Pediatric Stroke Due to Thromboembolism Secondary to Prominent Eustachian Valve With Patent Foramen Ovale.

Authors

Sindhu V Nambiar, Thomas Mathew, Mohammed Shakeebuddin Kashif, Raksha Mallya, Usha K Shastri, Sharath Kumar Gg

Published in

JACC. Case reports. Pages 108888. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

Pediatric strokes can occur from diverse causes, and thromboembolism can occur paradoxically in cardiac defects with right-to-left shunt, leading to stroke.
An 8-year-old boy presented to the pediatric emergency unit with sudden-onset right-sided stroke after a Valsalva maneuver. Neuroimaging revealed a left middle cerebral and middle cerebral-anterior cerebral watershed infarct with a thrombus in the proximal internal carotid artery. Cardiac evaluation showed a coexisting large persistent Eustachian valve and patent foramen ovale (PFO). He was started on aspirin and other supportive measures. He underwent an elective closure of the PFO.
A PFO can develop a right-to-left shunt during a Valsalva maneuver, causing paradoxical embolism of right heart system clots. Though treated medically, certain criteria, including presence of a large Eustachian valve, may warrant closure of the defect.
Cardiac thromboembolism should be considered in any sudden-onset pediatric cryptogenic strokes, especially after a Valsalva maneuver such as lifting a weight. Treatment strategies may differ from other strokes and may involve repair of the cardiac defect. This decision should be individualized for each pediatric case.

PMID:
42599263
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.

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