Paradoxial embolism as a cause of ischemic stroke in patient with sinus venosus atrial septal defect
https://doi.org/10.14412/2074-2711-2021-5-123-129
Abstract
We present a case report of a middle-aged patient with a rare sinus venosus atrial septal defect (ASD) and ischemic stroke that developed due to paradoxical embolism. Occlusion of the anterior cerebral artery led to a stroke with cognitive impairment, acalculia, and apraxia. Diagnostic ultrasound features of this anomaly in suspected cases are discussed. In the presented case, verification of the stroke cause became possible due to the contrast-enhanced computed tomography of the heart. ASD detection made it possible to refer the patient to the surgical treatment necessary to prevent both recurrent cerebral accidents and the progression of pulmonary hypertension, and the prevention of the development of right ventricular heart failure.
About the Authors
A. A. Kulesh
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
Aleksey Aleksandrovich Kulesh
26, Petropavlovskaya St., Perm 614990
S. A. Mekhryakov
City Clinical Hospital Four
Russian Federation
Russian Federation
2, KIM St., Perm 614107
L. I. Syromyatnikova
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, KIM St., Perm 614107
N. H. Gorst
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
26, Petropavlovskaya St., Perm 614990
S. O. Drobakha
City Clinical Hospital Four
Russian Federation
Russian Federation
2, KIM St., Perm 614107
E. V. Nikolaeva
Pyatigorsk City Clinical Hospital №2
Russian Federation
Russian Federation
6, Admiralskogo St., Pyatigorsk 357538
References
1. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018 Sep;17(9):790-801. doi: 10.1016/S1474-4422(18)30233-3
2. Renna R, Pilato F, Profice P, et al. Risk factor and etiology analysis of ischemic stroke in young adult patients. J Stroke Cerebrovasc Dis. 2014 Mar;23(3):e221-7. doi: 10.1016/j.jstrokecerebrovasdis.2013.10.008. Epub 2014 Jan 11.
3. Kalashnikova LA, Dobrynina LA. Ischemic stroke in young adults. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2017;117(8-2):3-12. doi: 10.17116/jnevro2017117823-12 (In Russ.).
4. Kulesh AA, Nurieva YuA, Syromyatnikova LI. Causes of ischemic stroke in patients younger than 45 years: analysis of data from the regional vascular center. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):24-30. doi: 10.14412/2074-2711-2021-1-24-30 (In Russ.).
5. Kulesh AA, Ognerubov DV, Mekhryakov SA, et al. Patent foramen ovale-related stroke: diagnostic approaches and the possibility of endovascular prophylaxis (clinical cases and literature review). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(2):72-8. doi: 10.14412/2074-2711-2020-2-72-78 (In Russ.).
6. Kulesh AA, Shestakov VV. Patent foramen ovale and embolic cryptogenic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2):4-11. doi: 10.14412/2074-2711-2019-2-4-11 (In Russ.).
7. Leppert M, Poisson SN, Carroll JD. Atrial Septal Defects and Cardioembolic Strokes. Cardiol Clin. 2016 May;34(2):225-30. doi: 10.1016/j.ccl.2015.12.004. Epub 2016 Mar 9.
8. Bradley EA, Zaidi AN. Atrial Septal Defect. Cardiol Clin. 2020 Aug;38(3):317-24. doi: 10.1016/j.ccl.2020.04.001. Epub 20020 Jun 6.
9. Geva T, Martins JD, Wald RM. Atrial septal defects. Lancet. 2014 May 31;383(9932):1921-32. doi: 10.1016/S0140-6736(13)62145-5. Epub 2014 Apr 8.
10. Bannan A, Shen R, Silvestry FE, Herrmann HC. Characteristics of adult patients with atrial septal defects presenting with paradoxical embolism. Catheter Cardiovasc Interv. 2009 Dec 1;74(7):1066-9. doi: 10.1002/ccd.22170
11. Broy C, Bennett S. Partial anomalous pulmonary venous return. Mil Med. 2008 Jun;173(6):523-4. doi: 10.7205/milmed.173.6.523
12. Kivistö S, Hänninen H, Holmström M. Partial anomalous pulmonary venous return and atrial septal defect in adult patients detected with 128-slice multidetector computed tomography. J Cardiothorac Surg. 2011 Sep 30;6:126. doi: 10.1186/1749-8090-6-126
13. Blake GE, Lakkireddy D. Atrial Septal Defect and Atrial Fibrillation: The Known and Unknown. J Atr Fibrillation. 2008 Sep 16;1(3):45. doi: 10.4022/jafib.45. eCollection Sep-Nov 2008.
