TITLE

Paradoxical Emboli in Children and Young Adults: Role of Atrial Septal Defect and Patent Foramen Ovale Device Closure

AUTHOR(S)
Bartz, Peter J.; Cetta, Frank; Cabalka, Allison K.; Reeder, Guy S.; Squarcia, Umberto; Agnetti, Aldo; Aurier, Enrico; Carano, Nicola; Tachana, Bertrand; Hagler, Donald J.
PUB. DATE
May 2006
SOURCE
Mayo Clinic Proceedings;May2006, Vol. 81 Issue 5, p615
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To describe a multicenter experience with patent foramen ovale (PFO) and atrial septal defect (ASD) device closure for presumed paradoxical emboli in children and young adults (<35 years old). PATIENTS AND METHODS: Medical records were reviewed of patients who had device closure of an ASD or PFO, who were younger than 35 years, and who had a history of presumed paradoxical embolus between January 1999 and August 2005 at Mayo Clinic, Rochester, Minn, University of Parma, Parma, Italy, and Loyola University Medical Center, Maywood, Ill. RESULTS: Forty-five patients fulfilled the inclusion criteria. Median patient age was 29.0 years (range, 5.0-34.9 years), and 23 patients (51%) were male. Clinical diagnoses included the following: stroke, 30 (67%); transient ischemic attack, 13 (29%); myocardial Infarction, 1 (2%); and renal Infarct, 1 (2%). Overall, 42 patients (93%) had a PFO, and 3 (7%) had an ASD. Seventeen patients had known cardiovascular disease risk factors: tobacco use (10 patients), hypercoagulable states (7 patients), systemic hypertension (3 patients), and hyperlipidemia (2 patients). No major procedural complications occurred. Median follow-up evaluation was performed at 5.3 months (range, 2.5-40.0 months). Forty- four patients (98%) had no recurrent neurologic events and no residual atrial shunt by contrast transthoracic echocardiography. CONCLUSIONS: Cryptogenic ischemic events occur In young patients and have serious sequelae. The potential for paradoxical embolization through a PFO or an ASD should be assessed In all such patients. In our short-term follow-up, device closure was a safe alternative therapeutic option for children and young adults with presumed paradoxical emboli.
ACCESSION #
21258734

 

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