Analysis of the interatrial septum by transesophageal echocardiography in adult cardiac surgical patients: anatomic variants and correlation with patent foramen ovale.

Objectives: The purpose of this study was to document the perioperative prevalence of anatomic variants of the interatrial septum (IAS), to classify atrial septal aneurysm based on mobility pattern, and to correlate anatomic variants of IAS with patent foramen ovale (PFO).

Design: A prospective observational study.

Setting: University hospital (single institution).

Participants: Patients presenting for cardiac surgery requiring transesophageal echocardiography.

Interventions: Multiplane TEE in 2 atrial views with color-flow Doppler and contrast echocardiography with a provocative respiratory maneuver.

Measurements And Main Results: The cohort size was 206. PFO prevalence was 30.1%. The prevalence of IAS lipomatous hypertrophy was 43.2%, atrial septal flap (ASF) 43.2%, and atrial septal aneurysm (ASA) 28.6%. ASF and ASA were significantly ( p < 0.05) associated with PFO. Selected ASA subtypes are significantly associated with PFO ( p < 0.05).

Conclusions: IAS anatomic variants are common in adult cardiac surgical patients undergoing multiplane TEE. The presence of ASF and ASA predicts enhanced PFO detection. ASA mobility patterns significantly correlate ( p < 0.05) with the presence of PFO.