To the Editor,
In the article titled "Thrombosed Congenital Aneurysm of the Membranous Interventricular Septum" by Ana Garrido Martín and José M. Oliver,1 the text states: "Although it has been speculated that membranous septum aneurysms may be an intracardiac source of emboli, this is the first case to our knowledge in which transesophageal echocardiography has detected a thrombosed aneurysm of the membranous interventricular septum."
Firstly, we believe that a cause-effect relationship between thrombosis in membranous septal aneurysms and embolic events has already been established. The relationship has been demonstrated in published cases that contain echocardiographic images of thrombus in membranous septal aneurysms in patients who had cerebral embolic events and who underwent operations in which the thrombus and the aneurysm were confirmed and corrected.2,3
Secondly, although transthoracic echocardiography was used for echocardiographic diagnosis in the first published cases,4 transesophageal echocardiography was already being employed for disease verification when more recent cases were published.2,3
Given this cause-effect relationship between aneurysm in the membranous septum and cerebrovascular accidents, it has been proposed that these aneurysms should be resected surgically in patients in whom cerebral emboli occur despite anticoagulant therapy, even when there is no echocardiographic evidence of thrombus.5