Association between atrial septal abnormalities (patent foramen ovale, atrial septal defect, interatrial septal aneurysm) and cryptogenic stroke in children

Among cardiac diseases, those defined as cardio-embolic generate blood clots that, when traveling in the bloodstream, can partially or completely obstruct brain vessels thus causing a transient ischemic attack or a stroke. Patency of foramen ovale, atrial septal defect, and interatrial septal aneurysm are well known cardiac anomalies whose clinical significance is still under debate. Usually diagnosed by echocardiography, they are often associated with otherwise unexplained (cryptogenic) stroke at a young age, including paediatric patients. Despite this widely reported in literature link, defining the exact pathogenetic mechanism by whom they are associated with systemic thromboembolism is difficult. In this practical review, we try to clarify their pathogenetic role in inducing cerebral ischemia. Related treatment options are discussed as well.