We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.
Atrial Septum ; Korea ; Myxoma* ; Recurrence*

Atrial Septum ; Heart Neoplasms ; Humans ; Osteosarcoma

Double atrial septum is very rare atrial septal malformation which has double layered atrial septum with persistent interatrial space between the two atria. Clinically, most cases of this anomaly are asymptomatic unless manifest as thromboembolic complications, such as stroke, or transient ischemic attack, that thrombus may be originated from this interatrial space. We report a case of a 69-year-old man who was diagnosed with isolated double atrial septum by transthoracic echocardiography.
Aged ; Atrial Septum* ; Echocardiography ; Humans ; Ischemic Attack, Transient ; Stroke ; Thrombosis

The diagnosis of atrial septal defect by transthoracic echocardiography remains difficult in a small subset of patients because of either suboptimal acoustic windows or unusual anatomy, for example, fenestrated defects. wer report the case of a 52-year-old woman with a fenestratdd atrial septal aneurysm that was incompletely visualized by transthoracic echocardiography. Subsequent transesophageal echocardiography demonstrated atrial septal defect and two fenestrations within the atrial septal aneurysm with left-to-right shunting. All echocardiographic findings were confirmed at surgery. This case demonstrates the addinional diagnostic accuracy of transesophageal echocardiography for detecting disease of the atrial septum.
Acoustics ; Aneurysm* ; Atrial Septum ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Atrial* ; Humans ; Middle Aged

Atrial Septal Defect(ASD) is usually suspected clinically but requires a confirmative diagnostic procedure before surgical repair. Conventional transthoracic echocardiography has relatively high sensitivity and specificity for ASD, but difficulty in visualizing the ASD occasionally. Transesophageal echocardiography has special advantages for investigating the posteriorly located cardiac structures, including the atrial septum, which is imaged perpendicularly at a relatively short distance. We describe a case in which ostium secundum ASD was not visualized by conventional transthoracic echocardiography, but was diagnosed confidently by transesophageal echocardiography. It is concluded that transesophageal echocardiography appears to be a promising diagnostic tools for the evaluation of ASD on the basis of its ability to provide excellent imaging of the entire atrial septum and related posterior cardiac structures.
Atrial Septum ; Echocardiography ; Echocardiography, Transesophageal* ; Heart Septal Defects, Atrial* ; Sensitivity and Specificity

To evaluate the morphology of atrial septum by the live three-dimensional echocardiography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneurysm, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.
Atrial Septum/*ultrasonography ; Echocardiography, Three-Dimensional/*methods ; Heart Septal Defects, Atrial/*pathology ; Heart Septal Defects, Atrial/*ultrasonography ; Young Adult

PURPOSE: Accurate measurement of defect size is important in transcatheter closure of atrial septal defect (ASD). We performed this study to analyze the difference between the measured ASD size and balloon occlusive diameter (BOD) by transthoracic (TTE) or transesophageal echocardiography (TEE). METHODS: We investigated 78 patients who underwent transcatheter closure of ASD. The defect size and the distance between the surrounding structures were measured by TTE and TEE. The BOD was measured by TEE during cardiac catheterization. Clinical characteristics and echocardiographic data were compared and analyzed. RESULTS: The difference between BOD and diameter by TTE was 4.8+/-3.6 mm on short axis view, 5.4+/-3.2 mm on long axis view. The difference between BOD and diameter by TEE was 3.6+/-2.2 mm on short axis view, 4.2+/-3.1 mm on long axis view. The difference between BOD and the diameter of defects on TTE, TEE had statistically significant positive correlations with the age of the patients, distance between the, defect and posterior atrial septal wall, the distance between the defect and the mitral valve leaflet, and the diameter of defects and the length of the atrial septum on TTE (P<0.05). CONCLUSION: BOD of ASD can be estimated by the diameter on TTE and TEE. BOD is expected to measure larger, depending on the size of defects, the distance from surrounding structures and the location of defects on echocardiography. Our data offers important information on details of transcatheter ASD closure which can be helpful in predicting suitability and judging the procedural appropriateness during the procedure.
Atrial Septum ; Axis, Cervical Vertebra ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Echocardiography, Transesophageal* ; Heart Septal Defects, Atrial* ; Humans ; Mitral Valve

