Thrombus in Transit within a Patent Foramen Ovale: Gone with the Cough!

Kim, Ji Hyun; Kim, Yong Jin

doi:10.4250/jcu.2011.19.4.196

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Treatment of a TIT is controversial due to the lack of prospective randomized trials, but a cardiothoracic surgeon should be consulted after diagnosis. 2 , 8 …”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there is only one published case of a TIT through a PFO that embolized during TOE, after the patient coughed. 2 Although TOE is associated with a low complication rate, oesophageal intubation can induce vagal and sympathetic reflexes, with blood pressure and heart rate fluctuations. Besides that, even after sedation and local anaesthesia of the pharynx, retching and coughing commonly occur, and the associated Valsalva manoeuvre induces changes in intrathoracic, central venous, and pulmonary pressures.…”

Section: Discussionmentioning

confidence: 99%

“…In this situation, the treatment is controversial and may include anticoagulation, fibrinolysis or cardiac surgery, or a combination of these. 2 …”

Section: Introductionmentioning

confidence: 99%

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Thrombus in transit through a patent foramen ovale: catch it if you can—a case report

Pires

Almeida

Santos

et al. 2021

European Heart Journal - Case Reports

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Background Patent foramen ovale (PFO) is one of the most common congenital heart defects, but the finding of a thrombus in transit (TIT) through a PFO is extremely rare. It’s a therapeutic challenge, and systemic anticoagulation, cardiac surgery or fibrinolysis should be considered. Case Summary A 43-year-old female was admitted with intermediate-high risk pulmonary embolism. Transthoracic echocardiogram revealed a large right atrial mobile mass that crossed the interatrial septum through a PFO, compatible with TIT, and the patient was started on unfractionated heparin. The diagnosis was confirmed by transesophageal echocardiogram (TEE). However, during TEE probe removal, the patient developed dyspnoea, sudoresis and peripheral desaturation, and new image acquisition revealed sudden mass disappearance. Due to the possibility of paradoxical embolization associated with Valsalva maneuver, fibrinolysis with alteplase was promptly started. The patient had no signs of embolic or hemorrhagic complications and remained clinically stable. She was discharged on warfarin and then underwent percutaneous transcatheter closure of PFO. Conclusion The treatment strategy of a TIT through a PFO is controversial, but surgery might be the most appropriate treatment for hemodynamically stable patients, while thrombolysis should be used in cases of hemodynamic instability. TEE is generally a safe procedure but pressure changes associated with Valsalva maneuver may induce embolization of a TIT and attention should be given to patient sedation and tolerance. After complete embolization of a TIT, emergent thrombolysis may be the only treatment option, in order to prevent disastrous consequences related to paradoxical embolism.

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“…Treatment of a TIT is controversial due to the lack of prospective randomized trials, but a cardiothoracic surgeon should be consulted after diagnosis. 2 , 8 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Thrombus in transit through a patent foramen ovale: catch it if you can—a case report

Pires

Almeida

Santos

et al. 2021

European Heart Journal - Case Reports

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show abstract

“…Physiologically, the passage of a thrombus through a PFO requires a higher right than left atrial pressure 4,5 ; therefore, numerous case reports have described this phenomenon in the context of pulmonary embolism due to increased right-sided pressures. 2,3,6,7 Hypoxemic respiratory failure and positive pressure ventilation can also increase pulmonary pressures and aggravate this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Right- and Left-Sided Embolic Phenomena in a Patient With Febrile Neutropenia

Al-Hamrashdi

Valiani

Khan

et al. 2016

Chest

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“…Thrombolysis was administered in four cases. One case was supposed to go for surgery, but the thrombi disappeared after spontaneous cough during TEE, and, due to a very high risk of paradoxical systemic embolism with potential disastrous consequences, he underwent emergent intravenous thrombolysis [ 7 ]. Five cases underwent emergent surgery which included cardiac thrombectomy and closure of the PFO.…”

Section: Discussionmentioning

confidence: 99%

Thrombus in Transit through Patent Foramen Ovale

Baydoun

Barakat

Hatem

et al. 2013

Case Reports in Cardiology

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A thrombus in transit through a patent foramen ovale (PFO) with impending paradoxical embolism is an extremely rare event. Due to its transient nature, it is unable to identify the thrombus, and most of the cases have been reported at autopsy. We are reporting a case of thrombus straddling the foramen ovale which was diagnosed by echocardiography and treated surgically. Through this personal case, an exhaustive review of the literature was performed. There were 88 cases reported. We concluded that there is no medical consensus about the best option for treatment. Nevertheless, surgery, which is associated with fewer complications of recurrent embolic events than those of thrombolysis and anticoagulation, appeared to be the best approach in patients who are not at a high surgical risk. Anticoagulant treatment appears to be an acceptable therapeutic alternative to surgery, particularly in patients with comorbidities who are at high surgical risk and for patients with small PFO. Thrombolysis is linked to the highest mortality, which could be explained by the severity of the patient's initial presentation. In conclusion, and after the cumulative effects of these case reports, we propose a diagram consisting of the use of the three therapeutic options in the different clinical scenarios.

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Thrombus in Transit within a Patent Foramen Ovale: Gone with the Cough!

Cited by 5 publications

References 12 publications

Thrombus in transit through a patent foramen ovale: catch it if you can—a case report

Thrombus in transit through a patent foramen ovale: catch it if you can—a case report

Right- and Left-Sided Embolic Phenomena in a Patient With Febrile Neutropenia

Thrombus in Transit through Patent Foramen Ovale

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