P

LA i

Subcostal

Shunt Interatriale

Fig. 7. (A) Parasternal short-axis (PSAX) and apical four-chamber views (A4C) show flow acceleration and left-to-right shunt across this secundum atrial septal defect on color Doppler examination. (B) Color flow Doppler applied to the interatrial septum from the subcostal window shows left-to-right shunt across interatrial septum. This view provides a better alignment for Doppler evaluation of shunt flow. (C) Continuous-wave Doppler examination of the atrial septal defect. Peak velocity of the left-to-right shunt across the defect was 1.3 m/s corresponding to peak gradient of 7.0 mmHg. (Please see companion DVD for corresponding video.)

Fig. 8. (A) Apical four-chamber frames showing hypermobile interatrial septum. (B) Parasternal short axis views showing hypermobile interatrial septum. (C) Color flow Doppler interrogation of hypermobile interatrial septum in A and B revealed transient left-to-right shunt (arrow) via a patent foramen ovale.

Interatrial Septum Short Axis

Fig. 8. (A) Apical four-chamber frames showing hypermobile interatrial septum. (B) Parasternal short axis views showing hypermobile interatrial septum. (C) Color flow Doppler interrogation of hypermobile interatrial septum in A and B revealed transient left-to-right shunt (arrow) via a patent foramen ovale.

the venous system to lodge in the systemic arteries, although the actual passage of a thromboembolus through a PFO is only rarely captured on echocardiography views (Fig. 9; please see companion DVD for corresponding video). The incidence of PFO appears to be higher in patients with ischemic stroke, exceeding threefold higher in patients younger than 55 yr old.

An atrial septal aneurysm (ASA) is an excessively redundant hypermobile area of the interatrial septum, which can be seen on echocardiogram (Figs. 10 and 11;

Transesophageal Echocardiography
Fig. 9. Serial transesophageal echocardiography images showing thromboembolus "in transit" (arrow) through a patent foramen ovale. (Please see companion DVD for corresponding video.)

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