Is a small interatrial septal aneurysm with right to left shunting always patched?

Depends: The opening can lead to blood clots from the leg veins go to the right heart, then the left heart and then to brain, causing a stroke. It makes to have it closed. Some experts recommend closure after the first stroke to prevent more strokes. However, it makes sense to have closure to prevent the first stroke. Maybe you never get a leg vein clot? Discuss with your doc.

You'll be fine: As long as no other medical problems, this should pose no threat to you. Even if you needed heart surgery for something else, this should not be fixed as recent studies show the treatment is worse than the disease. I would plan to have it followed by echo periodically. Again, a small assymptomatic ASD with atrial septal aneurysm is not a problem to worry about.

It depends: Typically a patent foramen ovale with intra-atrial septal aneurysm is closed if a patient has had a blood clot transit through the defect. This typically manifests as a stroke or other embolic event. If you have not had any embolic events treatment with Aspirin is all that is necessary. If you have had an event you should be on a blood thinner or consider having the defect closed. Good luck.