Diagnosis and treatment of paradoxical embolus

Abstract

Our institutional experience with PDE suggests the following: (1) saline solution contrast echocardiography is a useful noninvasive method to demonstrate PFO with right-left shunt that permits presumptive antemortem diagnosis; (2) recommendations for treatment vary with the certainty of diagnosis and should be individualized; (3) paradoxical embolus may account for a significant minority of acute arterial occlusions in the absence of a clear cardiac or proximal arterial source.

Paradoxical embolization via a patent foramen ovale following acute pulmonary embolism

“…Although the shunting of small volumes of deoxegenated blood into the systemic circulation is usually of little physiological consequence, a PFO is a route for thromboembolic material to enter the systemic circulation and produce paradoxical organ infarction. Cases of cerebral, visceral, coronary and ophthalmic paradoxical embolization have been published as well as case reports of thromboemboli arrested in the act of transgressing a PFO 2–4 .…”

“Lots of Clots”: Multiple thromboemboli including a huge paradoxical embolus in a 29-year old man

“…Paradoxical embolism (PDE) refers to the entry of a venous thrombus into the systemic arterial system via an intracardiac shunt, most commonly a PFO [2]. Complications of PDE include ischemic limb and stroke, depending on whether the peripheral or cerebral circulation is compromised by embolization.…”

Patent Foramen Ovale: Faces of Paradoxical Embolism

“…This is particularly true in young individuals and may account for as many as 47,000 cases a year in the United States alone [2,3]. Furthermore, paradoxical embolism may be responsible for a significant minority of acute peripheral arterial occlusions in the absence of a clear cardiac or proximal arterial source [4].…”