Transient cerebral ischemia in an elderly patient with patent foramen ovale and atrial septal aneurysm

Abstract

Cerebrovascular disease is one of the most common causes of cerebrovascular morbidity and mortality in developed countries; up to 40% of acute ischemic strokes in young adults are cryptogenic in nature – that is, no cause is determined. However, in more than half of these patients, patent foramen ovale (PFO) is seen along with an increased incidence of atrial septal aneurysm (ASA). The following is a report of an interesting case: a 68-year-old man with ASA and transient cerebral ischemia. Transesophageal echocardiography (TEE) showed the presence of ASA; a test with microbubbles derived from a mixture of air and saline or colloids pointed out a shunt on the foramen ovale following Valsalva’s maneuver. The patient underwent percutaneous transcatheter closure of the interatrial communication by an interventional cardiologist. TEE and transcranial Doppler or TEE with the microbubbles test are the recommended methods for detecting and quantifying intracardiac shunts, both at rest and following Valsalva’s maneuver. In patients following the first event of transient ischemic attack, and without clinical and anatomical risk factors (such as the presence of ASA, PFO, and basal shunt), pharmacological treatment with antiplatelets or anticoagulants is closely recommended. On the contrary, in patients following the first event of transient ischemic attack, or a recurrent event during antiplatelet treatment, the percutaneous closure of PFO is recommended.

Supranational (international) guidelines for management of the heart structural anomalies

“…В связи с этим уместным является представление рекомендаций целевого назначения ЧПЭхоКГ, предложенных A. Merante с соавт. [293].…”

Influence of the Valsalva maneuver on cardiac hemodynamics and right to left shunt in patients with patent foramen ovale

“…It is reported that PFO was associated with numerous disease processes including paradoxical embolism in cryptogenic stroke 4 , transient ischemic attack (TIA) 5 , latypnoea-orthodeoxia syndrome 6 , decompression sickness, migraine with aura and other venoarterial embolic phenomena 7 . Transcranial Doppler and transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) with the micro-bubbles test were commonly used methods to detect right-to-left shunt both at rest and during the Valsalva maneuver 8 9 . Since the original maneuver was first used by Valsalva in 1704, the VM has been widely used in clinical practice 10 .…”