Transit-Thrombus im offenen Foramen ovale mit pulmonaler und paradoxer Embolisation

Abstract

Ten days after surgical treatment of a gastric perforation a 70-year-old woman developed progressive dyspnoea and hypertension without any signs of deep vein thrombosis. Emergency echocardiography revealed acute cor pulmonale with a dilated right atrium and ventricle, as well as paradoxical ventricular septal motion. In addition it demonstrated an elongated, extremely mobile thrombus stuck in a patent foramen ovale with most of it floating in the right atrium, the remainder in the left atrium. Within 2 hours of the ultrasound examination she went into fulminant pulmonary embolism with circulatory arrest and paradoxical embolization from the atria to the brain, after which the intraatrial thrombus was no longer detectable. She was successfully resuscitated and thrombolysis was immediately started with tissue-plasminogen activator (100 mg over 90 min), with ensuing stabilization of the circulation. The patient was gradually weaned off the ventilator over the following few days, but she died 10 days after the resuscitation from the severe cerebral damage.

Intra‐arrest formation of right‐heart thrombi – a case illustrated by real‐time ultrasonography

“…In rare cases, the thrombus can migrate through a patent foramen ovale and lead to paradoxical embolisation . Mostly, it is diagnosed in the periarrest period, before or after cardiac arrest …”

Massive Pulmonary Embolism Complicated by a Patent Foramen Ovale with Straddling Thrombus: Report of a Case

“…34 Only 13 (28.2%) of the 46 patients presented with a typical pulmonary and paradoxical embolism. 3,5,6,9,10,12,13,18,24,25,27,28,38 In one patient, although there was entrapped thrombus in the foramen ovale, there was no embolic event. 45 There were no available data for four patients.…”