Diagnosis and management of entrapped embolus through a patent foramen ovale

Aboyans, Victor; Lacroix, Philippe; Ostyn, E.; Cornu, Élisabeth; Laskar, Marc

doi:10.1016/s1010-7940(98)00251-6

Cited by 67 publications

(53 citation statements)

References 32 publications

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“…4,7,9 TEE is crucial for accurate diagnosis and appropriate management when paradoxical embolism is suspected. 10 TEE study with color Doppler and contrast echocardiography is the most sensitive diagnostic technique for diagnosing PFO. 11 The four cases described in the literature of antemortem diagnosis of paradoxical coronary embolism with visualization of a thrombus crossing a PFO used TEE to establish the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…4,6,7 Mortality in paradoxical embolism with entrapped embolus is estimated at 21%. 10 The treatment of paradoxical or impending paradoxical embolism is a clinical dilemma. Acute treatment options include anticoagulation, fibrinolysis or surgical embolectomy.…”

Section: Discussionmentioning

confidence: 99%

“…In the presence of a thrombus with a high embolic potential, fibrinolysis carries a high risk of fragmentation and systemic embolization. 7,10 In the setting of a thrombus crossing a PFO, thrombolytic therapy has the potential to result in systemic embolization and devastating neurological complications. Surgery also enables simultaneous closure of the PFO.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery also enables simultaneous closure of the PFO. 6,7,10 Overall survival appears to be equivalent among the three therapeutic options, although more complications relating to arterial and pulmonary embolization occur with anticoagulation and fibrinolysis. For this reason, anticoagulation followed by surgical embolectomy has been recommended as the optimal therapy, although recommendations for the management of paradoxical embolism are based on small series and isolated case reports.…”

Section: Discussionmentioning

confidence: 99%

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Acute coronary syndrome of paradoxical origin

Ferreira

Freitas

Magno

et al. 2013

Revista Portuguesa de Cardiologia (English Edition)

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We describe a rare case of acute myocardial infarction secondary to paradoxical embolism complicating acute pulmonary embolism. A 44-year-old woman presented to the emergency department with chest pain. The physical examination was unremarkable except for oxygen saturation of 75%, and the electrocardiogram showed ST-segment elevation in the inferior leads. Urgent coronary angiography showed a distal occlusion of the right coronary artery and multiple thrombi were aspirated. Despite relief of chest pain and electrocardiogram normalization, her oxygen saturation remained low (90%) with high-flow oxygen by mask. The transthoracic echocardiogram showed a mass in the left atrium and dilatation of the right chambers, while the transesophageal echocardiogram showed a thrombus attached to the interatrial septum in the region of the foramen ovale. Color flow imaging was consistent with a patent foramen ovale. Thoracic computed tomography angiography documented thrombi in both branches of the pulmonary trunk. After five days on anticoagulation, the patient underwent surgical foramen ovale closure. © 2010 Sociedade Portuguesa de Cardiologia Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVEEmbolia paradoxal; Foramen ovale patente; Enfarte do miocárdio Síndrome coronária aguda de origem paradoxalResumo Descreve-se um caso raro de enfarte agudo do miocárdio por embolia paradoxal em contexto de tromboembolismo pulmonar agudo. Uma mulher de 44 anos recorreu à urgên-cia por dor torácica. A observação foi normal com exceção de saturação periférica de 75%. O electrocardiograma mostrou supradesnivelamento do segmento ST nas derivações inferiores. Realizou-se cateterismo urgente que mostrou coronária direita ocluída distalmente, tendo sido aspirados múltiplos trombos. Verificou-se alívio da dor e desaparecimento do supradesnivelamento de ST. No entanto, a saturação periférica mantinha-se baixa apesar de aporte com oxigénio. O ecocardiograma transtorácico mostrou massa auricular esquerda e dilatação das cavidades direitas. O ecocardiograma transesofágico revelou um trombo no septo interauricular, na região do foramen ovale. O estudo por Doppler-cor foi compatível com foramen ovale * Corresponding author. E-mail address: aritaf@gmail.com (A.R. Ferreira). patente. A angio-tomografia computorizada do tórax documentou trombos nos ramos principais da artéria pulmonar. Após cinco dias de anticoagulação a doente foi submetida a cirurgia cardíaca e o foramen ovale encerrado.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acute coronary syndrome of paradoxical origin

Ferreira

Freitas

Magno

et al. 2013

Revista Portuguesa de Cardiologia (English Edition)

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“…2 Using 3D TEE enables the sequential sectioning of an intracardiac mass and inspection of its inner aspects from multiple angles. This in turn helps to establish a more accurate diagnosis and more specific therapeutic interventions.…”

Section: Commentmentioning

confidence: 99%

Intracardiac Thrombus-in-Transit Characterized on 3-Dimensional Transesophageal Echocardiography

Sehli¹,

Soontrapa²,

Meyerrose³

et al. 2014

Texas Heart Institute Journal

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A 60-year-old woman presented with fever and shortness of breath of one week's duration. Physical examination disclosed a right-lower-quadrant abdominal mass and pretibial edema. A chest computed tomogram showed bilateral pulmonary embolism, and venous Doppler ultrasonographic imaging of the lower extremities revealed acute deep vein thrombosis (DVT) of the right common femoral vein. Abdominal ultrasonograms showed a large right ovarian mass. A 2-dimensional transthoracic echocardiogram (2D TTE) showed an echogenic mass in the atria. Two-dimensional transesophageal echocardiograms (TEE) revealed an aneurysmal interatrial septum and a large, mobile mass in the right atrium. The mass was in transit through a patent foramen ovale and extended into the left atrium ( Fig. 1). Three-dimensional (3D) TEE helped to characterize the mass as a thrombus-intransit that extended through the interatrial septum (Fig. 2). Upon sequential cropping of the images, echolucent components seen inside the mass were consistent with an intracardiac thrombus.1 The ovarian mass was found to be malignant. The patient was prescribed long-term anticoagulation. After 6 months, 2D TTE revealed complete resolution of the thrombus and no evidence of left-sided emboli. CommentThrombus-in-transit is rarely reported and is often associated with pulmonary embolism or paradoxical systemic embolism when an intracardiac shunt is present. In our patient, DVT associated with a hypercoagulable state of malignancy was thought to be responsible for the thrombus-in-transit and the pulmonary emboli.Thrombi-in-transit have almost exclusively been diagnosed with the use of echocardiography.2 Using 3D TEE enables the sequential sectioning of an intracardiac mass and inspection of its inner aspects from multiple angles. This in turn helps to establish a more accurate diagnosis and more specific therapeutic interventions. The most appropriate therapy for thrombus-in-transit has not been clearly defined; antico- Figure 1B. Images in Cardiovascular Medicine

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Schock durch akute Mitralklappendysfunktion mit schwerer Insuffizienz nach Beinvenenthrombose

Wacker¹,

Wacker²

2004

Internist

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Open surgical embolectomy may be life-saving in massive pulmonary embolism. Up to now there are no studies concerning the question whether the foramen ovale should be examined routinely during surgery and whether an open foramen ovale should be closed routinely in the same session. Even case reports regarding this question are missing. We report on a 74-year old female patient who developed pulmonary embolism due to deep venous thrombosis. Six days after successful surgical embolectomy the patient developed cardiogenic shock due to a huge thrombus from the right atrium through the foramen ovale into the left atrium and the left ventricle. Immediate surgical embolectomy of a 40-50 cm huge thrombus was successful. Immediately after surgery upon the cardiac mass the patient showed symptoms of acute right leg ischemia. Thus a second embolectomy was necessary, the surgeon removed a 10 cm thrombus from the right external iliacal artery. There was no evidence of another pulmonary embolism timely related to the paradoxical embolism.

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Diagnosis and management of entrapped embolus through a patent foramen ovale

Cited by 67 publications

References 32 publications

Acute coronary syndrome of paradoxical origin

Acute coronary syndrome of paradoxical origin

Intracardiac Thrombus-in-Transit Characterized on 3-Dimensional Transesophageal Echocardiography

Schock durch akute Mitralklappendysfunktion mit schwerer Insuffizienz nach Beinvenenthrombose

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