Ysabel Cecilia López-AldazoroClínica San Miguel, Spain
Title: Atrial septal aneurysm in identical twins
Introduction: Interatrial septal aneurysm (ISA) is a dilatation of saccular tissue, generally located in the foramen ovale area, which moves freely and protrudes into the right or left atrium, or even both. Today it is estimated that 85% of children born with congenital heart disease survive to adulthood, however, we have not found cases of ISA reported in identical twins in adulthood.
Methods: Two 55-year-old female patients, identical twins (EAM and RAM), height, 69 and 70.25 ins., weight, 164 and 145 lbs., body surface area, 1,899 and 1,826 m2 respectively, consulted for elevated blood pressure (160/90 and 160/95 mmHg respectively). One of them reported headache accompanied by joint pain and mild dyspnea, the other patient reported palpitations and mild dizziness. His parents are hypertensive. They were hospitalized at 5 months of age due to viral meningitis, with no further consequences. Antihypertensive treatment, laboratory, stress test, and echocardiogram/Doppler were prescribed.
Results: Laboratory tests were found to be normal. The stress test (protocol: Bruce) was reported to be negative for induced myocardial ischemia. The echocardiographic / Doppler results are observed in table # 1 and figure # 1-4.
Conclusions: Twins, particularly monochorionic twins, are at increased risk of congenital anomalies compared with singleton pregnancies, and the risk of cerebrovascular disease (CVD) or transient ischemic attack (TIA) in patients with ISA is 6.7% in adult patients. ISA has been associated with acquired cardiac diseases, such as valvular heart disease, cardiomyopathies, pulmonary and systemic hypertension, ischemic heart disease, arrhythmias, and thrombus formation. More recently, an association with embolic cerebrovascular pathology has been observed, both in TIA and CVD. For this reason, we consider that in adult patients who are identical twins when one of them is found with ISA, an evaluation should be carried out in their twin for its appropriate treatment and thus avoid future cardiovascular complications derived from this anomaly. According to our reviews, this is the first case of ISA in identical twins. New observations on ISA in twins are needed.