Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism: How to turn a procedure to a challenge
Kawtar Afrikh, Nadia Fellat, Rokya Fellat
Patients with Atrial Septal Aneurysm (ASA) associated with Patent Foramen Oval (PFO) are at higher risk for recurrent paradoxical embolism compared to patients with PFO alone. The ASA may increase the PFO diameter due to the highly mobile atrial septal tissue, leading to a more frequent and wider opening of an otherwise small channel. Atrial septal aneurysm has been also considered a nidus for local thrombus formation with subsequent embolization. Transcatheter treatment of ASA associated with PFO is safe and effective in patients with paradoxical embolism. The procedure effectively abolishes right-to-left shunt and decreases atrial septal mobility. But, the procedure is not free of difficulties and complications. We report the case of a 48 years old man, with recurrent stroke, related to the presence of a PFO with a huge ASA, to show the difficulty of occlusion of this defect. The procedure was performed under general anesthesia to allow continuous multiplane transoesophageal imaging of the atrial septum and related structures. Stretched diameter of the PFO was determined by TOE measures. The availability of one type of occluder (Amplatzer PFO Occluder), the importance of the aneurysm, and the impact of the importance of aneurysm on the inconstant and variable size of the PFO may be causing difficulties during the procedure and turn the procedure to a challenge.