Atrial septal aneurysm, Mitral Valve Prolapse Syndrome, Echocardiography, Real Time-3D-Echocardiography
A 68-year-old male presented to the out-patient clinic with history of intermittent palpitations and fatigability for past seven months. On cardiovascular system examination, mid-systolic click and pan-systolic murmur grade III/VI were audible at the apex with radiation to the base of heart. Echocardiographic study revealed atrial septal aneurysm (Figure 1, Figure 2, Video 1 and Video 2), along with prolapse of Posterior Mitral Leaflet (PML) into left atrium (Figure 3 and Figure 4). Color-doppler echocardiography revealed severe eccentric mitral regurgitation MR) jet impinging on atrial septal aneurysm with vena-contracta width of 10.9 mm (Figure 4 and Video 3).
Atrial Septal Aneurysm (ASA) is a congenital deformity of the inter-atrial septum with a prevalence of 1-2% in the adult population. It is usually associated with Patent Foramen Ovale (PFO), Atrial Septal Defect (ASD), Mitral Valve Prolapse Syndrome (MVPS), TVPS, Marfan's syndrome and aortic dissection.
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All authors contributed equally to the scientific content, designing and writing of this manuscript.
Figure 1: Apical 4 chamber view on 2-Dimensional echocardiography showing prolapse of PML and interatrial septal aneurysm.
Figure 2: 3D-Echocardiographic image showing atrial septal aneurysm in apical 4 chamber view.
Figure 3: Parasternal Long Axis (PLAX) view on 2D-echocardiography showing prolapse of PML.
Figure 4: 2D-Echocardiography with color doppler depicting severe eccentric MR jet directed along PML and jet impinging on interatrial septum near atrial septal aneurysm.
Video 1: Apical 4 chamber view showing prolapse of PML, interatrial septal aneurysm & spontaneous echo contrast in left ventricle.
Video 2: 2D-echocardiography PLAX view depicting prolapse of PML.
Video 3: 2D-echocardiography with color doppler showing severe eccentric MR jet impinging on atrial septal aneurysm.