Recurrence of cerebrovascular events in young adults with a secundum atrial septal defect.
BACKGROUND
The recurrence rate for cerebrovascular ischemic events in patients after a first TIA or CVA with an atrial septal defect type 2 (ASD2) remains unknown. At present, there are no guidelines with respect to appropriate treatment. The aim of this study was to determine incidence rates of recurrent cerebrovascular events in patients with ASD2.


METHODS
A multicenter, retrospective study was performed at selected centres in The Netherlands, United Kingdom and United States. All patients with ASD2 and a prior cerebrovascular event were identified from available databases. Clinical data were retrieved from medical files, electronic databases and radiographic charts.


RESULTS
Fifty-six adult patients born between 1950 and 1990 (median age at first cerebrovascular event 37.5, range 15-53 years) were recruited. Recurrent events (9 TIA, 2 CVA) were recorded in 11 patients (19.6%) during a median follow-up time of 5.3 years (range 0.2-28.9). Non-closure of the defect was the only significant predictor of a recurrent event (p=0.01).


CONCLUSIONS
Patients with an ASD2 and a history of a cerebrovascular ischemic event have a substantial risk for recurrent events. Closure of the ASD2 seems to substantially decrease the risk of recurrence. However, prospective randomized trials are needed to confirm our findings.
Lok
Sjoukje I
SI
University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Winkens
Bjorn
B
Dimopoulos
Konstantinos
K
Fernandes
Susan M
SM
Gatzoulis
Michael A
MA
Landzberg
Michael J
MJ
Mulder
Barbara J M
BJ
D000293:Adolescent; D000328:Adult; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology; D055815:Young Adult