Pearson A C, Nagelhout D, Castello R, Gomez C R, Labovitz A J
Department of Internal Medicine, Ohio State University Hospital, Columbus.
J Am Coll Cardiol. 1991 Nov 1;18(5):1223-9. doi: 10.1016/0735-1097(91)90539-l.
The prevalence and morphologic characteristics of atrial septal aneurysms identified by transesophageal echocardiography in 410 consecutive patients are described. Two groups of patients were compared: Group I consisted of 133 patients referred for evaluation of the potential source of an embolus and Group II consisted of 277 patients referred for other reasons. An atrial septal aneurysm was diagnosed by transesophageal echocardiography in 32 (8%) of the 410 patients. Surface echocardiography identified only 12 of these aneurysms. Atrial septal aneurysm was significantly more common in patients with stroke (20 [15%] of 133 vs. 12 [4%] of 277) (p less than 0.05); right to left shunting at the atrial level was demonstrated in 70% of patients in Group I and 75% of patients in Group II by saline contrast echocardiography. Four patients in Group I had an atrial septal defect with additional left to right flow. There was no difference between the two groups in aneurysm base width, total excursion or left atrial or right atrial excursion. However, Group I patients had a thinner atrial septal aneurysm than did Group II patients. It is concluded that an atrial septal aneurysm occurs commonly in patients with unexplained stroke, is more frequently detected by transesophageal echocardiography than by surface echocardiography and is usually associated with right to left atrial shunting. Treatment (anticoagulant therapy vs. surgery) of atrial septal aneurysm identified in stroke patients can be determined only by long-term follow-up studies.
本文描述了连续410例患者经食管超声心动图检查发现的房间隔瘤的患病率及形态学特征。将两组患者进行了比较：第一组由133例因评估潜在栓子来源而转诊的患者组成，第二组由277例因其他原因转诊的患者组成。410例患者中，经食管超声心动图诊断出32例（8%）房间隔瘤。体表超声心动图仅发现其中12例。房间隔瘤在中风患者中明显更常见（133例中有20例[15%]，而277例中有12例[4%]）（p<0.05）；通过盐水对比超声心动图，第一组70%的患者和第二组75%的患者在心房水平存在右向左分流。第一组中有4例患者存在房间隔缺损并伴有额外的左向右分流。两组在瘤体基部宽度、总偏移量或左心房或右心房偏移量方面无差异。然而，第一组患者的房间隔瘤比第二组患者的更薄。得出的结论是，房间隔瘤常见于不明原因中风的患者中，经食管超声心动图比体表超声心动图更常检测到，且通常与心房右向左分流相关。中风患者中发现的房间隔瘤的治疗（抗凝治疗与手术治疗）只能通过长期随访研究来确定。
