I agree with you. Small ASDs with a diameter of less than 5 mm and no evidence of right ventricle volume overload do not impact the natural history of the individual and thus may not require closure unless associated with paradoxical embolism.
I agree with you. In absence of RV volume overload and absence of paradoxical embolism the closure of small ASD (less than 6 mm) is not indicated. However, if the patient has migrane one need to do carotid ultrasound with venous injection of bubble contrast during valsalva maneuver to exclude paradoxical embolism under stress.
Dear Milad, I agree with you, but the most of neurologist do't perform echocardiogram and carotid ultrasound to avaulate ASD or PFO as etiology of migrane.
Yes, that is true Jacob but I think we, as cardiologist, have to spread this concept to help many patients with difficult migraine.
I agree. I don't make the closure. Sometimes neurologists could be theproblem. There is no indication of PFO or small ASD for migraine.
After the results of the MYST (for migraine) and CLOSURE-I trial and the most recent trials with PFO closure there is no evidence towards the benefit of closing these deffects. Despite the likely rationale due paradoxal thromboembolism, perhaps a high prevalence of undetected atrial fibrillation or even the presence of atrial septal aneurysms that even without a continuity solution remain a source of embolism may explain this lack of benefit...
There is really no indication to close small ASD's without RV overload. The PFO question is totally different: PFO closure is only justified after cryptic stroke with carefull exclusion of all other causes of stroke and if the patients are young and prefer closure to medical treatment. For migraine, the discussion is even more difficult, since with the available data, it seems impossible to correctly identifying those patients who will really benefit from closure.
The cases of atrial septal defects as small really have no close indication, considering the load of Qp: Qs for closure, the impact on the cavities.
There are some discussions in the literature about it yet, some point out that they are only indicated when the patient has had at least two transient cerebrovascular events and has been excluded other causes of cerebral embolism