J Cardiovasc Ultrasound.  2008 Mar;16(1):23-25. 10.4250/jcu.2008.16.1.23.

A Case of Successful Transcatheter Device Closure of Small Atrial Septal Defect in a Patient with Cerebral Infarction Presumably Caused by Paradoxical Emboli

• Kim KH
• Lee WS
• Cho JS
• Yoon HJ
• Ahn Y
• Jeong MH
• Cho JG
• Park JC
• Kang JC

• KMID: 1486606
• DOI: http://doi.org/10.4250/jcu.2008.16.1.23

Abstract

Precutaneous transcatheter device closure of interatrial communications is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical cerebral embolism. We report a case of successful percutaneous transcatheter closure of small atrial septal defect in a 34 year old female patient with acute cerebral infarction presumably caused by paradoxical embolism through the defect.

Keyword

Paradoxical embolism; Device closure

MeSH Terms

Cerebral Infarction
Embolism, Paradoxical
Female
Heart Septal Defects, Atrial
Humans
Intracranial Embolism

Figure

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  Fig. 1 Computed tomographic angiography of the brain revealed thrombotic occlusion in the distal basilar artery, P1 portion of both cerebral arteries, and the origin site of both superior cerebellar arteries (A). Magnetic resonance image of the brain revealed multifocal cerebral and cerebellar infarction (B).

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  Fig. 2 Conventional 4 vessel angiography also revealed thrombotic occlusion in the distal basilar artery, P1 portion of both cerebral arteries, and the origin site of both superior cerebellar arteries without distal flow (A, B). Follow up angiography just after the administration of intra-arterial urokinase revealed resolution of the thrombus with the restoration of distal flow.

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  Fig. 3 Transesophageal echocardiography revealed about 0.65 cm sized small ASD with abnormal left to right shunt. LA: left atrium, RA: right atrium, AO: aorta.

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  Fig. 4 Transesophageal echocardiography after the successful deployment of the Amplatzer septal occluder revealed well positioning of the device without residual shunt.

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