No abstract

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.

Device release was achieved by manipulation on the tricuspid apparatus.

Transcatheter occlusion of sinus venosus atrial septal defecta new therapeutic option?Oclusão transcateter de comunicação interatrial do tipo seio venoso -uma nova opção terapêutica?

background: The purpose of this study was to report an early experience with the use of the new CARDIA Ultrasept TM device for the percutaneous occlusion of patent foramen ovales. Methods: Patients of any age or weight with a patent foramen ovale and previous embolic events or migraines with poor clinical control were selected by transesophageal echocardiography. The efficacy criteria included a lack of residual shunt on the transesophageal echocardiogram with microbubble testing after six months and no recurrence of neurologic events. No patients were excluded based on the morphological patent foramen ovale criteria. results: From April of 2011 to May of 2012, 22 patients (six males and 16 females) ranging in age from 16 to 68 years were submitted to the occlusion procedure. Only one patient had no history of stroke or transient ischaemic attack, instead having migraines with a poor clinical response. No patient had an atrial septal aneurysm. The device was implanted in all cases, for a total of 23 devices; the 25 mm device was most often used. Only one patient presented a residual shunt at the one-month follow-up echocardiogram and remains under observation. There have been no recurrences to date. There were two minor complications and no deaths. Conclusions: The CARDIA Ultrasept TM device is safe, effective and easy to use. It must be further evaluated in more complex cases, such as larger patent foramen ovales and in the presence of atrial septal aneurysms.