Patent foramen ovale as lifesaving purging valve

Abstract

Patent foramen ovale is considered as a potential risk factor for stroke owing to paradoxic embolism, leading to the question "to close or not to close the patent foramen ovale". We report a 26-year-old woman with chest pain, dyspnoea, sudden severe pain in both legs and paraplegia. Thoracic and abdominal computed tomography revealed massive pulmonary embolism and complete obstruction of the abdominal aorta. Interventional removal of the aortic thrombus was undertaken using the Fogarty catheter technique via the femoral arterial approach. As a result of worsening of cardiopulmonary function during the procedure, additional local thrombolysis, with a total of 50 mg recombinant tissue plasminogen activator, and fragmentation of the thrombus in the right pulmonary artery were performed via a femoral vein approach. Ultrasound studies revealed a patent foramen ovale of about 12 mm diameter with a significant right to left shunt. Under favourable conditions, a patent foramen ovale may allow the escape of a thrombus, sufficient to cause a potentially fatal pulmonary embolism, into the arterial system, where it can be removed by interventional manoeuvres.

Paradoxical embolism: Experiences from a single center

“…PDE with descending aorta thrombus and thrombus-straddled PFO was exceedingly rare with only several case reports. 15 , 16 , 17 , 18 We had 1 case of each. In a study by Loscalzo, 6 23% of their cases had 2 separate embolic sites, and 10% had 3.…”