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

Benedik, Mirjana P; Zaletel, Marjan; Meglič, Nuška Pečarič; Podnar, Tomaž

doi:10.1136/adc.2010.203992

Cited by 24 publications

(12 citation statements)

References 21 publications

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“…In our pilot study (Dowling, et al, 2010), retrospective chart review found potential shunting in 11.7% (7/60) of children with stroke who did not have SCD (excluding children with known congenital heart disease). Benedik et al (2011) reported on transesophageal echocardiograms with contrast as well as using contrasted transcranial Doppler ultrasonography and reported potential shunting in 7/26 (27%) of controls compared with 11/23 (48%) of children with stroke or TIA (without SCD), excluding those with other identified aetiologies for stroke. Intrapulmonary shunting alone was an independent predictor of cryptogenic stroke or TIA in adults without SCA compared to controls (OR 2.6 (CI 1.6–4.2)) (Abushora, et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

et al. 2016

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“Paradoxical” embolization via intracardiac or intrapulmonary right-to-left shunts (RLS) is an established cause of stroke. Hypercoagulable states and increased right heart pressure, which both occur in sickle cell anaemia (SCA), predispose to paradoxical embolization. We hypothesized that children with SCA and overt stroke (SCA+stroke) have an increased prevalence of potential RLS. We performed contrasted transthoracic echocardiograms on 147 children (aged 2–19 years) with SCA+stroke) mean age 12.7±4.8 years, 54.4% male) and a control group without SCA or stroke (n=123; mean age 12.1±4.9 years, 53.3% male). RLS was defined as any potential RLS detected by any method, including intrapulmonary shunting. Echocardiograms were masked and adjudicated centrally. The prevalence of potential RLS was significantly higher in the SCA+stroke group than controls (45.6% vs. 23.6%, p<0.001). The odds ratio for potential RLS in the SCA+stroke group was 2.7 (95% confidence interval: 1.6–4.6) vs controls. In post hoc analyses, the SCA+stroke group had a higher prevalence of intrapulmonary (23.8% vs. 5.7%, p<0.001) but not intracardiac shunting (21.8% vs. 18.7%, p=0.533). SCA patients with potential RLS were more likely to report headache at stroke onset than those without. Intrapulmonary and intracardiac shunting may be an overlooked, independent and potentially modifiable risk factor for stroke in SCA.

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Section: Discussionmentioning

confidence: 99%

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

et al. 2016

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“…In RCTs only patients over 18 years old were included [3][4][5]. According to another publication by Benedik et al [23], transcatheter PFO closure in children is a relatively safe and effective procedure, which also makes it possible to discontinue long-lasting antithrombotic treatment, which is usually hard to maintain because of poor compliance and possible side effects. In our study the procedure was successfully completed in all patients, and no procedure-related complications were observed during hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

et al. 2016

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A b s t r a c tBackground and aim: Patent foramen ovale (PFO) may result in a cerebrovascular event -a presumed paradoxical embolism (PE). However, the presence of this phenomenon among paediatric patients was rarely evaluated. Transcatheter PFO closure was considered to be a method of treatment in such patients. Methods:For evaluation clinical data and long-term outcome, we reviewed records of patients below 18 years of age, with history of cerebrovascular event related to PE, who underwent procedure of percutaneous PFO closure in years 1999-2014 in our department.Results: Among 230 patients with cerebrovascular events who had PFO closed percutaneously, seven children (aged 12--16 years, five male) were selected. Indications for closure were cryptogenic stroke in two patients and transient ischaemic attack (TIA) in five patients. Diagnosis of PFO was established by transthoracic echocardiography, with right-to-left shunt (RLS) through PFO confirmed by transoesophageal echocardiography. Contrast transcranial Doppler (c-TCD) was performed preprocedurally in four patients, revealing significant RLS. For percutaneous closure of PFO different occluders (Starflex, Amplatzer PFO devices, Cardio-O-Fix) were used. Closure was successfully completed in all patients and no procedure-related complications were observed. Postprocedural c-TCD six months after closure revealed no significant RLS. During follow-up (3 to 10 years) one patient had an episode of recurrent TIA; however, in this patient paroxysmal atrial fibrillation was found during the follow-up period. Conclusions:Cerebral embolism due to PFO is uncommon in children. Transcatheter PFO closure in this group of patients is a safe and effective procedure. C-TCD is plausible technique for detection RLS and monitoring PFO closure efficacy in this group of patients.

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“…Predisposing conditions for ischemic cerebrovascular accidents in children include congenital heart malformations (congenital cyanotic complex heart malformations or acquired heart disease), sickle cell disease, infections, and collagen tissue abnormalities [13], but around half occur in children who were previously well (cryptogenic stroke) [14]. It is well known from literature, that one of the most common conditions associated with AIS is congenital heart malformations (like patent foramen ovale) [15][16][17][18][19][20][21][22][23][24][25].…”

Section: Etiologymentioning

confidence: 99%

“…While there is some evidence suggesting an important role of right-to-left shunting across an atrial defect, particularly among patients with prothrombotic conditions or cryptogenic stroke [10], the role of device closure remains undefined due to lack of sufficient evidence [11].…”

Section: Introductionmentioning

confidence: 99%

Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale: A case report

Panagopoulos¹,

Loukopoulou²,

Markogiannakis³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comCerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale: A case report Dimitrios Panagopoulos, Sofia Loukopoulou, Georgios Markogiannakis, Nikos Eleftherakis ABSTRACT Introduction: Arterial ischemic stroke (AIS), with an estimated incidence of 1.1-4.3 per 100,000, is an important cause of morbidity and mortality in children and the recurrence risk is high. Case Report: We present the case of an 11-year-old child who presented with a symptomatology of acute ischemic stroke of unknown etiology. The radiological investigation did not reveal any underlying brain abnormality that could cause the event. The diagnostic work up included an echocardiogram, which revealed a thrombus in the right atrium, in conjunction with a patent foramen ovale. The patient was initiated immediately on anticoagulation therapy with low molecular weight heparin and warfarin, but two days later she suffered pulmonary emboli, diagnosed with spiral thorax computed tomography scan. An ultrasound study of the vessels of the lower extremities revealed deep venous thrombosis, which was considered to be the underlying causative mechanism. Conclusion: To the best of our knowledge, this is the first documented case of right atrial thrombus resulting from deep venous thrombosis in a pediatric patient with patent foramen ovale and associated ischemic stroke event. A discussion regarding the definition of cryptogenic stroke, its etiology and relationship with deep venous thrombosis and the currently proposed therapy, follows.

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

Cited by 24 publications

References 21 publications

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

Increased prevalence of potential right‐to‐left shunting in children with sickle cell anaemia and stroke

Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events

Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale: A case report

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