scholarly journals Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Shruti Hegde ◽  
Mitesh Kabadi ◽  
Michael Johnstone
Keyword(s):  
Patent Foramen Ovale ◽  
Clinical Signs ◽  
Postoperative Recovery ◽  
Neurological Deficits ◽  
Leg Pain ◽  
Foramen Ovale ◽  
Transient Nature ◽  
First Case ◽  
Paradoxical Embolus ◽  
In Transit

Abstract Background  Detection of a thrombus in transit through a patent foramen ovale (PFO) is extremely rare due to the transient nature of the process. We report an unusual case of a large, paradoxical embolus in transit seen on echocardiography through a PFO that was not found upon atriotomy. Case summary  An 80-year-old woman presented to the emergency room with shortness of breath and right leg pain. She was haemodynamically stable on presentation, and her physical exam was unremarkable. An ultrasound of her right leg revealed a deep vein thrombus in the posterior tibial vein, and chest computed tomography angiography showed saddle pulmonary emboli. Transthoracic echocardiogram identified a large thrombus in transit through a PFO, which was confirmed with a transoesophageal echocardiogram (TOE). She underwent an emergency embolectomy. The thrombus in transit was confirmed by TOE prior to bypass initiation; however, no thrombi were found in any chambers of the heart following atriotomy. Her postoperative recovery was uneventful. She had no focal neurological deficits or any apparent signs of large vessel embolization. Discussion Cases of silent embolism have been reported in the literature, although they are rare. To our knowledge, this is the first case of a large thrombus in transit through a PFO in an elderly female that was confirmed by an intra-operative TOE but could not be found following atriotomy, with no obvious clinical signs of embolization.

Paradoxical Embolus Caught in Transit through a Patent Foramen Ovale

2010 ◽  
Vol 26 (2) ◽  
pp. 151-153 ◽  
Author(s):  
Dipesh K. Shah ◽  
Matthew J. Ritter ◽  
Lawrence J. Sinak ◽  
John A. Miller ◽  
Thoralf M. Sundt III
Keyword(s):  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Paradoxical Embolus ◽  
In Transit

scholarly journals Thrombus in Transit through Patent Foramen Ovale

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Hassan Baydoun ◽  
Iskander Barakat ◽  
Elie Hatem ◽  
Michel Chalhoub ◽  
Ali Mroueh
Keyword(s):  
Patent Foramen Ovale ◽  
Case Reports ◽  
Rare Event ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Surgical Risk ◽  
Transient Nature ◽  
Clinical Scenarios ◽  
High Surgical Risk ◽  
In Transit

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.

Platypnoea-orthodeoxia syndrome in the elderly: A difficult-to-make diagnosis of intracardiac right-to-left shunt

2017 ◽  
Vol 62 (3) ◽  
pp. 122-125 ◽  
Author(s):  
Enrico M Zardi ◽  
Silvia Spoto ◽  
Luciana Locorriere ◽  
Giulio Cacioli ◽  
Silvia Mazzaroppi ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Arteriovenous Malformations ◽  
Clinical Signs ◽  
Vascular Complications ◽  
The Elderly ◽  
Upright Position ◽  
Foramen Ovale ◽  
Case Presentation ◽  
Hepatic Diseases ◽  
Chronic Pulmonary Diseases

Introduction Platypnea-orthodeoxia syndrome is a combination of positional dyspnoea and hypoxemia; it is caused by several cardiac, pulmonary and hepatic diseases. Case presentation In this study, we describe a 77-year-old female affected by unexplained dizziness and hypoxia that exacerbated in upright position. After diagnosing platypnea-orthodeoxia syndrome and excluding all possible causes (liver cirrhosis, acute and chronic pulmonary diseases and arteriovenous malformations), the origin of the syndrome was individuated in the presence of a patent foramen ovale with right-to-left shunt. Endovascular patent foramen ovale closure permitted the resolution of symptoms and disappearance of platypnea-orthodeoxia syndrome. Conclusion Although patent foramen ovale may be present since birth without giving clinical signs, it may represent a common enough cause of platypnea-orthodeoxia syndrome and other vascular complications in the elderly.

Patent Foramen Ovale Device Closure in a 27 Years Old Young Lady with Cryptogenic Ischaemic Stroke - First Case Report from Bangladesh

2021 ◽  
Vol 13 (2) ◽  
pp. 227-234
Author(s):  
AQM Reza ◽  
Aparajita Karim ◽  
Mahmood Hasan Khan ◽  
Kazi Atiqur Rahman ◽  
Md Aliuzzaman Joarder ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Patent Foramen Ovale ◽  
Incidental Finding ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Coagulation Therapy ◽  
First Case ◽  
Treatment Paradigm ◽  
Meta Analyses

A patent foramen ovale (PFO) is highly prevalent in patients with strokes of unknown cause or cryptogenic strokes (CSs). It has been remained an unsolved question as to whether a PFO should be closed or not to prevent recurrent strokes in patients diagnosed with cryptogenic stroke (CS). A paradoxical embolism through a PFO is pointed as a leading cause of CS, especially in younger patients with low risk factors for stroke. It also remains an unsolved matter on type of anti-coagulation therapy, which would be better for patients with CS and a PFO. In addition, surgical and transcutaneous closure of a PFO has been proposed for the secondary prevention of stroke in patients with CS with PFO. Several randomized controlled trials have been conducted in recent years to test whether a PFO closure gives a significant benefit in the management of CS. Many investigators believed that a PFO was an incidental finding in patients with CS. However, meta-analyses and more recent specific trials have eliminated several confounding factors and possible biases and have also emphasized the use of a shunt closure over medical therapy in patients with CS. Therefore, these latest studies can possibly change the treatment paradigm in the near future. We are reporting a case of cryptogenic ischaemic stroke in middle cerebral artery territory due to paradoxical embolism through a PFO which was successfully closed with a device solely by a Bangladeshi Consultant & his team first time in Bangladesh. Cardiovasc. j. 2021; 13(2): 227-234

MANAGEMENT OF THROMBUS IN TRANSIT THROUGH A PATENT FORAMEN OVALE

2018 ◽  
Vol 71 (11) ◽  
pp. A2465
Author(s):  
Mohamed Ayan ◽  
Aneesha Ananthula ◽  
Jawahar L. Mehta ◽  
Srikanth Vallurupalli
Keyword(s):  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
In Transit

scholarly journals Caught in the middle: Thrombus-in-transit through patent foramen ovale

Cor et Vasa ◽  
2015 ◽  
Vol 57 (1) ◽  
pp. e59-e60 ◽  
Author(s):  
Saroj Neupane ◽  
Naga V. A. Kommuri ◽  
Andrew M. Hauser
Keyword(s):  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
In Transit
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