14. Nyboe C, Olsen MS, Nielsen-Kudsk JE, Hjortdal VE. Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure. Heart. 2015 May;101(9):706-11. doi: 10.1136/heartjnl-2014-306552. Epub 2015 Feb 17.
15. Berger F, Vogel M, Kramer A, et al. Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg. 1999 Jul;68(1):75-8. doi: 10.1016/s0003-4975(99)00478-6
16. Attenhofer Jost CH, Connolly HM, Danielson GK, et al. Sinus venosus atrial septal defect: long-term postoperative outcome for 115 patients. Circulation. 2005 Sep 27;112(13):1953-8. doi: 10.1161/CIRCULATIONAHA.104.493775. Epub 2005 Sep 19.
17. Karunanithi Z, Nyboe C, Hjortdal VE. Long-Term Risk of Atrial Fibrillation and Stroke in Patients with Atrial Septal Defect Diagnosed in Childhood. Am J Cardiol. 2017 Feb 1;119(3):461-5. doi: 10.1016/j.amjcard.2016.10.015. Epub 2016 Nov 1.
18. Windecker S, Stortecky S, Meier B. Paradoxical embolism. J Am Coll Cardiol. 2014 Jul 29;64(4):403-15. doi: 10.1016/j.jacc.2014.04.063
19. Cakmak S, Goldman C, Bozio A, et al. Sinus venosus-type atrial septal defect: a rare curable cause of recurrent transient neurological deficits. Stroke. 2006 Sep;37(9):2385-6. doi: 10.1161/01.STR.0000236635.44539.d4. Epub 2006 Aug 10.
20. O'Sullivan CJ, Magarzo JG, Bernheim AM, Eberli F. Paradoxical embolism via a sinus venosus atrial septal defect causing an inferior ST-segment elevation myocardial infarction in a 23-year-old woman. BMJ Case Rep. 2016 Apr 29;2016:bcr2016215184. doi: 10.1136/bcr-2016-215184
21. Amarenco P. Patent foramen ovale and the risk of stroke: smoking gun guilty by association? Heart. 2005 Apr;91(4):441-3. doi: 10.1136/hrt.2004.052241
22. Krumsdorf U, Ostermayer S, Billinger K, et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol. 2004 Jan 21;43(2):302-9. doi: 10.1016/j.jacc.2003.10.030
23. Pascoe RD, Oh JK, Warnes CA, et al. Diagnosis of sinus venosus atrial septal defect with transesophageal echocardiography. Circulation. 1996 Sep 1;94(5):1049-55. doi: 10.1161/01.cir.94.5.1049
24. Gaibazzi N, Montresor G, Poeta ML. Anatomy of a wrong diagnosis: false sinus venosus atrial septal defect. Cardiovasc Ultrasound. 2003 Nov 7;1:15. doi: 10.1186/1476-7120-1-15
25. Sharma AK, Nath RK, Pandit N. A case of sinus venosus atrial septal defect misdiagnosed as primary pulmonary hypertension. Hellenic J Cardiol. 2016 MarApr;57(2):124-8. doi: 10.1016/j.hjc.2016.03.005
26. Vodusek Z, Khaliqdina S, Borz-Baba C, Scandrett R. Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis. Cureus. 2019 Oct 17;11(10):e5936. doi: 10.7759/cureus.5936
27. Puchalski MD, Lui GK, Miller-Hance WC, et al. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic: Examination in Children and All Patients with Congenital Heart Disease: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019 Feb;32(2):173-215. doi: 10.1016/j.echo.2018.08.016
Review
For citations:
Kulesh A.A., Mekhryakov S.A., Syromyatnikova L.I., Gorst N.H., Drobakha S.O., Nikolaeva E.V. Paradoxial embolism as a cause of ischemic stroke in patient with sinus venosus atrial septal defect. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(5):123-129. https://doi.org/10.14412/2074-2711-2021-5-123-129
Views: 269
Email this article 