Recurrence of cerebrovascular events in young adults with a secundum atrial septal defect

Lok, Sjoukje I.; Winkens, Bjorn; Dimopoulos, Konstantinos; Fernandes, Susan M.; Gatzoulis, Michael A.; Landzberg, Michael J.; Mulder, Barbara J.M.

doi:10.1016/j.ijcard.2008.12.085

« Previous Next »International Journal of Cardiology
Volume 142, Issue 1 , Pages 44-49, 25 June 2010

Recurrence of cerebrovascular events in young adults with a secundum atrial septal defect☆

Sjoukje I. Lok
- University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
Bjorn Winkens
- Department of Methodology and Statistics, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Susan M. Fernandes
- Boston Adult Congenital Heart Service, Department of Cardiology, Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
Michael A. Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
Michael J. Landzberg
- Boston Adult Congenital Heart Service, Department of Cardiology, Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
Barbara J.M. Mulder
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
- Interuniversity Cardiology Institute Netherlands (ICIN/KNAW), Catharijnesingel 52, 3511 GC, Utrecht, The Netherlands
- Corresponding author. Academic Medical Centre, Department of Cardiology, B2-240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 20 566 2193; fax: +31 20 697 1385.

Received 19 August 2008; accepted 13 December 2008. published online 27 January 2009.

Abstract

Background

The recurrence rate for cerebrovascular ischemic events in patients after a first TIA or CVA with an atrial septal defect type 2 (ASD2) remains unknown. At present, there are no guidelines with respect to appropriate treatment. The aim of this study was to determine incidence rates of recurrent cerebrovascular events in patients with ASD2.

Methods

A multicenter, retrospective study was performed at selected centres in The Netherlands, United Kingdom and United States. All patients with ASD2 and a prior cerebrovascular event were identified from available databases. Clinical data were retrieved from medical files, electronic databases and radiographic charts.

Results

Fifty-six adult patients born between 1950 and 1990 (median age at first cerebrovascular event 37.5, range 15–53 years) were recruited. Recurrent events (9 TIA, 2 CVA) were recorded in 11 patients (19.6%) during a median follow-up time of 5.3 years (range 0.2–28.9). Non-closure of the defect was the only significant predictor of a recurrent event (p=0.01).

Conclusion

Patients with an ASD2 and a history of a cerebrovascular ischemic event have a substantial risk for recurrent events. Closure of the ASD2 seems to substantially decrease the risk of recurrence. However, prospective randomized trials are needed to confirm our findings.

Abbreviations: ASD2, atrial septal defect type 2, PFO, patent foramen ovale, TIA, transient ischemic attack, CVA, cerebrovascular accident, CIE, cerebrovascular ischemic events.