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

  • 1Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. kylee@yuhs.ac
  • 2Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 4Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.


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.
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.
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.


Heart septal defects, Atrial; Stroke; Echocardiography, Transesophageal

MeSH Terms

Aged, 80 and over
Cerebral Infarction
Echocardiography, Transesophageal
Heart Atria
Heart Defects, Congenital
Heart Septal Defects, Atrial*


  • 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.

  • 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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