Impending paradoxical embolus after massive pulmonary thromboembolism

Patent foramen ovale is a frequent congenital defect and when associated with pulmonary thromboembolism, leads to a worse prognosis of increasing the risk of systemic paradoxical embolisms. An unusual case is presented of an impending paradoxical embolism in a 54 year-old male with massive pulmonary...

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Bibliographic Details
Authors: Hidalgo-Torrico, Irene, Fletcher-Sanfeliu, Delfina, Enriquez, Fernando, Padrol, Daniel, Saez de Ibarra, Jose Ignacio, Fernández Tarrío, Rubén
Format: article
Publication Date:2019
Country:España
Institution:Conselleria de Salut i Consum del Govern de les Illes Balears
Repository:Docusalut
Language:Spanish
OAI Identifier:oai:docusalut.com:20.500.13003/17351
Online Access:https://hdl.handle.net/20.500.13003/17351
Access Level:Open access
Keyword:Paradoxical embolism
Transesophageal echocardiography
Pulmonary embolism
Patent foramen ovale
Description
Summary:Patent foramen ovale is a frequent congenital defect and when associated with pulmonary thromboembolism, leads to a worse prognosis of increasing the risk of systemic paradoxical embolisms. An unusual case is presented of an impending paradoxical embolism in a 54 year-old male with massive pulmonary thromboembolism. Using trans-oesophageal echocardiography, an image was obtained of a large thrombus in transit between the two atria through a patent foramen ovale. Emergency surgical intervention was performed by carrying out a thrombectomy through the right atrium and pulmonary embolectomy, with good results. The incidence of impending paradoxical embolus is extremely low, and for this reason this case represented a diagnostic and therapeutic challenge. Surgery was the treatment of choice, as it is associated with better results in terms of survival and incidence of post-operative embolic events in comparison with chronic anticoagulation and thrombolysis, although each patient should be carefully selected.