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Atrial Septal Anyerisum
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Atrial Septal Anyerisum

Hello and thanks for taking my question.  Could you please explain what an atrial  septal anyerisum is.  I have read about it but I am a little lost.  I had one show up on a tee and a echo.  However my dr never mentioned to me anything about it until I requested to look at my records.  Some things I would like to know are as follows.
1)  What clinical significance does this pose.  I dont have a hole or shunt that most people have with this.  Or at least it hasnt been detected by echo or tee.
2)  Since I dont have the hole is there any reason to think one could develop?
3)  I read that there is an increased risk of stroke with this. Is this true by documentation.
4)  I have mvp also is it possible all these were something I was born with?
5)  I also have mild aortic reg.  Normal tricuspid valve but mild dialaion of the aorta.  Is that something I could have been born with too?  I have been checked out by numerous drs and none of them seem concerned with anything other than the mitral valve.  It has 1+ reg and mild annular calcifcation.  Is the dialation of the aorta considered an anyerisum?  My dr said no and he is a very good dr but all the things that were not mentioned to me that I just recently found out about are driving me crazy so to speak.

Any help would be greatly appreciated.  Thanks
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239757_tn?1213813182
worried,

Calm down. It is an important finding, but certainly not the end of the world.

1) What clinical significance does this pose. I dont have a hole or shunt that most people have with this. Or at least it hasnt been detected by echo or tee.

There are 2 atria in the heart. A right and left.  The atrial septum is the wall that separates these 2 chambers. In some people, there is a little extra tissue between the 2 chambers that is mobile while the heart beats.  If the excursion of this wall is greater then normal, we describe it as an aneurysm. Sometimes this area is just a little 'floppy' and  the term anuerysm is overused without actually measuring the amount of excursion.  


2) Since I dont have the hole is there any reason to think one could develop?

No.  The hole would be an atrial septal defect (ASD) or patent foramen ovale (PFO).  These are congential defects meaning you are born with them.  If you dont have a hole there, it wont develop.

3) I read that there is an increased risk of stroke with this. Is this true by documentation.

There is an association. The degree of which is not perfectly understood.   It is greater for those that have both a PFO and aneurysm.  You should first discuss this finding with your doctor, or get a second opinion to determine if you have one. If so, you should discuss your options of anticoagulation with your physician.

4) I have mvp also is it possible all these were something I was born with?

Yes. They are relatively common and probably developed as your heart grew along with you.  You should maintain a healthy lifestyle with good cardiac risk factor control to prevent other heart disease from developing over your lifetime.


5) I also have mild aortic reg. Normal tricuspid valve but mild dialaion of the aorta. Is that something I could have been born with too? I have been checked out by numerous drs and none of them seem concerned with anything other than the mitral valve. It has 1+ reg and mild annular calcifcation. Is the dialation of the aorta considered an anyerisum?

No. There are specific criteria depending where you are measuring for defining the difference of anuerysm and dilation.  This is something that should be followed over time.

My dr said no and he is a very good dr but all the things that were not mentioned to me that I just recently found out about are driving me crazy so to speak.

Mild insuffieicenies of the valves are pretty common and not too much to worry about.  Your mitral regurgitation should be followed over time.  Without symptoms or indication of progression, there is no indication to even really do serial echos.  This is not the preactive however, and I generally would follow you with a yearly evaluation.

good luck
9 Comments
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Avatar_n_tn
Thanks so much for you response.  I checked the archives first and only found one other question about this subject.  When you hear the word anuerysm you tend to think of something about ready to pop.  Thats what had me worried to no end.  My dr said pretty much the same thing you did when I asked him but I just wanted some reassurance.  Thanks for you time and your response.
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Avatar_n_tn

I have recently had an echocardiogram which displayed, what "might" be an aneurysm or a "bulge" as my doctor called it, on the top of my aortic arch.  I went for an MRI (MRA) to confirm the irregularity but it didn't show up on the images.  I now have to, not "willingly" go for an angiogram (aortogram) this Thursday.  I am very nervous about the aortogram because it is the first invasive test that I am going through.  I am having done at Yale in New Haven, CT and realize I should trust the professionals but I know that any invasive procedure has its complications.

I am 37 years old, 6'6" tall, 220 lbs and was fairly active until this finding.  My doctor told me I can continue with my basketball activities but restricted me from any heavy lifting.

Are aortograms performed on people my age who do not have CAD and should the complications be less of a concern when CAD isn't present?  From what I understand they will not advance the catheter into my coronary arteries to release the dye.  The dye should be released in the arch which hopefully minimizes the chances of anything going wrong?

Any help on calming me down would be greatly appreciated.

Thanks!

