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Aneurysm bulges continually to the right atrium


Aneurysm predominantly bulges to the right atrium but has a phasic oscillation into the left atrium during the cardiorespiratory cycle


Aneurysm that oscillates between the right and left atrial chambers with each cardiac cycle


Aneurysm protruding exclusively into the left atrium


Class 1

No or minimal intimal thickening <3 mm

Class 2

Intimal layer thickness >3 mm

Class 3

Protruding atheroma <5 mm

Class 4

Protuding atheroma >5 mm

Class 5

Protuding atheroma >5 mm with a mobile fragment




<0.5 cm


0.5-2 cm


>2 cm

Normal pericardial thickness:1 to 2 mm.

1. Hanley PC, Tajik AJ, Hynes JK, et al. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol. 1985;6:1370-1382.  [PubMed: 4067118]
2. Katz ES, Tunick PA, Rusinek H, Ribakove G, Spencer FC, Kronzon I. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol. 1992;20:70-77.  [PubMed: 1607541]

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