title: Paradoxical emboli in children and young adults: role of atrial septal defect and patent foramen ovale device closure.
abstract: OBJECTIVE
  To describe a multicenter experience with patent foramen ovale (PFO) and atrial septal defect (ASD) device closure for presumed paradoxical emboli in children and young adults (<35 years old).
  
  
  METHODS
  Medical records were reviewed of patients who had device closure of an ASD or PFO, who were younger than 35 years, and who had a history of presumed paradoxical embolus between January 1999 and August 2005 at Mayo Clinic, Rochester, Minn, University of Parma, Parma, Italy, and Loyola University Medical Center, Maywood, Ill.
  
  
  RESULTS
  Forty-five patients fulfilled the inclusion criteria. Median patient age was 29.0 years (range, 5.0-34.9 years), and 23 patients (51%) were male. Clinical diagnoses included the following: stroke, 30 (67%); transient ischemic attack, 13 (29%); myocardial infarction, 1 (2%); and renal infarct, 1 (2%). Overall, 42 patients (93%) had a PFO, and 3 (7%) had an ASD. Seventeen patients had known cardiovascular disease risk factors: tobacco use (10 patients), hypercoagulable states (7 patients), systemic hypertension (3 patients), and hyperilpidemia (2 patients). No major procedural complications occurred. Median follow-up evaluation was performed at 5.3 months (range, 2.5-40.0 months). Forty-four patients (98%) had no recurrent neurologic events and no residual atrial shunt by contrast transthoracic echocardiography.
  
  
  CONCLUSIONS
  Cryptogenic ischemic events occur in young patients and have serious sequelae. The potential for paradoxical embolization through a PFO or an ASD should be assessed in all such patients. In our short-term follow-up, device closure was a safe alternative therapeutic option for children and young adults with presumed paradoxical emboli.
authors.affiliation: Division of Pediatric Cardiology Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bartz
authors.forename: Frank
authors.initials: F
authors.lastname: Cetta
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
authors.forename: Guy S
authors.initials: GS
authors.lastname: Reeder
authors.forename: Umberto
authors.initials: U
authors.lastname: Squarcia
authors.forename: Aldo
authors.initials: A
authors.lastname: Agnetti
authors.forename: Enrico
authors.initials: E
authors.lastname: Aurier
authors.forename: Nicola
authors.initials: N
authors.lastname: Carano
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tchana
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tachana
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Hagler
mesh_terms: D000293:Adolescent; D000328:Adult; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D019320:Embolism, Paradoxical / Q000150:complications*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D020521:Stroke / Q000209:etiology*