Related Experiment Video

Updated: Jun 3, 2026

Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension
09:23

Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension

Published on: February 11, 2017

A right-to-left shunt in children with arterial ischaemic stroke

Mirjana Perkovic Benedik1, Marjan Zaletel, Nuska Pecaric Meglic

  • 1Department of Paediatrics, University Medical Centre Ljubljana, Bohoričeva 20, Ljubljana, Slovenia. tomaz.podnar@mf.uni-lj.si

Archives of Disease in Childhood
|March 8, 2011
PubMed

Insights

Right-to-left shunt (RLS) is more common in children with arterial ischaemic stroke (AIS), especially those with prothrombotic disorders. This suggests paradoxical embolism is an important cause of pediatric AIS.

Area of Science:

  • Pediatric Neurology
  • Cardiovascular Research
  • Diagnostic Imaging

Background:

  • Arterial ischaemic stroke (AIS) in children is a significant neurological event.
  • Identifying the causes of pediatric AIS is crucial for effective treatment and prevention.
  • Right-to-left shunt (RLS) is a potential, yet often overlooked, mechanism for stroke.

Purpose of the Study:

  • To investigate the prevalence and severity of right-to-left shunt (RLS) in children diagnosed with arterial ischaemic stroke (AIS).
  • To compare RLS findings in children with AIS against a control group of healthy children.
  • To explore the association between RLS and prothrombotic disorders in pediatric AIS.

Main Methods:

  • A prospective study was conducted at a tertiary pediatric referral center.
  • Contrast transcranial Doppler (cTCD) with Valsalva maneuver was used to detect and quantify RLS.
  • Thirty consecutive children with AIS and a control group underwent cTCD.

Main Results:

  • The prevalence of RLS was significantly higher in children with AIS compared to controls (p<0.05).
  • Significantly more microembolic signals (MES) were detected in children with AIS than in controls (p<0.005).
  • RLS showed a significant association with AIS, particularly in cases with prothrombotic disorders or undetermined etiology (OR 6.10).

Conclusions:

  • Children with AIS, especially those with prothrombotic disorders or undetermined etiology, exhibit a higher prevalence of RLS and MES.
  • These findings highlight paradoxical embolism as a potentially significant and underestimated cause of AIS in the pediatric population.
  • Further research into RLS screening in pediatric AIS is warranted.
Abstract

More Related Videos

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)13:10

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Published on: April 24, 2017

Related Concept Videos

Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Stroke: Introduction and Types01:29

Stroke: Introduction and Types

A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...