Toward understanding the atrial septum in cryptogenic stroke
Paul E. Cotter,
Peter J. Martin,
Mark Belham,
Corresponding Author
Paul E. Cotter
Department of Medicine, University of Cambridge, Cambridge, UK
Paul E Cotter*, Department of Medicine, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Rd., Cambridge CB2 0QQ, UK.E-mail: [email protected]Search for more papers by this authorPeter J. Martin
Department of Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Search for more papers by this authorMark Belham
Department of Cardiology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Search for more papers by this authorPaul E. Cotter,
Peter J. Martin,
Mark Belham,
Corresponding Author
Paul E. Cotter
Department of Medicine, University of Cambridge, Cambridge, UK
Paul E Cotter*, Department of Medicine, University of Cambridge, Box 83, Addenbrooke's Hospital, Hills Rd., Cambridge CB2 0QQ, UK.E-mail: [email protected]Search for more papers by this authorPeter J. Martin
Department of Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Search for more papers by this authorMark Belham
Department of Cardiology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Search for more papers by this authorFirst published: 23 September 2011
Conflict of interest: None declared.
Funding: P. E. C. is funded by the National Institute of Health Research, Cambridge Biomedical Research Centre.
Abstract
Ischemic stroke in younger people is common, and often remains unexplained. There is a well-documented association between unexplained stroke in younger people, and the presence of a patent foramen ovale. Therefore, in the absence of a clear cause of stroke, the heart is often assessed in detail for such lower risk causes of stroke. This usually involves imaging with a transesophageal echo, and investigation for a right-to-left shunt. An understanding of the anatomy of the atrial septum, and its associated abnormalities, is important for the stroke neurologist charged with decision making regarding appropriate secondary prevention. In this paper, we review the development and anatomy of the right heart with a focus on patent foramen ovale, and other associated abnormalities. We discuss how the heart can be imaged in the case of unexplained stroke, and provide examples. Finally, we suggest a method of investigation, in light of the recent European Association of Echocardiography guidance. Our aim is to provide the neurologist with an understanding on how the heart can be investigated in unexplained stroke, and the significance of abnormalities detected.
Supporting Information
Supporting information material S1. TOE loop demonstrating a normal interatrial septum.
Supporting information material S2. Loop of a TTE bubble study with a very large left to right shunt.
Supporting information material S3. Loop of a TOE bubble study with a PFO.
Supporting information material S4. A sample report of a bubble-contrast transthoracic echo.
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