ATRIAL SEPTAL ANEURYSMS ASSOCIATED WITH C EREBRAL-ISCHEMIA IN YOUNG-ADULTS - 4 CASES

Transoesophageal echocardiography has improved the detection of potent ial sources of cerebral embolism. We report our experience with a grou p of 38 patients under 45 years of age who were examined after an arte rial ischaemic cerebral event. We observed 4 patients (2 males, 2 fema les; age 17, 24, 38 and 40 years) with an atrial septal aneurysm. Cere bral ischaemia was permanent in 3 patients and temporary in 1 and a ce rebral embolism was the most probable cause based on angiographic find ings. The atrial septal aneurysm was only diagnosed by transoesophagea l echocardiography (type IA in case 3, IB in the others). A patent for amen ovale was observed in 3 and this abnormality, which is known to h ave a high prevalence in the general population, could at most be an a ggravating factor. In our series, we can assume a causal association b etween atrial septal aneurysm and stroke in young patients (10,5% amon g 38 young stroke patients vs 3% of 30 patients referred for other rea sons). The treatment is still under discussion although the consensus would favour surgery if another heart malformation is associated, if a visible thrombus is identified or if repeated cerebrovascular events occur despite adequate anticoagulation. Studies conducted in large ser ies of patients should provide more adequate therapeutic schemas.