RESUMO
ABSTRACT Patent foramen ovale might cause cryptogenic strokes, including retinal artery occlusion. Herein, we describe a previously healthy young man who presented with central retinal artery occlusion in the setting of patent foramen ovale and explore the need for transesophageal echocardiogram for its diagnosis. Cardiovascular workup and neuroimaging were unremarkable. Transthoracic echocardiogram bubble study revealed a right to left atrial shunt and subsequent transesophageal echocardiogram disclosed patent foramen ovale. This congenital cardiac anomaly was the likely conduit for a thrombo-embolic central retinal artery occlusion. We identified seven patients with patent foramen ovale associated with central retinal artery occlusion in the literature. Transthoracic echocardiogram was diagnostic in only one patient (14.3%), whereas transesophageal echocardiogram was required to reveal patent foramen ovale in the remaining six (85.7%). Our case and the previous reports support the link between central retinal artery occlusion and patent foramen ovale. Therefore, providers should consider the more sensitive transesophageal echocardiogram during the initial evaluation of young patients without immediately identifiable causes of retinal artery occlusion.
RESUMO O forame oval patente pode estar associado a derrames criptogênicos que incluem a oclusão da artéria retiniana. Descrevemos aqui um jovem previamente saudável que apresentou oclusão da artéria central da retina associada ao forame oval patente, sendo considerado portanto, a necessidade de um ecocardiograma transesofágico para seu diagnóstico. A avaliação cardiovascular e a neuroimagem não foram significativas. O estudo da bolha no ecocardiograma transtorácico revelou um shunt atrial direito-esquerdo e o ecocardiograma transesofágico subsequente revelou um forame oval patente. Esta anomalia cardíaca congênita foi o provável conduíte para uma oclusão tromboembólica da artéria central retiniana Na literatura, foram identificadossete pacientes com forame oval patente associado à oclusão da artéria central retiniana. O ecocardiograma transtorácico diagnosticou apenas um paciente (14,3%), enquanto o ecocardiograma transesofágico foi necessário para revelar o forame oval patente nos seis casos restantes (85,7%). Nosso caso e relatos anteriores suportam a ligação entre a oclusão da artéria central retiniana e o forame oval patente. Os profissionais devem considerar, como sendo mais sensível, o ecocardiograma transesofágico na avaliação inicial de pacientes jovens sem causas imediatamente identificáveis de oclusões da artéria retiniana.
RESUMO
Patent foramen ovale might cause cryptogenic strokes, including retinal artery occlusion. Herein, we describe a previously healthy young man who presented with central retinal artery occlusion in the setting of patent foramen ovale and explore the need for transesophageal echocardiogram for its diagnosis. Cardiovascular workup and neuroimaging were unremarkable. Transthoracic echocardiogram bubble study revealed a right to left atrial shunt and subsequent transesophageal echocardiogram disclosed patent foramen ovale. This congenital cardiac anomaly was the likely conduit for a thrombo-embolic central retinal artery occlusion. We identified seven patients with patent foramen ovale associated with central retinal artery occlusion in the literature. Transthoracic echocardiogram was diagnostic in only one patient (14.3%), whereas transesophageal echocardiogram was required to reveal patent foramen ovale in the remaining six (85.7%). Our case and the previous reports support the link between central retinal artery occlusion and patent foramen ovale. Therefore, providers should consider the more sensitive transesophageal echocardiogram during the initial evaluation of young patients without immediately identifiable causes of retinal artery occlusion.