Multiple paradoxe Embolien bei offenem Foramen ovale

Knobloch, Wolfgang; Schlesinger, Alan E.; Jacksch, R

doi:10.1055/s-2001-15031

Cited by 6 publications

(3 citation statements)

References 3 publications

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“…Such diverse and relatively rarer presentations include acute limb ischaemia,4 6 7 renal infarction,8 9 ischaemia of the digestive tract10 and also myocardial infarction 11 12. Knobloch et al 13 reported a similar case in a young man with myocardial infarction, popliteal artery occlusion and carotid thrombus. The patient was then retrospectively found to have pulmonary embolism and PFO, which led to the diagnosis of paradoxical embolism.…”

Section: Discussionmentioning

confidence: 99%

A unique presentation of four thrombotic events at a time

et al. 2012

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A 72-year-old man was referred to our hospital as a case of postcardiac arrest following a long distance air flight. Work-up in the emergency department revealed the presence of deep vein thrombosis (DVT), bilateral pulmonary embolism, inferior STEMI (ST elevation myocardial infarction) and ischaemic stroke. He received thrombolysis by recombinant tissue plasminogen activator (tPA) following which his haemodynamic status improved, but he developed haemorrhagic transformation of the stroke as a complication. The haemorrhagic lesion gradually resolved with conservative management, leaving behind a residual neurological deficit. His haemodynamic status was stable after the management. Although a diagnosis of right-to-left shunt lesion was highly suggestive in this condition, it could not be confirmed on the transthoracic echocardiogram. Our patient had a unique presentation of multiple thrombi in different organs that caused significant morbidity and haemodynamic instability. There are no well-established guidelines that discuss the acute management of such cases. This situation requires a careful assessment and management of the patient by a multidisciplinary team.

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Section: Discussionmentioning

confidence: 99%

A unique presentation of four thrombotic events at a time

et al. 2012

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“… Biographical information Diagnosis Treatment (Coronary; Pulmonary and PFO closure) 1 Collado Fareed Moses et al [ 3 ] 71 years female NSTEMI; PE; PFO C: Occlusion of RCA; Aspiration thrombectomy; Antiplatelet treatment not mentioned Pul: Not mentioned PFO closure: Not suitable due to severe pulmonary hypertension 2 Rovner et al [ 11 ] 70 years female STEMI (anterolateral wall); PE; PFO C: No acute occlusion; Lucent area in OM; Antiplatelet treatment not mentioned Pul: Oral anticoagulant (Warfarin) PFO closure: Deferred due to sepsis from a urinary tract infection; Later lost to follow-up 3 Hline et al [ 12 ] 86 years female STEMI (inferior wall); PE; PFO C: Occlusion of RCA. Aspiration thrombectomy; Intracoronary heparin and abciximab; Antiplatelet treatment not mentioned Pul: Lifelong anticoagulant (Warfarin) PFO closure: Multidisciplinary discussion not recommend 4 Smith et al [ 10 ] 69 years female STEMI (inferior wall); PE; PFO; Acute RV Failure C: Occlusion of PD and PL; Aspiration thrombectomy and balloon dilation; Oral aspirin Pul: Pulmonary angiography, interventional clot fragment and aspiration; and intra-arterial thrombolysis; Long-term anticoagulant (Warfarin) PFO closure: No 5 Knobloch et al [ 13 ] 38 years male STEMI (inferior wall); PE and DVT. Embolic occlusion of the left popliteal artery and left carotid artery; PFO C: Normal coronary angiogram Pul: Not mentioned PFO closure: Yes, transcatheter Others: Left popliteal: Embolus removal with Fogarty catheter; Left carotid embolus: surgery 6 Haghi et al [ 14 ] 61 years female NSTEMI; PE; PFO C: Balloon angioplasty (OM) and oral Aspirin Pul: Long-term anticoagulant (Warfarin) PFO closure: No …”

Section: Discussionmentioning

confidence: 99%

Concomitant acute myocardial infarction and acute pulmonary embolism caused by paradoxical embolism: a case report

Chen

et al. 2021

BMC Cardiovasc Disord

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Background Due to its low incidence and diverse manifestations, paradoxical embolism (PDE) is still under-reported and is not routinely considered in differential diagnoses. Concomitant acute myocardial infarction (AMI) and acute pulmonary embolism (PE) caused by PDE has rarely been reported. Case presentation A 45-year-old woman presented with acute chest pain and difficulty with breathing. Multiple imaging modules including ECG, echocardiography, emergency cardioangiogram (CAG), and CT angiography of the pulmonary arteries showed acute occlusion of the posterolateral artery and acute PE. After coronary aspiration, no residual stenosis was observed. One month later, a bubble study showed inter-atrial communication via a patent foramen ovale (PFO). The AMI in this patient was finally attributed to PDE via the PFO. PFO closure was performed, and long-term anticoagulation was prescribed to prevent recurrent thromboembolic events. Conclusions PDE via PFO is a rare etiology of AMI, especially in patients with concomitant AMI and PE. Clinicians should be vigilant of this possibility and close the inter-atrial channel for secondary prevention.

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“…Besides, anticoagulation is associated with a high rate of long‐term side effects 12 . Transcatheter closure has yielded good results and little morbidity in some studies, 13–15 but is not a routine procedure for the combination of PFO and ASA, and can not be advised for all patients 16–18 …”

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confidence: 99%

Surgical Closure of Combined Symptomatic Patent Foramen Ovale and Atrial Septum Aneurysm for Prevention of Recurrent Cerebral Emboli

Klotz¹,

Tjan²,

Berendes

et al. 2005

Journal of Cardiac Surgery

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Background: Patients with patent foramen ovale (PFO) have an undefined but certainly considerable risk of repeated cerebral ischemia due to paradoxical embolism. Especially, if a cerebrovascular event has already occurred and the combination with an atrial septum aneurysm (ASA) is present this risk increases tremendously. The aim of this study was to demonstrate that surgical closure of PFO in combination with an ASA is safe and useful in preventing recurrent strokes. Methods: Ten patients with previous cerebral ischemia, proven by CT or MRI, and PFO in combination with an ASA were prospectively scheduled for surgical closure. Patients with extracardiac sources of embolic disease were excluded from this study. However, one patient suffered from a hypercoagulability syndrome. Results: All patients (mean age 35.5 ± 19.1 years) underwent direct suture of the PFO and plication of the ASA with the aid of cardiopulmonary bypass and cardioplegic arrest (n = 3) or ventricular fibrillation (n = 7). Mean operation time was 123.1 ± 20.2 minutes; mean bypass time was 34.5 ± 9.9 minutes. There was no mortality or significant postoperative morbidity. Mean hospital stay was 5.1 ± 1.5 days. During a follow-up of >4 years, no recurrent stroke or transient ischemic attack occurred and no patient received anticoagulation therapy. Conclusion: Our data suggest that surgical closure of PFO in combination with ASA in patients with previous stroke is safe and efficacious to prevent recurrent strokes and avoids lifelong anticoagulation.

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Multiple paradoxe Embolien bei offenem Foramen ovale

Cited by 6 publications

References 3 publications

A unique presentation of four thrombotic events at a time

A unique presentation of four thrombotic events at a time

Concomitant acute myocardial infarction and acute pulmonary embolism caused by paradoxical embolism: a case report

Surgical Closure of Combined Symptomatic Patent Foramen Ovale and Atrial Septum Aneurysm for Prevention of Recurrent Cerebral Emboli

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