Patent foramen ovale and unexplained ischemic cerebrovascular events in children.
OBJECTIVE
To consider the role of patent foramen ovale (PFO) in ischemic cerebrovascular event of unknown cause in children.


BACKGROUND
Data regarding the possibility of paradoxical embolism in unexplained ischemic cerebrovascular event in children are lacking.


METHODS
Between January 2005 and March 2007, all consecutive children evaluated due to ischemic cerebrovascular event were included in the retrospective study. In addition to the standard diagnostic protocol, a contrast transcranial Doppler (TCD) with Valsalva maneuver (VM) was performed in patients with unexplained events. Percutaneous PFO closure was offered to all patients with ischemic cerebrovascular event of unknown cause and presumed paradoxical embolism.


RESULTS
Eighteen patients aged between 2 and 17 years (median 11.5 years) were included in the study: 12 patients suffered ischemic stroke and six with transient ischemic attack (TIA). In six patients, ischemic stroke was of unknown cause and contrast TCD with VM was positive in four of them. In addition, TCD study was positive in five patients evaluated because of TIA. Nine patients with presumed paradoxical embolism underwent an attempt at the percutaneous PFO closure.


CONCLUSIONS
It appears that the role of PFO in ischemic cerebrovascular event of unknown cause in children may be underestimated. Contrast TCD with VM is a sensitive, noninvasive method for PFO detection, proved in our experience particularly suitable for children. In children with unexplained ischemic cerebrovascular event and presumed paradoxical embolism, percutaneous PFO closure should be considered.
University Medical Center, Ljubljana, Slovenia.
Mirjana Perkovic
MP
Benedik
Marjan
M
Zaletel
Nuska Pecaric
NP
Meglic
Tomaz
T
Podnar
D000293:Adolescent; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D019320:Embolism, Paradoxical / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods; D014636:Valsalva Maneuver