A life-long anticoagulation for the prevention of ischemic cerebral events by thromboemboli has been conventionally introduced for the treatment of an atrial septal aneurysm. However, due to the recent decrease of the risks in the open heart surgery, the alternative therapeutic modality has been introduced for the prevention of complications of the anticoagulation. A 41-year old female with dizziness was admitted to our hospital. She was diagnosed a shaving atrial fibrillation and a cerebellar infarction, and an atrial septal aneurysm was detected by transesophagel echocardiography that was not detected by the transthoracic echocardiography. Surgery was approached to the right submammarial anterolateral thoracotomy. The atrial septal aneurysm was obliterated by a purse-string suture and plication. Surgial results were excellent with normal sinus rhythms and esthetically satisfying appearance.
Adult ; Aneurysm* ; Atrial Fibrillation ; Dizziness ; Echocardiography ; Female ; Heart Septum ; Humans ; Infarction ; Sutures ; Thoracic Surgery ; Thoracotomy

The AV node is a structure in the atrial septum at the atrioventricular junction. The atrial septum is important for various types of supravenricular arrgythmia especially for AV node reentrant tachycardia. In this study, it was aimed to understand the electrical propagation in the atrium and the atrial septum, as well as the effects of perinodal cryosurgery. Eleven mongrel dogs weighing between 26.0kg and 34.5kg were divided into control(d dogs) and cryosurgery(6 dogs) group. The animals were anesthetized with pentobarbital sodium(30 mg/kg) and under a normothermic total cardiopulmonary bypass, endocardial template electrodes(left atrium ; 124, right atrium; 128 bipolar electrodes) were placed into the both atria. The endocardial electrocal activation was recorded using a 256 channel computerized mapping system during normal sinus rhythm, atrial pacing, and ventricular pacing. For the cryosurgery group, the endocardial electrical activation was recorded after eight weeks of discrete perinodal cryosurgery. The results are as followings : 1) The electrical propagation from the SA node to the AV node occurred mainly through thick muscle band of the crista terminalis of the right atrium and anterior limbus fossa ovalis. 2) Electrophysiologically, the atrial septum appeared to be 2 layers. 3) During ventricular pacing, the center of the Koch triangle was the first to respond to activation. When the atrial septum of the AV nodal area was activated, the electrical activations propagated asymmetrically and the activity of the left atrium was propagated through the Bachmann's bundle. The left atrial side of the atrial septum was activated 10-15 msec later than the right side during ventricular pacing. 4) The cryosurgery did not change any significant difference in the AH, HV, AV node effective refractory period and AV node Wenckebach period. However, the ventriculo-atrial conduction was blocked in 50% of the animals. 5) In cryosurgery group, the electrical propagation from the SA nodal area to both atrial was similar to the control group except along side the vertical right atrial incision site. 6) The endocardial activation map in the cryosurgery group showed that the activation was spread out from the lateral atrial tissue outside of the cryolesions. The left atrial side of the atrial septum was was activated 6-19 msec later than the right atrial side. In conclusion, electrophysiologically the atrial septum appears to be composed of 2 layers and there is no direct electrical propagation between the AV node and the left atrial side of the atrial septum. The cryosurgery did not influence the electrial activation sequence from the SA node to the AV node except the site of cryolesion.
Animals ; Atrial Septum* ; Atrioventricular Node ; Cardiopulmonary Bypass ; Cryosurgery* ; Dogs ; Heart Atria ; Pentobarbital ; Tachycardia

BACKGROUND AND OBJECTIVES: Pressure monitoring and injection of contrast media after piercing the fossa ovalis are used to avoid life-threatening complications during transseptal procedures. However, when performing those maneuvers, the information provided can only be obtained after having pierced structures that may not have been the intended target. When we injected the contrast media through a Brockenbrough needle before piercing the fossa, the dye that had collected under the membranous septum tented by the transseptal equipment (tenting) was observed on the left anterior oblique (LAO) projection and this indicated the fossa ovalis. This study was performed to evaluate the usefulness and safety of tenting in order to identify the membranous septum during transseptal procedures. SUBJECTS AND METHODS: Contrast injections were performed on the fossa ovalis and the septal wall surrounding it during 64 transseptal procedures. The rates of dye staining and tenting in both the muscular and membranous septums were compared. RESULTS: No areas of the muscular septum exhibited any tenting. Various rates of dye staining of those areas were observed. However, the membrane of the fossa exhibited tenting without dye staining in all 64 cases. The sensitivity of the tenting without dye staining to identify the Fossa was 98%, and the specificity was 100%. CONCLUSION: Tenting without dye staining could differentiate the membranous septum from the muscular one with high diagnostic accuracy. This method could be used as a safe landmark for the fossa ovalis before piercing it during transseptal procedures.
Atrial Septum ; Contrast Media ; Heart Atria ; Membranes ; Needles ; Punctures ; Sensitivity and Specificity