Young people have brain infarction because of a "hole" in the heart? This "hidden killer" cannot be underestimated

　　Xinhua News Agency, Beijing, February 8 -

　　Tian Xiaohang, Wang Jing

　　Cerebral infarction is a common disease in the elderly. Cerebral atherosclerosis and thrombosis are the most common pathological mechanisms of cerebral infarction.

However, the Department of Cardiology at Peking Union Medical College Hospital recently admitted to a young woman with a sudden cerebral infarction. The examination revealed that the cause was actually a "hole" in the heart.

　　The reporter learned from Peking Union Medical College Hospital that this 37-year-old patient, Ms. Li, had a sudden dizziness and decreased consciousness before going to bed one day, accompanied by vomiting. After getting up the next morning, she felt that her left body was weak, and she developed mobility disorders.

After going to a nearby hospital, he was diagnosed with cerebral infarction after examination. After receiving medication, his symptoms eased.

To further search for the cause, she went to Peking Union Medical College Hospital for treatment.

　　According to experts, for a young woman under the age of 40, cerebral infarction is not a common disease, and no atherosclerosis and stenosis or occlusion of cerebral blood vessels were found in the examination.

In young people, stroke is most likely to be the source of the heart. The most common cause is atrial fibrillation, but Ms. Li has no history of atrial fibrillation.

What caused Ms. Li's cerebral infarction?

　　Jing Zhicheng, director of the Department of Cardiology, Peking Union Medical College Hospital, arranged a transesophageal echocardiography for the patient, and found that there was a left-to-right shunt blood flow in the atrial septum of the heart; further transcranial Doppler ultrasound (TCD) foam test was performed, and the result was positive. Ms. Li was diagnosed with patent foramen ovale.

It turned out that this was the "culprit" that caused Ms. Li's cerebral infarction.

　　Why does patent foramen ovale cause stroke?

According to Li Jingyi, the attending physician of the Department of Cardiology, Peking Union Medical College Hospital, the foramen ovale is the passage between the left and right atriums of the heart during embryonic development. Generally, it gradually closes due to the increased pressure in the left atrium within 1 year after birth; if it does not close, it will It is called patent foramen ovale.

When infection and other factors cause thrombosis in the venous system, the embolus enters the left atrium from the right atrium through the open foramen ovale, and reaches the cerebrovascular with the systemic circulation, which can cause cerebral infarction, migraine, syncope and other clinical symptoms.

　　Li Jingyi said that the incidence of patent foramen ovale is relatively high in the population, about one-quarter, but it is usually asymptomatic or mild, and it is easy to be ignored. It is mostly found through physical examination.

　　After confirming the diagnosis, Jing Zhicheng and the leading minimally invasive cardiac surgery team performed patent foramen ovale occlusion for the patient.

After minimally invasively inserting a heart catheter through the femoral vein at the base of the thigh to send the occluder to the foramen ovale position, unfold the blocking umbrella to perfectly fit the foramen ovale and seal the gap.

Ms. Li recovered well the next day after the operation and was discharged smoothly.

　　"Stroke does not only occur in the elderly, nor is it only the problem of cerebral arteriosclerosis that leads to stroke. The relationship between patent foramen ovale and stroke should be paid enough attention." Jing Zhicheng introduced, a summary of 1032 studies worldwide A meta-analysis of the results showed that the incidence of patent foramen ovale in patients with cryptogenic stroke was many times higher than in healthy people.

　　"Patient foramen ovale has become one of the important causes of stroke in middle-aged and elderly people, especially young people." Jing Zhicheng said, as a doctor, you cannot simply "treat your head and feet with a headache". Causes of stroke, intractable migraine, etc., should be alert to the possibility of patent foramen ovale.

　　So, do you need surgery after finding the patent foramen ovale?

Jing Zhicheng believes that in addition to patients with cerebral infarction and intractable migraine, surgery is required for those who have a positive TCD foam test can also choose to undergo occlusion surgery to solve the potential risk, because the positive indicates the abnormal right to left shunt of the heart. And microemboli can be monitored in the cerebral artery.

The closure operation is a minimally invasive operation, with small wounds, short time, quick recovery, and little impact on life and work after surgery.

　　Experts said that in the face of cardiogenic stroke, it is necessary to establish the concept of "heart and brain co-treatment", and achieve early detection, early prevention, and early treatment through multidisciplinary teamwork such as cardiology and neurology.