Impending paradoxical embolism

Bonvini, Robert F.; Robert‐Ebadi, Helia; Fontana, Pierre; Fassa, Amir-Ali; Myers, Patrick-Olivier; Licker, Marc; Boehlen, Françoise; Righini, Marc

doi:10.1016/j.ancard.2008.05.002

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…Based on the site of embolization, paradoxical embolism may have varied presentations, such as ischemic stroke [ 2 ], myocardial infarction, acute abdomen due to bowel ischemia, hematuria from renal infarction, or peripheral arterial occlusion. IPDE is described as the presence of thrombotic material straddling the PFO [ 3 ]. The first case of paradoxical embolism was reported in 1877, but the first case of IPDE was reported only in late 1985 [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An Unusual Case of Impending Paradoxical Embolism Through a Patent Foramen Ovale in Renal Cell Carcinoma

Maturi¹,

Sharma²,

Wool³

et al. 2023

Cureus

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Section: Discussionmentioning

confidence: 99%

“…Depending on the site of the embolism, patients present with varied presentations [ 2 ]. Impending paradoxical embolism (IPDE) is described as the presence of a thrombus straddling through PFO [ 3 ]. It constitutes a clinical emergency due to the risk of massive systemic embolization.…”

Section: Introductionmentioning

confidence: 99%

An Unusual Case of Impending Paradoxical Embolism Through a Patent Foramen Ovale in Renal Cell Carcinoma

Maturi¹,

Sharma²,

Wool³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Thrombolysis has been used in paradoxical embolism with favourable outcomes 14–16. However, a significant mortality rate (16%–20%) associated with post-treatment systemic embolisation from segments of the large thrombus was considered a contraindication while the patient was clinically stable 17. The presence of pulmonary infarction and the risk of haemorrhagic transformation with thrombolysis were considered a significant risk.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria

Zafar¹,

Anderson

Cox

et al. 2018

BMJ Case Reports

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A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications. The significant pulmonary hypertension and right ventricular infarction raised the prospect of difficult weaning from cardiopulmonary bypass following thrombectomy. Thrombolysis, which has significant mortality rate, and systemic embolisation including pulmonary infarction with haemorrhagic transformation were also contraindications. A multidisciplinary approach was adopted and anticoagulation was therefore believed to be the safest and effective approach. Here, the use of anticoagulation alone was fortunately successful but could as easily end in disaster. This approach should be considered the ideal paradigm to yield optimum outcomes.

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“…Although rare, this syndrome is potentially life-threatening yet treatable. In reported IPDE cases, clinical presentation varied: about half the patients had a history of isolated pulmonary embolism (PE), in almost 35–40% of cases presented with a combination of PE and PDE, and the remaining cases solely manifested as PDE [ 6 ]. Presenting herein is a case of IPDE with pulmonary embolism and myocardial infarction in a 68-year-old female experiencing dizziness and chest tightness.…”

Section: Introductionmentioning

confidence: 99%

Successful surgical treatment of impending paradoxical embolism with pulmonary embolism and myocardial infarction

Liu,

Yang,

Sun

et al. 2024

J Cardiothorac Surg

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Background Paradoxical embolism is a rare cause of acute arterial occlusion. This phenomenon arises when embolic material travels from the venous system crosses an abnormal shunt such as patent foramen ovale, atrial septal defects, ventricular septal defects, or pulmonary arteriovenous malformations, into the arterial system. Impending paradoxical embolism refers to the presence of an entrapped thrombus in the patent foramen ovale. Case presentation We report a case of a 68-year-old female patient who presented with an impending paradoxical embolism, alongside both concomitant pulmonary embolism and myocardial infarction with ST-segment elevation. Swiftly addressed through emergency cardiac surgery and systemic anticoagulation, the patient’s condition was effectively treated. Conclusions While the ideal treatment strategy for impending paradoxical embolism remains a topic of debate due to limited and inconclusive evidence, emergent open surgery should be contemplated in patients as it signifies a critical clinical emergency.

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Impending paradoxical embolism

Cited by 8 publications

References 20 publications

An Unusual Case of Impending Paradoxical Embolism Through a Patent Foramen Ovale in Renal Cell Carcinoma

An Unusual Case of Impending Paradoxical Embolism Through a Patent Foramen Ovale in Renal Cell Carcinoma

Pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria

Successful surgical treatment of impending paradoxical embolism with pulmonary embolism and myocardial infarction

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