Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-18T23:58:34.792Z Has data issue: false hasContentIssue false

Ischaemic stroke with intact atrial septum – exclude arteriovenous malformations

Published online by Cambridge University Press:  25 January 2013

Friederike Doering*
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany
Andreas Eicken
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany
John Hess
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany
*
Correspondence to. Dr med. F. Doering, Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 München, Germany. Tel: 0049 89 1218 3305; Fax: 0049 89 1218 3333; E-mail: [email protected]

Abstract

A 44-year-old woman was referred to our centre for interventional cardiac catheterisation. The diagnostic work-up after a preceding ischaemic stroke led to the assumption of a patent foramen ovale due to a positive bubble study. Before the planned percutaneous closure of the patent foramen ovale, we performed a second bubble study, which showed an intact atrial septum. However, after two to three heart cycles bubbles could be detected in the left atrium, assuming a right-to-left shunt of an extracardiac origin most likely in the lung. We therefore performed cardiac catheterisation, yielding a pulmonary arteriovenous malformation in the lower lobe of the right lung. This was successfully closed interventionally by placing a Cook coil, as well as several plugs into the malformation and feeding vessels.

Type
Brief Reports
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Morier, J, Goncalves-Matoso, V, Michel, P. Multiple pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia complicated by embolic strokes. Arch Neurol 2011; 68: 672.Google Scholar
2. Letourneau-Guillon, L, Faughnan, ME, Soulez, G, et al. Embolization of pulmonary arteriovenous malformations with Amplatzer vascular plugs: safety and midterm effectiveness. J Vasc Interv Radiol 2010; 21: 649656.CrossRefGoogle ScholarPubMed
3. Hart, JL, Aldin, Z, Braude, P, Shovlin, CL, Jackson, J. Embolization of pulmonary arteriovenous malformations using the Amplatzer vascular plug: successful treatment of 69 consecutive patients. Eur Radiol 2010; 20: 26632670.CrossRefGoogle ScholarPubMed
4. Remy-Jardin, M, Dumont, P, Brillet, PY, Dupuis, P, Duhamel, A, Remy, J. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2–21-year follow-up. Radiology 2006; 239: 576585.Google Scholar
5. Gupta, S, Faughnan, ME, Bayoumi, AM. Embolization for pulmonary arteriovenous malformation in hereditary haemorrhagic telangiectasia: a decision analysis. Chest 2009; 136: 849858.Google Scholar
6. Faughnan, ME, Palda, VA, Garcia-Tsao, G, et al. International guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia. J Med Genet 2011; 48: 7387.Google Scholar
7. Govani, FS, Shovlin, CL. Hereditary haemorrhagic telangiectasia: a clinical and scientific review. Eur J Hum Genet 2009; 17: 860871.Google Scholar
8. Shovlin, CL, Guttmacher, AE, Buscarini, E, et al. Diagnostic criteria for hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet 2000; 91: 6667.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
9. Kurshid, I, Downie, G. Pulmonary arteriovenous malformation. Postgrad Med J 2002; 78: 191197.Google Scholar
10. Shovlin, CL, Jackson, JE, Bamford, KB, et al. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia. Thorax 2008; 63: 259266.Google Scholar