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A 15 year old active female with a clinical transient ischaemic attack was referred to our institute to rule out a cardioembolic origin to the episode. Magnetic resonance (MR) imaging revealed a mobile atrial septal aneurysm into the right atrium during systole with a 17 mm protrusion beyond the plane of the interatrial septum and a diameter of the base of aneurysm portion of the interatrial septum of 16 mm (panels A and B, videos 1 and 2: to view video footage visit the Heart website—http://www.heartjnl.com/supplemental). The use of high resolution cine gradient echo sequence is particularly sensitive for detecting slow flow and is able to differentiate it from a mass. The aneurysm of the fossa ovalis in this sequence showed slow flow and it might indicate the possibility of formation of thrombi in the saccular cavity (panel A)
Aneurysm of the fossa ovalis is a protruding, space occupying, atrial septal structure clinically identified by serial imaging modalities. An association between atrial septal aneurysm and focal cerebral ischaemic events (stroke and transient ischaemic attack) has been suggested. Nevertheless, the role of aneurysm of the fossa ovalis as a risk factor for cerebral ischaemia is poorly defined. MR imaging techniques such as phase contrast sequences allow quantification of blood velocity profiles through these septal defects at different times during the cardiac cycle.
To view video footage visit the Heart website—http://www.heartjnl.com/supplemental