Migotanie przedsionków czy przetrwały otwór owalny — gdzie leży przyczyna nawracających udarów niedokrwiennych mózgu?

Abstract

Ischemic stroke is one of the major causes of death and disability in high-developed countries. Closure of PFO is recommended if other causes of ischemic stroke, like atrial fibrillation, were excluded, especially in young patients. We present a case report of a 75-years-old female patient with five ischemic strokes in her medical history and newly diagnosed patent foramen ovale. Atrial fibrillation was detected 25 years after first ischemic event. Implementation of anticoagulation therapy has prevented new ischemic strokes in our patient. According to emerging meta-analyses such treatment is sufficient not only in AF, but also in PFO related ischemic strokes. The patient had another risk factors for paradoxical embolism such as varices, post-thrombotic syndrome of lower limbs and the Eustachian valve, so it is unclear whether AF has been the major cause of all ischemic stroke in present case. Significant bleeding from limb varices during anticoagulation treatment occurred and required urgent surgical intervention. Because of the high risk of recurrent haemorrhages (HAS-BLED Score – 4 points), the patient was considered to two percutaneous procedures: occlusion of the left atrial appendage (LAA) and consecutively second - PFO closure as additional prevention of stroke. This is an illustrative case that opens discussion on necessity and timing of cardiac interventions once possible cardiac sources of ischemic strokes are found and new facts arise.