Characteristics of adult patients with atrial septal defects presenting with paradoxical embolism.
BACKGROUND
The association between patent foramen ovale (PFO), atrial septal aneurysm, and cryptogenic stroke due to paradoxical embolism has been established. The correlation between atrial septal defect (ASD) in adults and paradoxical embolism is less well defined.


METHODS
We examined our single center experience with 329 adult patients undergoing percutaneous device closure of interatrial communication defects to identify clinical and morphologic differences among adult patients with ASDs who presented with or without paradoxical embolism. Comparison was made with patients with PFO.


RESULTS
Although a significant left-to-right shunt was the predominant indication for ASD closure, 20 patients (14%) presented with a paradoxical embolism. These patients tended to be younger and had smaller defects (both by size and shunt ratio) than ASD patients without paradoxical embolism, and were more likely to be female than PFO patients.


CONCLUSIONS
The incidence of adult patients with ASD who presented with paradoxical embolism is higher than expected and suggests that this diagnosis should be considered in patients with cryptogenic stroke.
Bannan
Amr
A
Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Shen
Rhuna
R
Silvestry
Frank E
FE
Herrmann
Howard C
HC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation; D019320:Embolism, Paradoxical / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult