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Cryptogenic stroke caused by patent foramen ovale with thrombophilia and accessory tricuspid valve in a teenager

Published online by Cambridge University Press:  23 February 2022

Hiroya TakafujiOpen the ORCID record for Hiroya Takafuji[Opens in a new window],
Nahoko Kato and
Kotaro Obunai
Hiroya Takafuji*
Affiliation:
Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
Nahoko Kato
Affiliation:
Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
Kotaro Obunai
Affiliation:
Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
*
Author for correspondence: H. Takafuji, Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan. Tel: +81-47-351-3101; Fax: +81-47-352-6237. E-mail: hiroyat@jadecom.jp
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Abstract

Accessory tricuspid valve is rare congenital abnormality. We describe a case of cryptogenic stroke in teenager boy caused by patent foramen ovale with thrombophilia and accessory tricuspid valve.

Keywords

Cryptogenic strokepatent foramen ovalethrombophiliaaccessory tricuspid valveteenager

Information

Type
Images in Congenital Cardiac Disease
Information
Cardiology in the Young , Volume 32 , Issue 3 , March 2022, pp. 478 - 479
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

A 14-year-old boy presented to our hospital with complaints of sudden severe headache and dimmed vision. He had a history of migraine. Emergency magnetic resonance imaging revealed an embolic stroke in the thalamus, within the left cerebral hemisphere. Transthoracic echocardiography showed a mobile structure in the right ventricle (Fig 1, video 1), and subsequent transesophageal echocardiography confirmed that the structure was attached to the leaflet of the tricuspid valve and the right ventricle wall; therefore, it was suspected to be an accessory tricuspid valve (Fig 2, video 2). Furthermore, transesophageal echocardiography showed persistent colour flow through a patent foramen ovale at rest (Fig 3) without Valsalva manoeuvre. A laboratory test showed protein S deficiency. We performed percutaneous patent foramen ovale closure to prevent stroke recurrence. A 25-mm Amplatzer patent foramen ovale occluder (Abbott, Chicago, Illinois) was successfully deployed (Fig 4). Cryptogenic stroke caused by patent foramen ovale in children is very rare. Furthermore, a combination of patent foramen ovale and thrombophilia is known to increase the risk for cryptogenic stroke. Moreover, accessory tricuspid valve is rare congenital abnormality associated with congenital intracardiac shunt heart diseases.Reference Yoon, Shaqra, Levin, Rudin and Bella1 Although little is known about its clinical features, in this teenage patient, it may have been associated with stroke caused by a thrombus occurring due to a hypercoagulable disorder with significantly mobile accessory structure.

Figure 1.

Transthoracic echocardiography showing a mobile structure in the right ventricle.

Figure 2.

Transesophageal echocardiography showing a structure was attached to the leaflet of the tricuspid valve and the right ventricle wall.

Figure 3.

Transesophageal echocardiography showing persistent colour flow through a patent foramen ovale.

Figure 4.

A 25-mm Amplatzer PFO occluder was successfully deployed. LA left atrium; LV left ventricle; RA right atrium; RV right ventricle.

Supplementary material

To view supplementary material for this article, please visit https://doi.org/10.1017/S1047951122000518

Acknowledgements

None.

Financial support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Conflicts of interest

None.

Ethical standards

All study procedures complied with the ethical standards of the Helsinki Declaration.

References

Yoon, A, Shaqra, H, Levin, M, Rudin, B, Bella, JN. Accessory tricuspid valve leaflet in an asymptomatic adult. Tex Heart Inst J 2008; 35: 327–328.Google Scholar
Figure 0

Figure 1.Transthoracic echocardiography showing a mobile structure in the right ventricle.

Figure 1

Figure 2.Transesophageal echocardiography showing a structure was attached to the leaflet of the tricuspid valve and the right ventricle wall.

Figure 2

Figure 3.Transesophageal echocardiography showing persistent colour flow through a patent foramen ovale.

Figure 3

Figure 4.A 25-mm Amplatzer PFO occluder was successfully deployed. LA left atrium; LV left ventricle; RA right atrium; RV right ventricle.

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