Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

GRADING OF ATRIAL SEPTAL ANEURYSMS (ASA) (15 mm of the atrial septum extending 15 mm into either atrial chamber)1

|Download (.pdf)|Print
Type Description
1R The atrial septal aneurysm (ASA) protrudes from the midline of the atria to the right atrium throughout the cardiorespiratory cycle
2L The ASA protrudes from the midline of the atrial septum to the left atrium throughout the cardiorespiratory cycle
3RL The maximal excursion of the ASA is toward the right atrium with a lesser excursion toward the left atrium
4LR The maximal excursion of the ASA is toward the left atrium with a lesser excursion toward the right atrium
5 The ASA movement is bidirectional and equidistant to the right as well as to the left atrium during the cardiorespiratory cycle


|Download (.pdf)|Print
Grade Severity Description
1 Normal Intimal thickness <2 mm
2 Mild Mild (focal or diffuse) intimal thickening of 2–3 mm
3 Moderate Atheroma >3–5 mm (no mobile/ulcerated components)
4 Severe Atheroma >5 mm (no mobile/ulcerated components)
5 Complex Grade 2, 3, or 4 atheroma plus mobile or ulcerated components


|Download (.pdf)|Print
Type Description
I Attachment site leak
A Proximal leak
B Distal leak
C Iliac occluder
II Branch leaks
A To-and-fro simple flow from branch vessel into aneurysmal sac
B Complex flow through two or more branch vessels into the aneurysmal sac
III Graft defect
A Midgraft hole
B Junctional leak or graft disconnection
C Other mechanisms (e.g., failure from suture holes)
IV Graft wall porosity


|Download (.pdf)|Print
End-diastolic Separation of Pericardial Layers (mm) Grade Volume (mL)
<10 Small 50–100
10–20 Moderate 100–500
>20 Large >500

Normal pericardial thickness: 1 to 2 mm


1. +
Olivares-Reyes A, Chan S, Lazar EJ. Atrial septal aneurysms: A new classification in two-hundred five adults. J Am Soc Echocardiogr. 1997;10:644–656.  [PubMed: 9282354]
2. +
Goldstein SA, Evangelista A, Abbara S,  et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2015;28(2):119–182.  [PubMed: 25623219]
3. +
Veith FJ, Baum RA, Ohki T,  et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002;35(5):1029–1035.  [PubMed: 12021724]
4. +
Klein AL, Abbara S, Agler DA,  et ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.