Atrial septal aneurysm. Morphological characteristics in a large population: pathological associations. A French multicenter study on 259 patients investigated by transoesophageal echocardiography

Int J Cardiol. 1995 Nov 10;52(1):59-65. doi: 10.1016/0167-5273(95)02444-2.


A strong association between interatrial septal aneurysm (IASA) and stroke has recently led many authors to consider IASA as a potential cardiac source of embolism. We studied the morphological characteristics and main associations of IASA in a large cooperative study based on transoesophageal echocardiographic examinations; 259 IASA were studied in 134 men and 125 women with a mean age of 59 +/- 15 years. Fifty-five percent of IASA were found to overlap the commonly described fossa ovalis region. IASA protruded into the right atrium in 90% of the cases. They appeared thin in 81% of the patients and highly mobile in 79%. Fifty-eight percent of patients had a history of systemic embolic events, while an atrial septal shunt was detected in 61% of the patients. In patients with an embolic event, only the mobility of IASA was significantly higher than in those with no embolic event. In nine cases a pulmonary embolism was associated with arterial embolism. Furthermore, we reported three cases of paradoxical embolism. However, the true demonstration of a thrombus within the IASA was quite rare.

Conclusion: IASA is probably an important risk factor for stroke. In patients with IASA and a history of embolic events, IASA may enhance migration of a thrombus constituted in situ or transiting through it. Marked mobility of IASA may also increase the risk of peripheral embolus.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebrovascular Disorders / epidemiology
  • Echocardiography, Transesophageal*
  • Female
  • France / epidemiology
  • Heart Aneurysm / diagnostic imaging*
  • Heart Aneurysm / epidemiology
  • Heart Aneurysm / pathology*
  • Heart Atria / diagnostic imaging
  • Heart Atria / pathology
  • Heart Septum / diagnostic imaging
  • Heart Septum / pathology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors