1. Transient cerebral ischemia in an elderly patient with patent foramen ovale and atrial septal aneurysm
- Author
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Alfonso Merante, Giovanni Ruotolo, Pietro Gareri, Alessandro Ferraro, Alberto Castagna, Norma Marigliano, and Mafalda Candigliota
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,Ultrasonography, Doppler, Transcranial ,Valsalva Maneuver ,medicine.medical_treatment ,patent foramen ovale ,Ischemia ,Foramen Ovale, Patent ,Case Report ,elderly ,Intracardiac injection ,Heart Septal Defects, Atrial ,percutaneous closure ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Valsalva maneuver ,Humans ,cardiovascular diseases ,Heart Aneurysm ,Aged ,business.industry ,Incidence ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Transcranial Doppler ,Surgery ,Ischemic Attack, Transient ,Patent foramen ovale ,Cardiology ,transient cerebral ischemia ,Geriatrics and Gerontology ,business ,Echocardiography, Transesophageal ,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.
- Published
- 2015