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[Interventional closure of an open foramen ovale in a patient with recurrent cerebral ischemia]
C Teupe1, M Schneider, W Nacimiento
1Klinikum der Universität, Abteilung für Kardiologie, Frankfurt/M.
Insights
A patent foramen ovale with a septal aneurysm caused recurrent ischemia. Non-operative closure using a Rashkind occluder resolved the shunt and prevented further neurological events.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Recurrent ischemic events in young adults can be challenging to diagnose.
- Patent foramen ovale (PFO) with atrial septal aneurysm is a potential cause of paradoxical embolism.
- Contrast Doppler echocardiography is crucial for diagnosing intracardiac shunts.
Observation:
- A 24-year-old female presented with recurrent ischemia.
- Contrast Doppler echocardiography revealed a PFO with an atrial septal aneurysm and significant right-to-left shunt during Valsalva.
- Cerebral symptoms were attributed to paradoxical embolism after excluding other causes.
Findings:
- The PFO and atrial septal aneurysm were successfully closed using a 17-mm Rashkind occluder.
- The procedure was performed without complications.
- Six-month follow-up showed no residual shunt and no further neurological events.
Implications:
- Non-operative closure of PFO with atrial septal aneurysm is feasible and effective.
- This technique offers an alternative to anticoagulation or surgery for selected patients.
- Minimally invasive closure can prevent recurrent paradoxical embolism and improve patient outcomes.
Abstract:
In a 24-year-old female patient suffering from recurrent ischemia, an aneurysm of the atrial septum and a patent foramen ovale with significant right-to-left shunt during the Valsalva maneuver were detected by means of contrast Doppler echocardiography. After other causes had been excluded, paradoxical embolism was suspected to be the cause of the cerebral symptoms. The defect was closed by a 17-mm Rashkind occluder without complications. Six months later no residual shunt was detected and no further neurological event had occurred. This case demonstrates the feasibility of non-operative closure of those defects. This new technique could represent an alternative to long-term anticoagulation or operative procedures in selected patients.