Clinically silent atrial septal defects with evidence for cerebral embolization

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Cerebral embolization in young patients (≤50 years) often has an undetermined cause.
• Standard physical, radiographic, and electrocardiographic exams were normal in these eleven patients.

Purpose of the Study:

• To investigate the prevalence of interatrial communications in young stroke patients.
• To identify the utility of contrast echocardiography in diagnosing these defects.

Main Methods:

• Eleven consecutive patients with stroke and cerebral embolization underwent comprehensive evaluations.
• Microcavitation contrast two-dimensional echocardiography was used to detect shunts.
• Cardiac catheterization was performed in a subset of patients.

Main Results:

• Eight of eleven patients exhibited right-to-left shunts at the atrial level via contrast echocardiography.
• Five of six patients undergoing catheterization were diagnosed with an atrial septal defect.
• Surgical closure was performed on four patients with defects ranging from 5-10 mm.

Conclusions:

• Interatrial communications are common in young stroke patients, suggesting paradoxical embolization.
• Contrast two-dimensional echocardiography is a reliable noninvasive method for detecting these defects.