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

Authors Merante A, Gareri P, Castagna A, Marigliano NM, Candigliota M, Ferraro A, Ruotolo G

Received 2 January 2015

Accepted for publication 1 April 2015

Published 7 September 2015 Volume 2015:10 Pages 1445—1449

DOI https://doi.org/10.2147/CIA.S80190

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Richard Walker

Alfonso Merante,1 Pietro Gareri,2 Alberto Castagna,2 Norma Maria Marigliano,3 Mafalda Candigliota,4 Alessandro Ferraro,4 Giovanni Ruotolo1

1Geriatric Unit, “Pugliese-Ciaccio” Hospital, 2Azienda Sanitaria Provinciale (ASP), Catanzaro, 3SERT Taranto, ASL Taranto, 4Intensive Cardiology Unit, “Pugliese-Ciaccio” Hospital, Catanzaro, Italy

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.

Keywords: atrial septal aneurysm, patent foramen ovale, elderly, transient cerebral ischemia, percutaneous closure

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