Association between Atrial Septal Aneurysm and Patent Foramen ovale in Young Patients with Recent Stroke and Normal Carotid Arteries

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.

Download Full-text

Patent foramen ovale in a cohort of young patients with cryptogenic ischemic stroke

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2005000300012 ◽

2005 ◽

Vol 63 (2b) ◽

pp. 427-429 ◽

Cited By ~ 3

Author(s):

Marcus Tulius T. Silva ◽

Roíza Rodrigues ◽

João Tress ◽

Rosaura Victer ◽

Francisco Chamiê

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Young Patients ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Surgical Closure ◽

Small Series ◽

Percutaneous Device ◽

Ischemic Events

OBJECTIVE: Although its role is a matter of debate, some studies described a higher prevalence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in young stroke patients, with higher risk with PFO / ASA association (OR 4.96). The aim of this study was determine the prevalence of PFO and ASA in a cohort of cryptogenic ischemic stroke (IS) patients younger than 55 years and to follow-up after surgical or percutaneous endovascular closure (PEC). METHOD: In 21 months we identified all patients less than 55 years old with IS who were admitted to our hospital. Cryptogenic IS was considered if there is not an identifiably cause to cerebral ischemia. Transesophageal echocardiography (TEE) was performed in all patients. After interatrial septal abnormalities diagnosis, percutaneous device closure was offered to all. Patients were followed monthly and keeped with oral AAS or Clopidogrel. RESULTS: We identified 189 patients with IS and 32 were less than 55 years old (16.9%). In 29 the IS was cryptogenic. TEE was performed in all patients and some form of interatrial septal abnormality was identified in 12 (12/29 - 41.3%); 5 had a PFO and in 7 there was PFO plus ASA. Ten patients were submitted to PEC and 2 were submitted to surgical closure. In mid-term follow-up (28 months) no ischemic events occurred and 2 patients related disappearance of migraine symptoms. CONCLUSION: Our small series description is in accordance with other studies and suggests a possible relation between interatrial septal abnormalities and IS in a cohort of young patient.

Download Full-text

P559 Mitral valve prolapse and atrial septal aneurysm in young patients with stroke and normal carotid arteries

European Heart Journal ◽

10.1016/s0195-668x(03)93997-2 ◽

2003 ◽

Vol 24 (5) ◽

pp. 92

Author(s):

A MATTIOLI

Keyword(s):

Mitral Valve ◽

Mitral Valve Prolapse ◽

Carotid Arteries ◽

Young Patients ◽

Atrial Septal Aneurysm

Download Full-text

476 Presence of concomitant atrial septal aneurysm is associated with multiple acute cerebral ischemic lesions in cryptogenic stroke due to patent foramen ovale

European Journal of Echocardiography ◽

10.1016/s1525-2167(06)60266-7 ◽

2006 ◽

Vol 7 ◽

pp. S73-S73

Author(s):

A KESSELSCHAEFER ◽

L BONATI ◽

S ENGELTER ◽

P LYRER ◽

D TOBLER ◽

...

Keyword(s):

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Cerebral Ischemic

Download Full-text

Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both

ACC Current Journal Review ◽

10.1016/s1062-1458(02)00641-4 ◽

2002 ◽

Vol 11 (3) ◽

pp. 93

Author(s):

J.L. Mas ◽

C. Arquizan ◽

C. Lamy ◽

M. Zuber ◽

L. Cabanes ◽

...

Keyword(s):

Patent Foramen Ovale ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Cerebrovascular Events

Download Full-text

Dramatic decrease in the pulmonary artery systolic pressure and disappearance of the interatrial shunt with sildenafil treatment in a patient with primary pulmonary hypertension with atrial septal aneurysm and a severe right to left shunt through the patent foramen ovale

International Journal of Cardiology ◽

10.1016/j.ijcard.2005.05.076 ◽

2006 ◽

Vol 110 (1) ◽

pp. 97-99 ◽

Cited By ~ 5

Author(s):

Osman Karakaya ◽

Nihal Özdemir ◽

Cihangir Kaymaz ◽

Irfan Barutcu

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Patent Foramen Ovale ◽

Primary Pulmonary Hypertension ◽

Systolic Pressure ◽

Pulmonary Artery Systolic Pressure ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Dramatic Decrease ◽

Interatrial Shunt

Download Full-text

Atrial Septal Aneurysm and Patent Foramen Ovale Are Less Prevalent in the Indo-Asian Than in the Caucasian or Afro-Caribbean Population

Angiology ◽

10.1177/0003319709339590 ◽

2009 ◽

Vol 61 (2) ◽

pp. 205-210 ◽

Cited By ~ 6

Author(s):

Abdul-Majeed Salmasi ◽

Huda Salmasi ◽

Sara Rawlins ◽

Mustapha Baakil ◽

Mark Dancy

Keyword(s):

Patent Foramen Ovale ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Caribbean Population

Download Full-text

Abstract 2922: Patent Foramen Ovale Is A Cause Of Ischemic Stroke In Patients With Antiphospholipid Syndrome

Stroke ◽

10.1161/str.43.suppl_1.a2922 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Yoshiaki Shimada

Keyword(s):

Ischemic Stroke ◽

Antiphospholipid Syndrome ◽

Patent Foramen Ovale ◽

Multiple Logistic Regression Analysis ◽

Cryptogenic Stroke ◽

Control Group ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Stroke Patients ◽

Significant Difference

Background: The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial and/or venous thrombosis and recurrent fetal loss, and can be an independent risk factor for a first-ever ischemic stroke especially in young female patients. Patent foramen ovale (PFO) has been established as a cause of cryptogenic stroke. Atrial septal aneurysm (ASA) is associated with PFO. Until recently, the precise pathophysiology of APS as causing ischemic stroke has been essentially unknown. In the present study, we investigated the relationship between APS and potential embolic sources including PFO and ASA using transesophageal echocardiography (TEE). Methods: This study was a retrospective case series design. From July 2006 to June 2008, 120 patients with ischemic stroke who admitted to Juntendo University Hospital underwent TEE. In this study period, consecutive ischemic stoke patients diagnosed as APS based on the modified Sapporo criteria were enrolled and classified into APS group. Controls were selected among age- and gender-matched stroke patients without APS who also underwent TEE. We assessed clinical characteristics and presence of embolic sources including PFO and atrial septal aneurysm (ASA) between APS and Control groups. Results: Nine of ischemic stroke patients with APS and 41 controls were included. Primary APS was present in one patient (11.1%) of the APS group, and APS with SLE were found in eight patients (88.9%). There is no significant difference in age, risk factors for ischemic stroke, and MRI findings between two groups. The prevalence of PFO and ASA were significantly higher in APS group compared to Control group (89% vs 41%, P=0.027; 67% vs 20%, P=0.015, respectively). C reactive protein was relatively higher in APS group. Multiple logistic regression analysis showed that PFO (OR: 13.71; 95% CI: 1.01 to 185.62; P=0.049) and ASA (OR: 8.06; 95% CI: 1.17 to 55.59; P=0.034) were independently associated with the APS group. Conclusion: Atrial septal abnormalities including PFO and ASA are strongly associated with APS group, and could be potential embolic sources in ischemic stroke patients with APS.

Download Full-text