Paradoxical emboli following a pulmonary embolus in the presence of a patent foramen ovale

Abstract

A paradoxical embolism is defined as a systemic arterial embolus due to passage of a venous thrombus through a right to left shunt. We describe a case of acute cerebral vascular accident (CVA), right subclavian arterial embolus, and pulmonary emboli in the setting of a large patent foramen ovale (PFO). A 74-year-old woman with multiple comorbidities presented to the emergency department with acute onset of shortness of breath, weakness, and right arm pain. She was found to have bilateral pulmonary emboli, left CVA, and a right subclavian arterial embolus on computed tomography (CT). She emergently underwent embolectomy of her right upper extremity along with a fasciotomy. On chest CT, a PFO was visualized.Transesophageal echocardiogram (TEE) revealed a large PFO with at least a 3-mm primum/secundum separation and evidence of right to left shunting. Multidisciplinary consensus was that she would benefit from closure of her PFO in order to reduce her risk of further emboli. The patient was agreeable and taken to the catheterization lab where a sizing balloon over a stiff wire was advanced to measure the size of the defect. A 25-mm Cardioform device was successfully delivered across the defect. The patient was started on oral anticoagulation and antiplatelets. In summary, increase in right-sided pressures from pulmonary emboli can cause right to left shunting and lead to a paradoxical embolus. Assessment of patients who present with acute CVA or arterial embolus in the setting of pulmonary emboli with elevated right atrial pressures should include an evaluation for a PFO. Closure of PFO in these patients is of potential additive benefit.

Risk of Stroke in Patients With Patent Foramen Ovale Who Had Pulmonary Embolism

“…At the same time it is worth considering that not all PFOs are of the same size. Smaller PFOs have less blood flow and therefore a lower chance of a thrombus crossing [26,27]. Interestingly, we found an even higher frequency of association of stroke in our group of patients with PFOwoPE (39.2%), but the difference was not statistically significant (P = 0.682).…”

From kidney to kidney: an unusual case of paradoxical embolism through a patent foramen ovale

“…1d). Paradoxical renal thromboembolic events – although rare – are already reported in literature, 2,3 while PFO is a well known cardiac source of embolism, especially in case of right atrial pressure increase 4,5 . In our case, the clinical picture suggested that an abrupt increase in PAPs due to paraneoplastic pulmonary embolism created a paradoxical embolization in the kidneys through an otherwise silent PFO.…”

“…Paradoxical renal thromboembolic events -although rare -are already reported in literature, 2,3 while PFO is a well known cardiac source of embolism, especially in case of right atrial pressure increase. 4,5 In our case, the clinical picture suggested that an abrupt increase in PAPs due to paraneoplastic pulmonary embolism created a paradoxical embolization in the kidneys through an otherwise silent PFO. Patient was successfully treated with subcutaneous heparin in the acute phase and with long-term anticoagulants (Apixaban 10 mg twice daily for 7 days followed by 5 mg twice daily).…”

Proteomic analysis in the diagnostics of chronic heart failure with normal ejection fraction

“…Так, например, у пациентов, гетерозиготных по полиморфизмам фактора V свертывания крови (мутация Лейдена) или мутациям гена PROC, изменение статуса от повышенного свертывания до венозного тромбоза запускается взаимодействием генетических и средовых факторов. Примером негенетических факторов может быть наличие беременности, прием пероральных противозачаточных средств, пожилой возраст, обездвиживание, новообразования, патология сердца, постоперационное состояние [34][35][36][37].…”