Transcatheter atrial septal defect closure in a patient with paradoxical brain emboli: who should treat it and who should be treated?
This report presents the case of a 51-year-old female who was admitted to a local hospital because of a persistent headache. A diagnosis of multiple cerebral infarctions was thereafter made, but there was no evidence of either atherosclerosis or atrial fibrillation. The case was thought to be a cryptogenic stroke, however, Doppler ultrasonography of the lower extremities showed venous insufficiency. Transesophageal echocardiography revealed a secundum atrial septal defect (ASD) with a left to right shunt. Therefore, the final diagnosis was paradoxical brain emboli, and transcatheter ASD closure was successfully performed by cardiologists without any sequelae.
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan. harahide@aol.com
Hidehiko
H
Hara
Tomotaka
T
Nakayama
Hiroyuki
H
Matsuura
Kaori
K
Sato
Go
G
Hashimoto
Hisao
H
Yoshikawa
Makoto
M
Suzuki
Fumihiko
F
Hara
Masahiko
M
Harada
Kenji
K
Wagatsuma
Kaoru
K
Sugi
Tsutomu
T
Saji
Masato
M
Nakamura
D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000601:surgery*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D016896:Treatment Outcome