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Atrial septal defects: the role in the development of cerebral circulation disorders caused by paradoxical embolism

https://doi.org/10.14412/2074-2711-2021-6-142-146

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Abstract

 The article presents a case report of a patient with cardioembolic ischemic stroke (IS), which was the first clinical manifestation of  congenital atrial septal defect (ASD), asymptomatic until adulthood.  The issues of anatomical classification, restructuring of  intracardiac hemodynamics depending on the size and localization  of ASD, its role in the development of IS are discussed. The  diagnostic algorithm in patients with IS caused by paradoxical  embolism is described, the current possibilities of ASD treatment  and prevention of related disorders of cerebral circulation are  discussed. 

About the Authors

A. V. Belopasova
Research Center of Neurology
Russian Federation

 80, Volokolamskoe Shosse, Moscow 125367, Russia 



L. A. Dobrinina
Research Center of Neurology
Russian Federation

 80, Volokolamskoe Shosse, Moscow 125367, Russia 



A. O. Chechetkin
Research Center of Neurology
Russian Federation

 80, Volokolamskoe Shosse, Moscow 125367, Russia 



A. R. Karshieva
Research Center of Neurology
Russian Federation

 80, Volokolamskoe Shosse, Moscow 125367, Russia 



L. Yu. Ananieva
Research Center of Neurology
Russian Federation

 80, Volokolamskoe Shosse, Moscow 125367, Russia 



D. S. Pushkina
Research Center of Neurology
Russian Federation

 80, Volokolamskoe Shosse, Moscow 125367, Russia 



References

1. Dobrynina LA, Kalashnikova LA, Pavlova LN. Ischemic stroke in young age. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2011;111(3):4-8 (In Russ.).

2. Kristensen B, Malm J, Carlberg B, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke. 1997 Sep;28(9):1702-9. doi: 10.1161/01.str.28.9.1702

3. Fu Q, Guo X, Mo D, Chen B. Young Paradoxical Stroke Treated Successfully With Mechanical Thrombectomy Using Solitaire and Transcatheter Closure of Patent Foramen Oval. Int Heart J. 2017 Oct 21;58(5):812-5. doi: 10.1536/ihj.16-461. Epub 2017 Sep 30.

4. Homma S, Messe SR, Rundek T, et al. Patent foramen ovale. Nat Rev Dis Primers. 2016 Jan 21;2:15086. doi: 10.1038/nrdp.2015.86

5. Rostad H, Sörland S. Atrial septal defect of secundum type in patients under 40 years of age. A review of 481 operated cases. Symptoms, signs, treatment and early results. Scand J Thorac Cardiovasc Surg. 1979;13(2):123-7. doi: 10.3109/14017437909100977

6. Association of Cardiovascular Surgeons in Russia. Clinical guidelines. Atrial septal defect, 2019. Available from: https://racvs.ru/clinic/files/2020/dmpp.pdf (In Russ.).

7. Van der Linde D, Konings EE, Slager MA, et al. Birth Prevalence of Congenital Heart Disease Worldwide: A Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2011 Nov 15;58(21):2241-7. doi: 10.1016/j.jacc.2011.08.025

8. Perrot A, Schmitt KR, Roth EMG, et al. CCN1 Mutation is Associated with Atrial Septal Defect. Pediatr Cardiol. 2015 Feb;36(2):295-9. doi: 10.1007/s00246-014-1001-8. Epub 2014 Aug 19.

9. Sridharan S. Cardiovascular MRI in Congenital Heart Disease: An Imaging Atlas, Springer; 2010. P. 24.

10. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021 Feb 11;42(6):563-645. doi: 10.1093/eurheartj/ehaa554

11. Geva T, Martins JD, Wald RM. Atrial septal defects. Lancet. 014 May 31;383(9932):1921-32. doi: 10.1016/S0140-6736(13)62145-5. Epub 2014 Apr 8.

12. McMahon CJ, Feltes TF, Fraley JK, et al. Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart. 2002 Mar;87(3):256-9. doi: 10.1136/heart.87.3.256

13. Behjati-Ardakani M, Golshan M, AkhavanKarbasi S, et al. The Clinical Course of Patients with Atrial Septal Defects. Iran J Pediatr. 2016 Aug 1;26(4):e4649. doi: 10.5812/ijp.4649. eCollection 2016 Aug.

14. 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.

15. Levin AR, Spach MS, Boineau JP, et al. Atrial pressure-flow dynamics in atrial septal defects (secundum type). Circulation. 1968 Apr;37(4):476-88. doi: 10.1161/01.cir.37.4.476

16. Langholz D, Louie EK, Konstadt SN, et al. Transesophageal echocardiographic demonstration of distinct mechanisms for right to left shunting across a patent foramen ovale in the absence of pulmonary hypertension. J Am Coll Cardiol. 1991 Oct;18(4):1112-7. doi: 10.1016/0735-1097(91)90775-5

17. Kerut EK, Norfleet WT, Plotnick GD, Giles TD. Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol. 2001 Sep;38(3):613-23. doi: 10.1016/s0735-1097(01)01427-9

18. Khokhlunov MS, Kislukhin TV, Shorokhov SE. Atrial septal defects: clinical presentation, echocardiographic evaluation, and treatment. Kardiologiya: Novosti. Mneniya. Obucheniye. 2015;3(6):42-7 (In Russ.).

