title: Transient cerebral ischemia in an elderly patient with patent foramen ovale and atrial septal aneurysm.
abstract: Cerebrovascular disease is one of the most common causes of cerebrovascular morbidity and mortality in developed countries; up to 40% of acute ischemic strokes in young adults are cryptogenic in nature - that is, no cause is determined. However, in more than half of these patients, patent foramen ovale (PFO) is seen along with an increased incidence of atrial septal aneurysm (ASA). The following is a report of an interesting case: a 68-year-old man with ASA and transient cerebral ischemia. Transesophageal echocardiography (TEE) showed the presence of ASA; a test with microbubbles derived from a mixture of air and saline or colloids pointed out a shunt on the foramen ovale following Valsalva's maneuver. The patient underwent percutaneous transcatheter closure of the interatrial communication by an interventional cardiologist. TEE and transcranial Doppler or TEE with the microbubbles test are the recommended methods for detecting and quantifying intracardiac shunts, both at rest and following Valsalva's maneuver. In patients following the first event of transient ischemic attack, and without clinical and anatomical risk factors (such as the presence of ASA, PFO, and basal shunt), pharmacological treatment with antiplatelets or anticoagulants is closely recommended. On the contrary, in patients following the first event of transient ischemic attack, or a recurrent event during antiplatelet treatment, the percutaneous closure of PFO is recommended.
authors.affiliation: Geriatric Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Merante
authors.affiliation: Azienda Sanitaria Provinciale (ASP), Catanzaro, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gareri
authors.affiliation: Azienda Sanitaria Provinciale (ASP), Catanzaro, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Castagna
authors.affiliation: SERT Taranto, ASL Taranto, Italy.
authors.forename: Norma Maria
authors.initials: NM
authors.lastname: Marigliano
authors.affiliation: Intensive Cardiology Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Candigliota
authors.affiliation: Intensive Cardiology Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferraro
authors.affiliation: Geriatric Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruotolo
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging; D006322:Heart Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D062645:Percutaneous Coronary Intervention; D017585:Ultrasonography, Doppler, Transcranial; D014636:Valsalva Maneuver
keywords: atrial septal aneurysm; elderly; patent foramen ovale; percutaneous closure; transient cerebral ischemia