Author + information
- Received January 15, 2010
- Accepted February 4, 2010
- Published online November 23, 2010.
A 76-year-old woman presented with acute lower limb ischemia. Transthoracic echocardiography showed highly mobile structures present in both atria. Transesophageal echocardiography (TEE) demonstrated a single fusiform mass straddling the interatrial septum (A)and extending through both the mitral (B)and the tricuspid valve (C, white arrows). Repeat TEE following 6 months of anticoagulation revealed a 3-mm secundum atrial septal defect (D, Online Videos 1A, 1B, 1C, and 1D). Paradoxical embolism is well described in the presence of patent foramen ovale. A possible association with atrial septal defects was recently raised in a retrospective study (1). This report brings confirmatory evidence to support this association. This could have management implications in a subgroup of patients with atrial septal defect. In this case, we prescribed lifelong oral anticoagulation.
- Received January 15, 2010.
- Accepted February 4, 2010.
- American College of Cardiology Foundation