Massive Pulmonary Embolism Complicated by a Patent Foramen Ovale with Straddling Thrombus: Report of a Case

Abstract

We report a case of massive right pulmonary embolism with a patent foramen ovale and straddling thrombus, occurring a few days after cesarean section in a 31-year-old woman. Preoperatively, a mass was seen echocardiographically in four cardiac cavities. We performed emergency surgery because of the patient's acute hemodynamic deterioration. Intraoperatively, we found a thrombus entrapped in the patent foramen ovale. Most of the thrombus was floating in the right atrium and a long end was found in the left atrium, in addition to the pulmonary emboli. We removed the thrombus, closed the patent foramen ovale by direct suturing, and performed pulmonary embolectomy. Histological examination confirmed thrombi. Doppler examination of the venous system did not reveal any possible source of the thrombus. The patient is now well and free from recurrence of embolic disease 1 year after surgery. We review the literature on this relatively unusual thromboembolic disease.

Life-Threatening Pulmonary Embolism Associated with a Thrombus Straddling a Patent Foramen Ovale: Report of a Case

“…On analysis of reported cases of straddling thrombi 4,5 including the present one, median age at presentation was 59 years old (range 20–84) with a slight female predominance (male to female ratio 17:21). They carry a high mortality (16%) and require emergency treatment, although the optimal strategy is controversial.…”

“…Straddling thrombi in the patent foramen ovale are even more rare, with only 49 clinical cases reported 4,5 . The physiopathology is not clear.…”

Successful surgical treatment for a thrombus straddling a patent foramen ovale: a case report

“…A thrombus straddling a PFO in PE is extremely rare and has a high risk of impending PDE (IPDE). The mortality rate with IPDE has been reported to be 16%–21% [3-6]; therefore, IPDE should be promptly diagnosed and treated.…”

Double-edged sword in the heart

“…Anticoagulant therapy, thrombolytics, and surgical removal of the thrombus or a combination of these treatments are the therapeutic choices [6,8]. Therefore, a biatrial trapped thrombus seems like a 'double-edged sword' due to its potential embolism risk.…”