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Case Report: Residual Atrial Shunt Lesions in Aging Adults With Congenital Heart Disease: An Underestimated Risk of

Matthias Schneider1,2, Varius Dannenberg3, Bernd Opgen-Rhein4

  • 1Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany.

Frontiers in Cardiovascular Medicine
|April 4, 2022
PubMed

Insights

Paradoxical cerebral embolism can occur in adults with congenital heart disease (ACHD) who have residual atrial shunts. Regular lifelong follow-up is crucial for these patients, even with stable lesions.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Adults with congenital heart disease (ACHD) often have residual atrial shunts.
  • Paradoxical embolism is a rare but serious complication.
  • Venous thrombosis risk increases with age.

Observation:

  • Two adult cases of paradoxical cerebral embolism were identified.
  • Case 1: A 59-year-old male with a detached atrial septal defect (ASD) closure patch.
  • Case 2: A 57-year-old male with Ebstein's anomaly and a patent foramen ovale.

Findings:

  • Residual atrial shunts in ACHD patients may predispose them to paradoxical embolism.
  • Potential mechanisms include dislodged closure devices or persistent shunts.
  • The risk may be higher in older ACHD patients with venous thrombosis.

Implications:

  • Increased vigilance for paradoxical embolism is warranted in ACHD patients with atrial shunts.
  • Lifelong monitoring of ACHD patients, including those with seemingly stable lesions, is essential.
  • Early detection and management of paradoxical embolism can improve outcomes.

Keywords:
ASDEbstein anomalyadults with congenital heart diseasecardioembolic and cryptogenic strokecase reportechocardiographyembolic stroke

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