Analysis of 15 Cases of Patent Foramen Ovale Complicated with Atrial Septal Lambl’s Excrescences Diagnosed by Three-Dimensional Transesophageal Echocardiography

Abstract

Objective: To observe linear echoes on the right atrial side of the atrial septum in patients with patent foramen ovale using three-dimensional transesophageal echocardiography, and to explore their pathogenesis and diagnostic value. Methods: A retrospective analysis was conducted on 1013 patients diagnosed with patent foramen ovale by transesophageal echocardiography from March 2020 to September 2025. Under TEE, the atrial septum structure, foramen ovale tunnel length, bilateral opening sizes, and abnormal echo attachments were observed. Results: Among 1013 patients, 15 (1.48%) showed linear isoechoic structures fluttering on the right atrial side of the atrial septum. TEE revealed isoechoic attachments at the fossa ovalis that swung with the cardiac cycle: 12 patients had single and 3 had multiple excrescences, ranging from 1.9 mm×1.3 mm to 5.3 mm×2.3 mm. All 15 patients received dual antiplatelet therapy; 3-month follow-up TEE showed no significant changes in morphology, size, or location. Subsequent interventional procedures were performed, with no embolism or adverse events during follow-up. Conclusions: Patent foramen ovale complicated with right atrial linear echoes has low incidence. The ultrasound manifestations and pathogenesis closely resemble Lambl’s excrescences, suggesting these are non-thrombotic and non-infectious. Transesophageal echocardiography can sensitively detect such excrescences, offering important value for diagnosis and clinical treatment guidance.