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Case Reports
. 2022 Nov 28;20(1):28.
doi: 10.1186/s12947-022-00298-x.

Life-threatening paradoxical thromboembolism in a patient with patent foramen ovale

Antonio Rizza  1 , Francesco Negro  2 , Tommaso Gasbarri  3 , Roberto Arpesani  4 , Baldassare Ferro  5 , Paolo Roncucci  5 , Cataldo Palmieri  1 , Simone Sorbo  1 , Emilio Maria Pasanisi  6 , Marco Solinas  3 , Sergio Berti  1
Affiliations
Case Reports

Life-threatening paradoxical thromboembolism in a patient with patent foramen ovale

Antonio Rizza et al. Cardiovasc Ultrasound. .

Abstract

Background: Venous thromboembolism represents the third most frequent acute cardiovascular syndrome worldwide. Its clinical manifestations are deep vein thrombosis and/or pulmonary embolism. Despite a considerable mortality, diagnosis is often missed. CASE PRESENTATION: We report the management of a female patient with high-risk pulmonary thromboembolism treated initially with thromboaspiration, complicated by embolus jailing in a patent foramen ovale. In this situation, left cardiac chambers and systemic circulation were jeopardized by this floating embolus.

Conclusions: High-risk pulmonary embolism requires reperfusion strategy but sometimes mechanical thromboaspiration may be not fully successful; transesophageal echocardiography led to a prompt diagnosis of this unexpected finding; in this very particular case, open surgery represented a bail-out procedure to avoid cerebral and systemic embolism.

Keywords: Deep vein thrombosis; Paradoxical embolization; Patent foramen ovale; Pulmonary embolism.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A-B Computed tomography pulmonary angiogram in axial scan (A) coronal scan (B). Bilateral pulmonary artery emboli are shown by red arrows. AA = ascending aorta. AAr = aortic arc.; DA = descending aorta. PA = pulmonary artery. RPA = right pulmonary artery
Fig. 2
Fig. 2
A-C Transesophageal echocardiogram; inverted four chamber midesophageal scan (A-B) shows dilated right chambers and a thrombus involving left atrium, right atrium and mitral valve; short axis midesophageal scan (C) shows thrombus crossing the interatrial septum. AV = aortic valve. IA = interatrial septum. LA = left atrium. MV = mitral valve. RA = right atrium. Th = thrombus
Fig. 3
Fig. 3
A-B Real images of thrombus preserved in formalin after surgical intervention
See this image and copyright information in PMC

References

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    1. Rivera-Lebron B, McDaniel M, Ahrar K, et al. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin Appl Thromb. 2019;25:1076029619853037. - PMC - PubMed
    1. Pristipino C, Sievert H, D’Ascenzo F, et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. EuroIntervention. 2019;40(38):3182–95. - PubMed

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