Massive pulmonary embolism with a large thrombus stuck in patent foramen ovale – an impending paradoxical embolism
Authors:
Josef Hornof; Ondřej Čermák
Authors‘ workplace:
Interní oddělení, Nemocnice Slaný, Slaný
Published in:
Vnitř Lék 2021; 67(2): 114-118
Category:
Case Reports
Overview
Patent foramen ovale is a persisting communication between the left and right atrium, present in approximately 25% of population, usually asymptomatic. Under normal conditions there is either no blood flow or a hemodynamically nonsignificant left-to-right shunt between the atria. However, increased right atrium pressure, as it is in pulmonary embolism, can make PFO a right-to-left shunt and poses a risk of paradoxical systemic embolism, including the risk of ischemic stroke. Here we report a case of a patient presenting with venous thromboembolism provoked by a recent polytrauma. We identified a large thrombus stuck in patent foramen ovale – an impending paradoxical embolism. Both surgical intervention and systemic thrombolysis were contraindicated so the patient was administered an anticoagulation treatment with unfractionated heparin and warfarin. By frequent echocardiography we were able to monitor complete resolution of the thrombus by 6 months from the diagnosis, with no systemic embolism.
Keywords:
anticoagulation – impending paradoxical embolism – patent foramen ovale – Pulmonary embolism
Sources
1. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res 2016; 118(9): 1340–1347. Dostupné z DOI: .
2. Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107(23 Suppl 1): 19–116. Dostupné z DOI: .
3. 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. Eur Heart J 2019; 40(38): 3182–3195. Dostupné z DOI: .
4. Windecker S, Stortecky S, Meier B. Paradoxical Embolism. J Am Coll Cardiol 2014; 64(4): 403–415. Dostupné z DOI: .
5. Homma S, Sacco RL, Di Tullio MR et al. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation 2002; 105(22): 2625–2631. Dostupné z DOI: .
6. Takagi H, Umemoto T. et al. A meta‑analysis of case‑ control studies of the association of migraine and patent foramen ovale. J Cardiol 2016; 67(6): 493–503. Dostupné z DOI: .
7. Bonvini RF, Robert‑Ebadi H, Fontana P et al. Impending paradoxical embolism: When and how to treat. Annales de Cardiologie et d’Angéiologie 2008; 57(4): 234–237. Dostupné z DOI: .
8. Meacham RR, Headley AS, Bronze MS et al. Impending Paradoxical Embolism. Arch Intern Med 1998; 158(5): 438–448. Dostupné z DOI: .
9. Nellessen U, Daniel WG, Matheis G et al. Impending paradoxical embolism from atrial thrombus: correct diagnosis by transesophageal echocardiography and prevention by surgery. J Am Coll Cardiol 1985; 5(4): 1002–1004. Dostupné z DOI: .
10. Erkut B, Kocak H, Becit N et al. Massive Pulmonary Embolism Complicated by a Patent Foramen Ovale with Straddling Thrombus: Report of a Case. Surg Today 2006;36(6):528- 33. Dostupné z DOI: .
11. Mirijello A et al. Paradoxical embolism with thrombus stuck in a patent foramen ovale: a review of treatment strategies. Eur Rev Med Pharmacol Sci 2018;22(24):8885-8890. Dostupné z DOI: .
12. Myers PO, Bounameaux H, Panos A et al. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest 2010;137(1):164–170. Dostupné z DOI: .
13. Park CI, Noble S, Parsai C et al. High‑risk pulmonary embolism with impending paradoxical embolism successfully treated with percutaneous catheter‑based thrombectomy. Cardiovasc Med 2011;14:127-30. Dostupné z DOI:
14. Ishida T et al. A Successful Treatment Strategy for Paradoxical Cerebral Embolism Accompanied by Entrapped Thrombus in Patent Foramen Ovale. Intern Med 2020;59(2):211- 214. Dostupné z DOI: .
15. Varvařovský I, Mates M, Horák D et al. Odborné stanovisko pro uzávěr otevřeného foramen ovale (PFO) Společný dokument České asociace intervenční kardiologie České kardiologické společnosti, České neurologické společnosti a České asociace kardiovaskulárních zobrazovacích metod České kardiologické společnosti. Interv Akut Kardiol 2020; 19(1): 18–23. Dostupné z DOI: .
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2021 Issue 2
Most read in this issue
- Diagnostics and therapy of chronic pancreatitis according to UEG guidelines
- Glucagon in treatment of hypoglycemia – novelties
- Perindopril: a long-term certainty in treating hypertension
- Current view of diagnosis and treatment of latent autoimmune diabetes in adults