~Bob
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Avatar_n_tn
I have never had the test your talking about I dont think...lol I have had a heart cath and two ablations.  Which are both invasive procedures.  I cant tell you I wasnt nervous but they turned out fine.  The risk you are talking about are very small but never the less very real and I realize that.  However the heart cath was very quick for me.  The ablation was 9 and a half hours but I was pretty much out of it and didnt hurt or anything with either of the procedures.  Good luck on the procedure.  Youll do fine just wait and see.
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21064_tn?1309312333
Saw this on the CCF website and thought I'd share it:

February 1st: Live Web Chat with Cleveland Clinic Heart Surgeon
01/13/2005

If you need info on heart rhythm disorders, don't miss the upcoming live Web Chat with heart surgeon A. Marc Gillinov, M.D.

The topic is: Surgical Treatment for Atrial Fibrillation.

Chat with Dr. Gillinov on WebMD
Tuesday, February 1, 2005, 2 p.m. Eastern Standard Time

Visit WebMD for more information and to register

Atrial Fibrillation (AF) is the most common irregular heart rhythm. Some important facts include:

It affects about 2.2 million Americans and is associated with multiple complications, including stroke.
New treatments are emerging as researchers uncover new techniques and technology for optimal restoration of normal cardiac rhythm to AF patients.
Dr. A. Marc Gillinov, a Cleveland Clinic Heart Center surgeon, will discuss surgical intervention for the treatment of AF. In addition to traditional surgery, new minimally invasive approaches are available that feature shorter procedure times, smaller incisions and a more rapid recovery.

Dr. Gillinov is surgical director of the Center for Atrial Fibrillation and a staff cardiac surgeon at the Cleveland Clinic Heart Center. He is board-certified by the American Board of Surgery and the American Board of Thoracic Surgery. He received his M.D. from Johns Hopkins University School of Medicine, and performed his clinical and advanced training in general surgery and cardiac and thoracic surgery at The Johns Hopkins Hospital. He joined the staff of the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery in 1997.

His primary clinical and research interests center on mitral valve disease and atrial fibrillation, in which he has been instrumental in the development of new, less invasive approaches. He has delivered hundreds of invited lectures at hospitals, academic meetings and seminars in the United States and abroad. To his credit are more than 150 publications, four continuing medical educational films and 13 contributory chapters to medical/surgical textbooks. In addition, he holds two patents and has been very active in the scientific development of percutaneous approaches to heart valve disease. He is a recognized expert in mitral valve repair surgery and in the study and treatment of atrial fibrillation.

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Avatar_m_tn
Bob, I understand your concerns. Last year, I had an echo as part of a workup by my cardiologist (chasing some PAC's and PVC's), that showed a dilated aortic root. I had a followup CT which showed a 5cm ascending aortic aneurysm. I had surgery to graft it Feb '04. From my understanding, standard echo is the least accurate at diagnosing aortic aneurysyms, better procedures are MRI, trans-esophogeal echo (TEE), CT, and aortograms. They're doing the aortogram because they want a very clear picture of your arch and ascending aorta to see if you show any aneurysm, CAD has nothing to do with it. Personally, I'd want them to look at my cardiac arteries while they're at it, just to see if there are any indications of blockage. When they did me, the day before surgery they did an angiogram/aortogram, and I was glad to hear they saw no evidence of CAD.

Be glad they're checking you out. Aortic aneurysm is a silent killer and if it dissects, you're much worse off than if they detect it early and fix it. I'm back to a very active family and athletic life with relatively low impacts as a result of my surgery. I was as wound-up as you are, but try to relax and wait for the test results. The fact that your MRI was clean is a very positive sign.
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Avatar_n_tn
I am interested in the Doctor's thoughts....but I have to work that day.  If you will be participating, let me know what he says about percutaneous mitral valve repairs.  That would have been wonderful in my situation but instead I went down a very bad path and will live with the effects forever.  Thanks if you can.
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21064_tn?1309312333
Hi Dotty!

I'm not sure if I will be participating since I do not have AF. However, if I do not have to work, and I end up registering, I will DEFINITELY ask about "percutaneous mitral valve repairs". Anything in particular that I should ask?  Because I face the possibility of MR surgery, I'm also interested in ongoing techniques for repair/replacement. As I recall you had two valve surgeries, and I know it was a very diffuclt year. I will ask whatever I can to help : )

connie
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Avatar_n_tn
Connie,

Yes, I have had two very difficult years.  Two open heart surgeries and many other procedures and now congestive heart failure etc. etc.  I just want to know if they are at a point of being able to repair the MV percutaneously.  I think that may have been very important in my situation if that had been possible.  This won't help me but I am just interested in where they are with this and if this is even a possibility.  I am sure it isn't possible in all MV situations but maybe in earlier stages of the disease it may be worthwhile to explore.
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