Treatment of recurrent stroke and pulmonary thromboembolism with percutaneous closure of a patent foramen ovale and placement of inferior vena cava filter

Donti, Andrea; Giardini, Alessandro; Formigari, Roberto; Bronzetti, Gabriele; Prandstraller, Daniela; Bonvicini, Marco; Picchio, Fernando Maria

doi:10.1002/ccd.10446

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…Large PFO size, young age, and hypercoagulable states appear to be additional risk factors for paradoxical embolization. [1][2][3][4] Our patient's case indicates the usefulness of multimodal imaging for viewing the origin and embolic sequelae of a mobile thrombus as it crosses a PFO. Figure 3.…”

Section: Commentmentioning

confidence: 76%

Caught in the Act: Paradoxical Emboli

Layoun¹,

Yang²,

Honda³

et al. 2018

Texas Heart Institute Journal

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A 29-year-old woman who had factor V Leiden thrombophilia and an indwelling venous catheter for chronic pain therapy presented with dyspnea, fever, and abdominal pain. Computed tomography revealed septic pulmonary emboli with surrounding consolidation and thrombus extending from the superior vena cava to the right atrium (Fig. 1), as well as wedge-shaped splenic infarcts (Fig. 2). Blood cultures grew Staphylococcus aureus. A transesophageal echocardiogram (TEE) showed a large patent foramen ovale (PFO); severe right-to-left shunting (>20 microbubbles); and a mobile, stalked thrombus in the right atrium, extending into the left atrium (Fig. 3).The patient later had an acute ischemic stroke. No atrial thrombus was detected on repeat TEE. Antibiotic therapy and anticoagulation improved her symptoms. She later underwent percutaneous PFO closure with use of a 25-mm Gore ® Cardioform Septal Occluder (W.L. Gore & Associates, Inc.) (Fig. 4). Results of repeat color-f low Doppler imaging and a bubble study revealed no interatrial shunting. Images in Cardiovascular Medicine

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Section: Commentmentioning

confidence: 76%

Caught in the Act: Paradoxical Emboli

Layoun¹,

Yang²,

Honda³

et al. 2018

Texas Heart Institute Journal

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“…In patients with recurrent PE and paradoxical embolism, percutaneous closure of the patent foramen ovale and placement of an inferior vena cava filter prevented recurrent thromboembolic events. 34 Additional studies are required to investigate the long-term efficacy and safety of this approach. In patients with acute PE, free-floating right heart thrombi increase the risk for adverse clinical events.…”

Section: Echocardiographymentioning

confidence: 99%

Risk Stratification of Acute Pulmonary Embolism

Kucher

Goldhaber

2006

Semin Thromb Hemost

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Acute pulmonary embolism (PE) is a potentially life-threatening condition, with an overall 3-month mortality rate of 15% and with right ventricular failure as the most common cause of early death. Risk stratification facilitates identification of high-risk patients and may be helpful in guiding the initial and long-term management. In patients with massive PE and hemodynamic instability, rapid risk assessment is paramount and bedside echocardiography and multislice chest computed tomography (CT) are useful for identifying patients who may benefit from thrombolysis or embolectomy. Cardiac biomarkers, including troponin and the natriuretic peptides, are sensitive markers of right ventricular function. Low levels of troponin, B-type natriuretic peptide (BNP), and NT-terminal proBNP are all highly sensitive assays for identifying patients with an uneventful clinical course. Multislice chest CT is not only useful to diagnose or exclude PE; it also is useful for risk assessment. A right-to-left ventricular dimension ratio > 0.9 on the reconstructed CT four-chamber view identifies patients at increased risk of early death. This article focuses on risk stratification tools, including the clinical examination, electrocardiography, echocardiography, cardiac biomarkers, and chest CT.

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“…Few reports exist on this condition. In almost all cases, ECSS is thought to be the consequence of a paradoxical embolism through a patent foramen ovale (PFO) [2][3][4][5][6][7][8][9][10][11][12][13]. In the present article, we describe a new case and review available data in literature.…”

mentioning

confidence: 99%