DK2985_C000 1..28 - AlSharqia Echo Club

Intracavitary Contents 503artery catheterization, pacemaker insertion, or when cardioplegiais given into the CS (see Fig. 6.23).II.ATRIAL SEPTAL ANEURYSMThe presence of an atrial septal aneurysm is found in 1% ofadults at autopsy. The redundancy of the atrial septum maypresent as a fixed protruding bulge or a mobile aneurysm.By definition, the deviation of the septum from the medianplane should exceed at least 11 mm while the base of theaneurysm should measure at least 15 mm (8). In the caseof mobile aneurysms, the excursion of the septummeasured from the extreme right to the extreme leftshould reach at least 15 mm. When the atrial septal aneurysmis fixed, the septum is usually deviated towards theatrium with the lower atrial pressure. Mobile atrial septalaneurysms exhibit a phasic excursion alternatively to theright and to the left as the pressure gradient between thetwo atria varies according to respiration and the phase ofthe cardiac cycle. Atrial septal aneurysms are usuallyfound in the area of the fossa ovalis. In many cases,these aneurysms represent an incidental finding (Fig. 23.9).They have been associated with an increased risk ofembolic events as thrombus may form within the concavityof the aneurysm. Some degree of shunt can beseen in up to 90% of cases with the theoretical associatedrisk of paradoxical embolus: therefore the presence of ashunt at the atrial level should always be sought (8).This is particularly important in young patients presentingwith unexplained peripheral or cerebral emboli. The bestview for identifying an atrial septal aneurysm by TEE isthe bicaval long-axis view at the level of the atrialseptum at an angle of 90–1108. The atrial septal aneurysmcan also be visualized in the mid-esophageal four-chamberview at 08 (Fig. 23.9).III.PRIMARY CARDIAC NEOPLASMTumors in the heart most often represent metastases fromother primary neoplasms, while primary cardiac tumorsare much less common with a prevalence of 0.02%reported in a large autopsy series (9). Benign tumorsaccount for 75% of all primary cardiac tumors, threetimes as frequent as malignant tumors. Myxoma, themost common benign tumor, has an incidence of 0.5per million population per year. On the other hand, themajority of malignant primary cardiac tumors are constitutedby sarcomas. While tumors involving the heartmay be intracavitary, intramural, or extracardiac, mostatrial tumors present as an intracavitary mass, whereasventricular tumors are more commonly intramural(Fig. 23.10).(A)(B)IAS ANEURYSMLARALVRV(C)Figure 23.9 (A, B) A 57-year-old woman with atrial septal aneurysm. (C) A contrast study was obtained to rule out suspectedinteratrial communication (IAS, interatrial septum; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle).