Large Atrial Septal Aneurysm Associated with Secundum Atrial Septal Defect

Navigating the Complexities: Addressing the Challenges of Aneurysmal Atrial Septal Defects

Aneurysmal atrial septal defects (ASDs) represent a rare subset of congenital cardiac anomalies, characterized by bulging of the interatrial septum. This condition poses unique challenges in diagnosis, management, and outcomes due to its variable clinical presentation and associated complications. While echocardiography remains the cornerstone of diagnosis, advanced imaging modalities such as cardiac magnetic resonance imaging (MRI) and computed tomography (CT) may provide additional insights. Optimal management strategies for aneurysmal ASDs require careful consideration of patient-specific factors, including the size and location of the defect, associated cardiovascular abnormalities, and the presence of pulmonary hypertension. Surgical repair, whether through conventional open-heart techniques or transcatheter interventions, remains the primary treatment modality; however, the approach may vary based on individual patient characteristics. Anesthetic considerations, including hemodynamic monitoring and perioperative care, are crucial in optimizing outcomes and reducing the risk of complications during surgical interventions. Long-term follow-up is essential to monitor potential complications such as residual shunting, arrhythmias, and the development of pulmonary vascular disease. Collaborative efforts among cardiologists, cardiothoracic surgeons, anesthesiologists, and other multidisciplinary specialists are paramount in providing comprehensive care for patients with aneurysmal ASDs.

Atrial Septal Aneurysm: An Incidental Finding or a Clinically Significant Anomaly?

Atrial septal aneurysm (ASA) is a condition involving the bulging of the interatrial septum into one or both of the atrial chambers. We present the case of an ASA found on transesophageal echocardiogram in a patient who presented with exertional dyspnea. This case report aims to highlight the growing clinical association of ASA with arterial embolism through various mechanisms and emphasize the unknown aspects of clinical management for such patients. While there are currently no clear recommendations on whether to start anticoagulation after an ASA is diagnosed, many suggest a careful patient-centered approach for such decisions due to the reported increased risk of thromboembolic events. Further studies regarding the significance of ASA and cardioembolic events are needed.