Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries - A multicentre study

Background Atrial septal aneurysm has been considered a potential source of cardiogenic embolism for many years. The present study evaluated the preva lence and characteristics of atrial septal aneurysm in a patient population with stroke and normal carotid arteries compared to a control population w ithout stroke. Methods A total of 606 patients were enrolled between November 1990 and Dec ember 1996. The study group included 245 patients who had experienced cereb ral ischaemic attack but had normal carotid arteries. The control group inc luded 316 age- and sex-matched patients undergoing transoesophageal echocar diography for indications other than a search for a cardiac source of embol ism. The prevalence and morphological characteristics of atrial septal aneu rysm were evaluated and compared. Results We reported a higher prevalence of atrial septal. aneurysm in the g roup with cerebral ischaemia; 68 patients (27.7%) vs 36 patients (9.9%) fro m the control group; P<0.001. A patent foramen ovale was detected with cont rast injection in 69.2% of the patients with atrial septal a patent foramen ovale (odds ratio of patent foramen ovale 4.2; 95% CI 1.03-9.8). Multivari ate analysis showed that atrial septal aneurysm was an independent predicto r of an embolic event. In the 95% of patients with atrial septal aneurysm a nd cerebral ischaemia aged less than 45 years, transoesophageal echocardiog raphy did not detect a source of embolism other than an associated patent f oramen ovale. Conclusions The prevalence of atrial septal aneurysm in patients with cereb ral ischaemia and normal carotid arteries was 27.7%, higher than the contro l group. Atrial septal aneurysm was frequently associated with patent foram en ovale. In patients less than 45 years old, atrial septal aneurysm was th e only potential cardiac source of embolism detected with transoesophageal echocardiography. (C) 2001 The European Society of Cardiology.