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Recurrent minor strokes/TIA with a right to left shunt
Manuel Cortes1, Guy S Mayeda2, Ming W Liu3
1Department of Cardiology, University of New Mexico, Albuquerque, New Mexico, USA.
BMJ Case Reports
|July 12, 2018
Summary
A patient with a suspected patent foramen ovale experienced a cerebrovascular accident. Non-invasive embolisation successfully closed an underlying pulmonary arteriovenous fistula, resolving the issue.
Area of Science:
- Cardiology
- Neurology
- Interventional Radiology
Background:
- Patent foramen ovale (PFO) is a potential cause of cryptogenic cerebrovascular accidents.
- Pulmonary arteriovenous fistulas (PAVs) can lead to paradoxical emboli and neurological events.
Observation:
- A patient presented with a cerebrovascular accident (stroke) initially suspected to be due to a patent foramen ovale.
- Diagnostic imaging revealed an incidental finding of a pulmonary arteriovenous fistula.
Findings:
- The pulmonary arteriovenous fistula was successfully treated using non-invasive percutaneous selective segmental pulmonary artery embolisation.
- Closure of the fistula was confirmed, leading to resolution of the patient's neurological symptoms.
Implications:
- This case highlights the importance of considering and investigating PAVs in patients with cerebrovascular accidents, even when PFO is suspected.
- Percutaneous embolisation offers a minimally invasive and effective treatment option for PAVs, preventing embolic events.
- Successful closure of PAVs can significantly improve patient outcomes and reduce the risk of recurrent neurological events.
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