J Neurocrit Care.  2018 Dec;11(2):124-128. 10.18700/jnc.180037.

Stroke Recurrence in a Patient Twelve Years after Repair of a Secundum Atrial Septal Defect

• Ok T
• La YK
• Cha HS
• Cheon K
• Choi BK
• Yi GJ
• Lee KY

• KMID: 2434839
• DOI: http://doi.org/10.18700/jnc.180037

Abstract

BACKGROUND
Secundum atrial septal defect (ASD) is a common congenital heart defect in adults. Patients with ASDs at high risk of cardiovascular complications undergo either surgical repair or percutaneous device closure.
CASE REPORT
We report the case of an 85-year-old male with unusual recurrent cerebral infarctions. The patient has undergone repair of secundum ASD 12 years ago. Evaluation by transesophageal echocardiography revealed a mobile mass at the patch repair site in the left atrium. The mass was surgically removed due to recurrent stroke during the anticoagulation.
CONCLUSION
This case emphasizes the importance of regular cardiac checkup and the need to consider cardioembolic source as being part of the etiology of stroke recurrence, even if the event occurs many years after intracardiac shunt closures.

Keyword

Heart septal defects, Atrial; Stroke; Echocardiography, Transesophageal

MeSH Terms

Adult
Aged, 80 and over
Cerebral Infarction
Echocardiography, Transesophageal
Heart Atria
Heart Defects, Congenital
Heart Septal Defects, Atrial*
Humans
Male
Recurrence*
Stroke*

Figure

• 

  Figure 1. Brain MRI of recurrent cerebral infarctions and contrast enhanced MRA. (A) Diffusion weighted MRI shows acute infarction on the right occipital lobe. (B) MRA shows no significant stenosis on bilateral proximal internal carotid and vertebral arteries. (C) First follow up diffusion weighted MRI shows acute cerebral infarction on the left parietal lobe. (D) Second follow up diffusion weighted MRI shows acute infarction on the left parieto-occipital lobe. MRI, magnetic resonance image; MRA, magnetic resonance angiography.

• 

  Figure 2. Transesophageal echocardiography shows hypermobile amorphous echogenic mass (0.89×0.42 cm, arrow) attached to the patch repair site of atrial septal defect in the left atrium.

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  Figure 3. Surgical specimen of cardiac mass shows fibrosis and acute suppurative inflammation on (A) H&E stain, ×40 view (B) H&E stain, ×400 view.

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