial septal aneurysm and lead to embol ization or, alternatively, thrombi from the inflow region of the inferior v ena cava may become trapped in the atrial septal aneurysm and pass through the patent foramen ovale to bring about embolization in the arterial bloods tream. Current treatment consists of life-long anticoagulation with cumarin derivatives in order to prevent further neurological complications. With t his treatment, however, the risk of producing hemorrhages cannot be regarde d as trivial, especially in old people. Surgical intervention with the insertion of a button device has so far only been attempted in a few isolated cases, and it is in any case no use if th ere is only an atrial septal aneurysm without a patent foramen ovale. As an alternative to administering anticoagulants for the rest of the patie nt's life, we operated on five, cases of atrial septal aneurysm with patent foramen ovale followed by the appearance of cerebral ischemia. As with the surgical treatment of atrial septal defects in general, the risk of the op eration (or of subsequent complications) is very slight indeed. No such pro blems arose in any of our patients, no blood transfusions were necessary, a nd after short postoperative treatment they could all be discharged. For younger patients with little risk from the treatment itself, we regard surgical intervention in cases of atrial septal aneurysm with a patent fora men ovale and cerebral ischemia as an important therapeutic alternative.