Cas du 04/03/2015: A billowing structure in the LA

Presentation: A patient had the following echo loop.

#1: What is the diagnosis?
#2: Is the RAP higher than, equal to, or lower than the LAP?
#3: What is your recommended therapy for the diagnosis?













Explanation:

The diagnosis is a huge interatrial septal aneurysm (IASA). The RAP exceeds the LAP throughout the cardiac cycle because the aneurysm never enters the RA.  There might be equalization of the RAP and the LAP at the end of diastole.

 

IASA is associated with atrial fibrillation, embolic strokes and migraine headaches.  Treatment remain controversial in that asymptomatic patients may not have any complications from their IASA.  Patients with a history of migraine headaches have had their PFO closed by a device with resolution of their headaches, but, it is unclear if those results will translate to closure of an IASA. Certianly, patients with a history of a stroke or TIA where the IASA is the most likely etiology, should have corrective therapy or be on prophylactic therapy.