19. Kitamura T, Arakawa S, Murao K, et al. Paradoxical Brain Embolism in Elderly Subjects with Small Atrial Septal Defects. J Stroke Cerebrovasc Dis. 2018 Jul;27(7):1987-91. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.053. Epub 2018 Mar 20.

20. Pizova NV. Ischemic stroke and inherited thrombophilias. Annaly klinicheskoy i eksperimental'noy nevrologii = Annals of Clinical and Experimental Neurology. 2017;11(4):71-80. doi: 10.18454/ACEN.2017.4.8 (In Russ.).

21. Campello E, Luca S, Adamo A, et al. Thrombophilia, risk factors and prevention. Expert Rev Hematol. 2019 Mar;12(3):147-58. doi: 10.1080/17474086.2019.1583555. Epub 2019 Feb 26.

22. Kulesh AA, Drobakha VE, Shestakov VV. Cryptogenic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):14-21. doi: 10.14412/2074-2711-2019-4-14-21 (In Russ.).

23. Shiller N, Shiller MA. Klinicheskaya ekhokardiografiya [Clinical echocardiography]. Moscow; 1993. 213 p. (In Russ.).

24. Chechetkin AO. Contrast transcranial doppler ultrasound in the diagnosis of the patent foramen ovale – methodical aspects. Ul'trazvukovaya i funktsional'naya diagnostika. 2007;(1):102-18 (In Russ.).

25. Rigatelli G, Dell’Avvocata F, Tarantini G, et al. Clinical, hemodynamic, and intracardiac echocardiographic characteristics of secundum atrial septal defects-related paradoxical embolism. J Interv Cardiol. 2014 Dec;27(6):542-7. doi: 10.1111/joic.12159. Epub 2014 Nov 23.

26. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Apr 2;73(12):e81-e192. doi: 10.1016/j.jacc.2018.08.1029. Epub 2018 Aug 16.

27. Cramer SC, Rordorf G, Maki JH, et al. Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) study. Stroke. 2004 Jan;35(1):46-50. doi: 10.1161/01.STR.0000106137.42649.AB. Epub 2003 Dec 4.

28. Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014 Apr;13(4):429-38. doi: 10.1016/S1474-4422(13)70310-7

29. Bannan A, Shen R, Silvestry FE, Herrmann HC. Characteristics of adult patient with atrial septal defects presenting with paradoxical embolism. Catheter Cardiovasc Interv. 2009 Dec 1;74(7):1066-9. doi: 10.1002/ccd.22170

30. O’Byrne ML, Levi DS. State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart. Interv Cardiol Clin. 2019 Jan;8(1):11-21. doi: 10.1016/j.iccl.2018.08.008

31. Karamlou T, Diggs BS, Ungerleider RM, et al. Adults or big kids: what is the ideal clinical environment for management of grown-up patients with congenital heart disease? Ann Thorac Surg. 2010 Aug;90(2):573-9. doi: 10.1016/j.athoracsur.2010.02.078

32. Baharestani B, Rezaei S, Jalili Shahdashti F, et al. Experiences in surgical closure of atrial septal defect with anterior mini-thoracotomy approach. J Cardiovasc Thorac Res. 2014;6(3):181-4. doi: 10.15171/jcvtr.2014.008. Epub 2014 Sep 30.

33. Oster M, Bhatt A, Zaragoza-Macias E, et al. Interventional therapy versus medical therapy for secundum atrial septal defect: a systematic review (part 2) for the 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Apr 2;73(12):1579-95. doi: 10.1016/j.jacc.2018.08.1032. Epub 2018 Aug 16.

34. Yap SC. Atrial fibrillation and stroke after atrial septal defect closure. Is earlier closure warranted? Heart. 2015 May;101(9):661-2. doi: 10.1136/heartjnl-2015-307554. Epub 2015 Feb 23.

35. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014 Jul;45(7):2160-236. doi: 10.1161/STR.0000000000000024. Epub 2014 May 1.

36. Nyboe C, Olsen MS, Nielsen-Kudsk JE, et al. Atrial fibrillation and stroke in adult patients with atrial septal defect and long-term effect of closure. Heart. 2015 May;101(9):706-11. doi: 10.1136/heartjnl-2014-306552. Epub 2015 Feb 17.


Review

For citations:


Belopasova A.V., Dobrinina L.A., Chechetkin A.O., Karshieva A.R., Ananieva L.Yu., Pushkina D.S. Atrial septal defects: the role in the development of cerebral circulation disorders caused by paradoxical embolism. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(6):142-146. (In Russ.) https://doi.org/10.14412/2074-2711-2021-6-142-146

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)