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Abstract: This case refers to a 34-year-old female patient with recurrent headaches and dizziness for more than 4 years, with pain located on the left side of the brain, who was treated at other hospitals several times with poor success with oral medications. After examination of cardiac ultrasound and cranial CT, she was diagnosed with a central atrial septal defect (foramen ovale not closed), which is a type of atrial septal defect.
Basic information】Female, 34 years old
Disease Type】Atrial septal defect
Hospital】The Second Affiliated Hospital of Anhui Medical University
Date of consultation】March 2022
Treatment plan】Transfemoral septal defect closure + medication (aspirin)
Treatment Period】4 days in hospital, review after 1 month
Results】Migraine and dizziness disappeared, and no abnormal shunt was found in the atrial septum on review.
I. Initial consultation
The patient was 34 years old, with recurrent headache and dizziness for more than 4 years, the pain was located on the left side of the brain, and she was treated in the neurology departments of several hospitals. Physical examination: clear consciousness, normal response, no facial cyanosis, no thoracic deformity, L/6 soft systolic murmur was heard between 2-4 ribs at the left edge of the sternum, no murmur was heard in other valve auscultation areas, heart rate 76 beats/min, rhythmical. In our outpatient clinic, cardiac ultrasound examination suggested a central atrial septal defect (foramen ovale not closed) with left-to-right shunt at the atrial level, and the size of the defect was 11×11×11 mm. Cranial CT: no obvious infarct lesion was seen, and the electrocardiogram was normal.
II. Treatment history
The patient was diagnosed with a central atrial septal defect (foramen ovale unclosed), which is a migraine caused by abnormal atrial septal shunt, and there were clear indications for atrial septal occlusion. On the second postoperative day, oral aspirin antiplatelet therapy was given to prevent local thrombosis caused by the blocker. The postoperative ultrasound showed that there was no abnormal shunt in the atrial septum and the blocking parachute was in a reliable position. The patient was discharged from the hospital on the 4th day with no obvious headache and dizziness, and was asked to come back to the hospital for a review in 1 month.
III. Treatment effect
After the atrial septal defect blocking, the migraine and dizziness symptoms disappeared significantly, and the sleep quality improved significantly, achieving the effect of eradicating headache and dizziness. 1 month after the operation, the cardiac ultrasound showed no abnormal shunt in the atrial septum, and the blocker was in the atrial septal position.
IV. Precautions
The patient’s symptoms have disappeared after treatment, and we are glad that we can help the patient to solve the problem that has been bothering him for many years. After surgery, patients still need to pay attention to rest in the early stage and avoid strenuous exercise to prevent detachment of the blocker caused by strenuous exercise. At the same time, oral aspirin antiplatelet therapy was given for six months after surgery to prevent the occurrence of embolism. Because the blocker has metal components, avoid doing MRI to avoid accidents such as detachment. During the period of oral aspirin, it is necessary to review the blood routine every 2-3 months to understand the situation of platelets and to avoid bleeding caused by excessive anti-platelet therapy.
V. Personal insight
Adults with unexplained migraine, dizziness, or even cerebral infarction, with no obvious organic lesion after neurological examination, which cannot explain the symptoms that appear, need to check cardiac ultrasound, and if the diagnosis of the presence of central atrial septal defect (unclosed foramen ovale) with left-to-right shunt abnormalities, need to promptly deal with the atrial septum. At present, treatment is mainly performed by minimally invasive percutaneous atrial septal occlusion methods, either under X-ray intervention or under ultrasound guidance, the latter without radiographic damage and with less trauma, which has become the mainstream procedure. After the atrial septal occlusion, the symptoms will disappear and a complete cure can be achieved. Therefore, a definite diagnosis of atrial septal defect requires timely treatment for a limited period of time to reduce the occurrence of complications.