C44 ATRIAL SEPTAL ABNORMALITIES: A CASE OF DOUBLE INTERATRIAL SEPTUM

Abstract The Case A 41–year–old asymptomatic male was referred to our cardiology outpatient clinic for diagnostic evaluation of a suspected bicuspid aortic valve at transthoracic echocardiography. Trans–oesophageal imaging ruled–out the valve, but detected an accessory membrane lining interatrial septum with double–layered appearance encompassing most fossa ovalis. Agitated saline infusion demonstrated inter–atrial communication right–to–left shunt under Valsalva manoeuvre. Cardiovascular magnetic resonance cine confirmed presence double featuring midline recess enclosed by two septa. Under end–expiratory breath–holding conditions, transient observed confirming echocardiographic (Panel 1). No history cerebrovascular disease and no clinical or findings right heart overload were registered. Discussion Double is rare congenital condition, morphological side, allegedly associated increased risk left–sided embolic events due blood stasis within chamber, that often found in continuity both atria through patent foramen ovale additional septal fenestrations. In this case, multimodality effectively able detect atrial abnormality distinguish from others alterations shown table below (Table Nevertheless, significance remains uncertain, clear relationship stroke known recommendation can be made regarding decision–making long–term anti–thrombotic management. High quality evidences are needed evaluate whether other abnormalities might considered as actionable factors ischemic not.