To explore the clinical characteristics and the efficacy of occlusion in patients with atrial septal defect (ASD), presenting predominantly with neurological symptoms caused by right to left shunt.

Patients with ASD who complained of migraine or stroke related symptoms in the Department of Neurology, the First Affiliated Hospital with Nanjing Medical University from January 2019 to October 2021 were enrolled, and the right to left shunt was confirmed by contrast transcranial Doppler (c-TCD). The data of basic information, c-TCD, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and right heart catheterization were collected to analyze the clinical characteristics of the patients. The postoperative follow-up ranged from 0.5 to 1.5 years. Migraine patients needed to complete the headache impact test (HIT-6) and the migraine disability assessment scale (MIDAS) to evaluate the efficacy of occlusion.

A total of 14 patients were enrolled in the study, with an average age of (55.8±12.4) years, including 9 women (57.1%,9/14). There were 6 cases of migraine and 8 cases of stroke. Echocardiography and right cardiac catheterization showed that there was no compensatory enlargement in the right heart. Pulmonary vascular resistance was <3 Wood. There was no right cardiac volume overload. All the 14 patients underwent transcutaneous closure of atrial septal defect. The HIT-6 and MIDAS scores of 6 migraine patients were significantly lower than those before operation (P=0.024; P=0.027). There was no stroke recurrence in 8 patients with ischemic stroke.

The initial symptom of atrial septal defect in adult without increased right ventricular volume load can be manifested as neurological symptoms, and c-TCD could be positive. Transcatheter closure therapy can effectively alleviate the symptoms of patients.