Usefulness of Transesophageal Echocardiography in the Diagnosis and Surgical Management of a Paradoxical Embolus Extending Through a Patent Foramen Ovale

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.

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

Erkut

Koçak

Becit

et al. 2006

Surg Today

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Diagnosis and management of entrapped embolus through a patent foramen ovale

Aboyans

Lacroix

Ostyn

et al. 1998

European Journal of Cardio-Thoracic Surgery

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The diagnosis of impending paradoxical embolus by echocardiography is exceptional and its management remains unclear. Through a personal case, we performed an exhaustive review of the medical literature of this rare finding. Since the first report, only 43 cases have ever been reported. The superiority of transesophageal echocardiography is underlined. The clinical features are complex. The classical simultaneous pulmonary and paradoxical embolism is often absent. Therapeutic options are cardiac surgery, thrombolysis or anticoagulation. The early mortality rate is high (21%). In addition, recurrent embolisms are reported when a medical treatment is chosen. The cumulative results of each possibility are described.

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Use of transoesophageal echocardiography in impending paradoxical embolism due to thrombus straddling a patent foramen ovale

Webb

Falter

2007

European Journal of Anaesthesiology

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Usefulness of Transesophageal Echocardiography in the Diagnosis and Surgical Management of a Paradoxical Embolus Extending Through a Patent Foramen Ovale

Cited by 4 publications

References 4 publications

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

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

Diagnosis and management of entrapped embolus through a patent foramen ovale

Use of transoesophageal echocardiography in impending paradoxical embolism due to thrombus straddling a patent foramen ovale

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