Patent Foramen Ovale And Stroke In Adolescents - To Close Or Not To Close?

Sónia Silva
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Abstract

Stroke is a rare condition in childhood and about half of the cases are due to an arterial ischemic event. Although the long list of known causes, many cases remain undetermined, so-called cryptogenic strokes. However, increasing evidence indicates that some of these cryptogenic cases can be a result of a paradoxical embolism via a Patent Foramen Ovale (PFO) with a right-to-left intracardiac shunt, but the exact contribution of PFO to stroke or stroke recurrence in childhood remains unclear. Considering this, as a second line of study, a transthoracic and transoesophageal echocardiogram should be done in all cases to rule out a possible right-to-left shunt, such as PFO. Optimal treatment for acute ischemic strokes in children is con-troversial, with lacking studies. Closure of PFO should be considered as a preventive measure depending on individual risk factors and anatomic features. We present two cases of a 16-year-old boy and a 17-year-old girl who had an event of cerebral ischemia documented on MRI, and in whom was found a PFO with a shunt, with the remaining exhaustive etiologic investigation all negative. Both of them underwent percutaneous closure of the PFO.
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青少年卵圆孔未闭与中风——闭合还是不闭合?
中风在儿童时期是一种罕见的情况,大约一半的病例是由于动脉缺血性事件引起的。尽管已知的病因很长,但许多病例仍未确定,即所谓的隐源性中风。然而,越来越多的证据表明,这些隐性病例中的一些可能是通过具有从右到左心内分流的Foramen Ovale专利(PFO)引起的反常栓塞的结果,但PFO对儿童中风或中风复发的确切影响尚不清楚。考虑到这一点,作为第二项研究,在所有情况下都应进行经胸和经食管超声心动图检查,以排除可能的左右分流,如PFO。儿童急性缺血性中风的最佳治疗是可逆的,缺乏研究。PFO的闭合应视为一种预防措施,具体取决于个体风险因素和解剖特征。我们报告了两例病例,一名16岁男孩和一名17岁女孩,他们在MRI上记录了脑缺血事件,其中发现了PFO伴分流,其余详尽的病因调查均为阴性。两人均接受了经皮PFO封堵术。
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