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Intracardiac versus extracardiac shunt in a young man with ischaemic stroke
  1. Mafalda Carrington1,
  2. Ana Rita Pereira2,
  3. Inês Carmo Mendes3 and
  4. Rui Anjos3
  1. 1Cardiology, Hospital do Espirito Santo EPE, Évora, Portugal
  2. 2Cardiology, Hospital Garcia de Orta EPE, Almada, Portugal
  3. 3Pediatric Cardiology Department and Reference Center for Congenital Heart Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Lisboa, Portugal
  1. Correspondence to Dr Mafalda Carrington; mafaldacarrington{at}


A 24-year-old man with a history of recent ischaemic stroke was diagnosed with patent foramen ovale (PFO) and referred for closure at our hospital. At admission, besides low peripheral oxygen saturation (88%), physical examination was otherwise normal. We performed intraprocedural transoesophageal echocardiogram that revealed no PFO, although agitated saline injection demonstrated bubbles lately on the left atrium. The atrial septum could not be crossed. We suspected an extracardiac shunt, so pulmonary angiograms were performed that revealed the presence of a left pulmonary arteriovenous malformation (PAVM). A Konar-MF Occluder was used to occlude the PAVM, with a satisfactory result. At 6 months follow-up, the patient had normal peripheral oxygen saturation and a new pulmonary angiogram showed no residual shunt. Intrapulmonary shunts are a rare and under-recognised cause of paradoxical emboli in young patients; physicians should be aware of this diagnosis as percutaneous occlusion is indicated and critical to avoid recurrent ischaemic episodes.

  • interventional cardiology
  • radiology (diagnostics)
  • stroke

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  • Contributors MC and ARP are equal contributors and were responsible for drafting the manuscript; IMC was responsible for critically revising the manuscript; RA is the Head of Department and final approved the manuscript submitted. All authors participated on the diagnosis and management of this patient. These authors have contributed equally to this work and share first authorship

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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