Türk Beyin Damar Hast Derg. 2018; 24(2): 46-51 | DOI: 10.5505/tbdhd.2018.21548

Patent Foramen Ovale in Young Patients with Ischemic Stroke

Zeynep Özözen Ayas¹, Aslý Aksoy Gündoðdu², Çaðýn Mustafa Üreyen^3
1Yunus Emre State Hospital, Department of Neurology, Eskiþehir, Turkey
²Namýk Kemal University, Faculty of Medicine, Department of Neurology, Tekirdað, Turkey
³Antalya Training and Research Hospital, Department of Cardiology, Antalya, Turkey

INTRODUCTION: The foramen ovale is a hole in the interatrial septum in prenatal period, which is closed after birth with the increase of left atrium pressure. If it does not close, stroke due to parodoxically embolism, local thrombosis, arrhythmia and hypercoagulability can be seen. In this article, the frequency of patent foramen ovale (PFO) and atrial septal aneurysm (ASA), treatment approaches and follow-up results have been reported in young stroke patients.
METHODS: The files of 163 young stroke patients between 18 and 45 years of age who were followed up at our clinic were reviewed retrospectively. Transthoracic echocardiography (TTE) revealed PFO in 2 patients, ASA in 2 patients. Transeosophageal echocardiography (TEE) reported PFO in 5 patients. Age, gender, premorbid disease and antiaggregant-anticoagulant medical theraphy, routine tests, imaging, TTE and TEE findings, treatment protocols, stroke recurrence were recorded.

RESULTS: PFO was detected in 5 of 163 young stroke patients (3.06%) (3K, 2E). The average age was 30.2 (18-42). One patient had transient ischemic attack and 4 patients had stroke. There was a 1 patient has a previous stroke and 2 patients were smokers. Carotis stenosis was not detected in patients. ANA was positive in recurrent stroke patient, another patient had recurrent abortion, heterozygote mutation of FVL, MTHFR C677T and A1298C and hyperhomocysteinemia. One patient had PFO and no other pathological result for etiological investigation. Endovascular closure was performed in 2 patients. 2 patients were treated with acetylsalicylic acid and 2 patients were treated with warfarin. No recurrent stroke was seen in 3-5 year follow-ups.

DISCUSSION AND CONCLUSION: PFO investigation in young patients should be perform as a medical and surgically treatable factor against the risk of recurrence. In addition to the cryptogenic case, it is emphasized in all young stroke patients that TTE and TTE should be performed even in the presence of a known risk factor.

Keywords: Ischemic stroke in young patients, patent foramen ovale, treatment

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Genç Ýskemik Ýnmeli Hastalarda Patent Foramen Ovale

Zeynep Özözen Ayas¹, Aslý Aksoy Gündoðdu², Çaðýn Mustafa Üreyen^3
1Yunus Emre Devlet Hastanesi, Nöroloji Kliniði, Eskiþehir
²Namýk Kemal Üniversitesi Týp Fakültesi, Nöroloji Anabilim Dalý, Tekirdað
³Antalya Eðitim ve Araþtýrma Hastanesi, Kardiyoloji Kiniði, Antalya

GÝRÝÞ ve AMAÇ: Foramen ovale doðum öncesi dönemde interatrial septumda bulunan, doðumdan sonra sol atrium basýncýnýn artmasýyla kapanan açýklýktýr. Kapanmamasý durumda parodoksal emboli, lokal trombüs, aritmiler ve hiperkoagülabiliteye baðlý inme görülebilmektedir. Bu yazýda genç inmeli hastalarda patent foramen ovale (PFO) ve atrial septal anevrizma (ASA) sýklýðý, tedavi yaklaþýmlarý ve takip sonuçlarý bildirilmiþtir.
YÖNTEM ve GEREÇLER: Kliniðimizde izlenen 18-45yaþ arasý 163 genç inmeli hastanýn dosyalarý retrospektif olarak deðerlendirildi. Transtorasik ekokardiografide (TTE) 2 hastada PFO, 2 hastada ASA saptandý. Tranözefageal ekokardiografide (TÖE) 5 hastada PFO kaydedildi. Yaþ, cinsiyet, premorbid hastalýk ile antiagregan-antikoagülan ilaç kullanýmý, rutin test, görüntülemeler, TTE ve TÖE bulgularý ile tedavi protokolleri, inme rekürrensi kaydedildi.
BULGULAR: PFO, 163 genç inmeli hastanýn 5’inde (%3,06) (3K,2E) saptandý. Yaþ ortalamalarý 30.2 (18-42) idi. Bir hastada geçici iskemik atak, 4 hastada inme mevcuttu. Bir hastanýn daha önce geçirilmiþ inme öyküsü ve 2 hastanýn sigara içiciliði öyküsü vardý. Hastalarda karotis darlýðý saptanmadý. Rekürren inmeli hastada ANA pozitifliði, diðer hastada rekürren abortus, FVL, MTHFR C677T ve A1298C heterozigot mutasyonu ile hiperhomosisteinemi saptandý. Bir hastada MTHFR A1298C ve C677T heterozigot mutasyonun birlikteliði ve bir hastada MTHFR C677T heterozigot mutasyonu ve AKA pozitifliði tespit edildi. 1 hastanýn etiyolojik araþtýrmasýnda PFO varlýðý dýþýnda baþka bir patolojik sonuca rastlanýlmadý. 2 hastaya endovasküler kapatma yapýldý. 2 hasta asetilsalisilik asit, 2 hasta warfarin ile izlendi. 3-5 senelik takiplerinde rekürren inme izlenmedi.
TARTIÞMA ve SONUÇ: Genç inmelerde PFO araþtýrýlmasý tekrarlama riskine karþý medikal ve cerrahi olarak tedavi edilebilir bir faktör olduðundan mutlaka yapýlmalýdýr. Kriptojenik vakalarla birlikte genç hastalarda, bilinen risk faktörü varlýðýnda TTE ile TÖE yapýlmasý gerekliliði vurgulanmýþtýr.

Anahtar Kelimeler: Genç iskemik inmeli hasta, patent foramen ovale, tedavi

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