Abstract Details

Title Correlation of Atrial Septal Defect Size as Measured by Intracardiac Echocardiography and Transcranial Doppler Ultrasound in Children and Young Adults

Topic Child Neurology/Developmental Neurobiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 102

Objective

Background BACKGROUND: Right to left shunts (RLS) found with patent foramen ovale are implicated in the pathophysiology of cryptogenic stroke, migraine headaches as well as decompression illness. Our dysautonomia clinic has studied a syndrome of neurocardiogenic syncope, migraine headaches and positive tilt table testing associated with atrial septal defects (ASD). RLS are typically diagnosed non-invasively using echocardiography ± transcranial Doppler ultrasound (TCD). However, intracardiac echocardiography (ICE) provides a superior image of the cardiac septum.

Design/Methods DESIGN/METHODS: We performed a restrospective analysis of a prospectively obtained registry of patients that underwent simultaneous TCD and ICE shunt testing ± endovascular ASD closure. All patients underwent general anesthesia and bilateral TCD monitoring of the middle cerebral artery. Valsalva was manually produced by the anesthesiologist at 40mm Hg. Simultaneous assessment of RLS was performed using ICE and TCD monitoring after injection of agitated saline into the femoral vein sheath. If negative, a direct right atrial injection was performed. The size of ASD was measured by ICE independent of TCD results.

Results RESULTS: Between 9/2010 and 7/2012, 112 patients underwent testing. RLS was found in 81.1 and 71.4 percent by ICE and TCD, respectively. Curtain (too many bubbles to count) TCD shunts had larger physical ASDs compared to non-curtain (2.8mm ± 1.7 vs 1.7mm ± 0.9, p=0.004). Additional cardiac abnormalities, such as Atrial Septal Aneurysm and/or Multifenestrated ASD, had larger ASD sizes compared to those without (3.5mm ± 1.7 vs 1.9 ± 1.3, p=0.0001).

Conclusions CONCLUSIONS: Curtain result on TCD bubble studies is associated with significantly larger ASDs and other cardiac abnormalities in children and young adults.

Authors/Disclosures
David Doan, MD (Child Neurology & Stroke of Houston, PLLC) PRESENTER	No disclosure on file
Andrew D. Barreto, MD (University of Texas Health Science Center At Houston (UTHealth))	No disclosure on file
Scott D. Newsome, DO, FAAN (Johns Hopkins Hospital)	Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Newsome has received research support from Biogen. The institution of Dr. Newsome has received research support from Genentech/Roche. The institution of Dr. Newsome has received research support from Department of Defense. The institution of Dr. Newsome has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Newsome has received research support from National MS Society. The institution of Dr. Newsome has received research support from Lundbeck. The institution of Dr. Newsome has received research support from Sanofi. The institution of Dr. Newsome has received research support from Kyverna Therapeutics. Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving as a Lead PI for Clinical Trial with Roche.
Eva E. Fulep (Univ of Texas Health Science Center)	No disclosure on file
	No disclosure on file
Ian J. Butler, MD (UTHealth McGovern Medical School)	No disclosure on file

��ɫ��

��ɫ��