Patent foramen ovale and unexplained ischemic cerebrovascular events in children

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

doi:10.1002/ccd.21305

Cited by 33 publications

(35 citation statements)

References 25 publications

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“…There is a shortage of data regarding the implication of PFO in the child population [13,14]. Ischaemic cerebrovascular events are relatively rare in this group of patients, but they are increasingly recognised [15,16], resulting in disability and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…C-TCD is a minimally invasive procedure, harmless to children, except for getting vein access, and not requiring general anaesthesia or even pharmacological sedation. As the Valsalva manoeuvre is easy to learn and conduct in such circumstances, c-TCD seems to be particularly suitable for children, even as young as five years old [13]. A weakness of this method can be positive MES detection due to RLS different than PFO, i.e.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Another study reports prothrombotic abnormalities present in 20-50 % of children with arterial ischemic stroke [22,35].…”

Section: Prothrombotic Disordersmentioning

confidence: 97%

“…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%

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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“…Risk factors for recurrent stroke in SS include acute chest syndrome, severe anemia, cerebral vasculopathy, previous stroke and transcranial Doppler ultrasound velocity > 200 cm/sec [3]. Other rare causes of recurrent stroke in patients without SS include paradoxical embolization due to patent foramen ovale [4].…”

Section: Introductionmentioning

confidence: 99%

Primary Stroke in a Woman With Sickle Cell Anemia Responsive to Hydroxyurea Therapy

Ballas¹,

Martínez²,

Savage³

2014

Hemoglobin

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Patent foramen ovale and unexplained ischemic cerebrovascular events in children

Cited by 33 publications

References 25 publications

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

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

Primary Stroke in a Woman With Sickle Cell Anemia Responsive to Hydroxyurea Therapy

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