Congenital Cardiac Defects, Such as Eustachian Valve, May Increase the Risk of Cryptogenic Stroke: A Case Report

摘要

Eustachian valve is an embryonic endocardial heart structure;after birth it becomes an embryogenic residue and its persistance in adult life is unusual.xa0The literature reports some cases of association between Eustachian valve and PFO and is known that the prominent Eustachian valve can represent a way facilitating systemic embolism.Several studies also investigated the role of Eustachian valve in the pathophysiology of both migraine and cerebral embolism.xa0In addiction is known how Eustachian valve may increase the risk ofxa0endocarditis, which mostly affects intravenous drug abusers or those withxa0implanted medical devices or central venous catheters. The most commonly identified organism isxa0Staphylococcus aureusxa0(approximately 53% of cases).xa0We present a case of a 46-year-old woman with known migraine. She wasxa0hospitalized in Stroke Unit for a cryptogenic stroke with a right-to-left shunt detected with transcranial doppler ultrasound with “bubble test” and a patentxa0foramen ovale with right-to-left shunt with a fenestration of atrial septumxa0and a voluminous Eustachian valve detected with transesophageal echocardiography;she developed fever with a blood cultures positive for methicillin-resis-xa0tantxa0Staphylococcus aureusxa0(MRSA), even if without evidence of endocarditis vegetations.xa0In summary,xa0the objective of our paper is to present an examplexa0of a correlation between the persistence of the Eustachian valve with bothcryptogenetic stroke, possible valve infection and migraine.