Inter-Atrial Septal Aneurysm Ala M-Mode!

The above transesophageal echocardiogram (TEE) images were obtained as part of work-up for a cardiac source of embolus in a patient with stroke. The midesophageal view in figure A revealed a highly mobile interatrial septal aneurysm (IASA) with spontaneous right to left bubble shunting indicative of a patient foramen ovale (PFO). The IASA mobility is further demonstrated using TEE m-mode in the midesophageal view in figure B, revealing an exaggerated excursion of the fossa ovalis exceeding 1.5 cm. The aneurysmal fossa ovalis with a small superior communication is again demonstrated in the deep stomach view in figure C, while color flow Doppler across the septum in figure D demonstrated spontaneous left to right shunting.