scholarly journals Multiorgan paradoxical embolism in an elderly female with a patent foramen ovale: a case report

2019 ◽  
Vol 92 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Dimitrios Anyfantakis ◽  
Paraskevi Karona ◽  
Pagona Kastanaki ◽  
Athanasios Kourakos ◽  
Miltiades Kastanakis
Keyword(s):  
Patent Foramen Ovale ◽  
Arterial Occlusion ◽  
Systemic Circulation ◽  
Paradoxical Embolism ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Foramen Ovale ◽  
Vein Thrombosis ◽  
Initiation Of Therapy ◽  
Deep Vein

Paradoxical embolism is an uncommon cause of arterial occlusion with a high mortality burden. Current evidence suggests that patent foramen ovale is the most important etiological factor of paradoxical embolism, by acting as a pathway for a thromboembolic material originating from the peripheral veins, passing through the lungs and entering the systemic circulation. Here we present a case of paradoxical embolism in the mesenteric and renal arteries associated with pulmonary embolism and deep vein thrombosis in an elderly woman with no predisposing risk factor. A diagnosis of paradoxical embolism was considered and the presence of a patent foramen ovale was consequently confirmed with a transesophageal echocardiography. Urgent thrombolysis saved the life of the patient. Paradoxical embolism represents an emergency and therefore prompt diagnosis and initiation of therapy may prevent adverse outcomes.

Abstract WP362: Over-Utilization of Studies to Detect Deep Venous Thrombosis in Stroke Patients With Patent Foramen Ovale

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sophie Samuel ◽  
Thuy Nguyen ◽  
Sujan T Reddy ◽  
Kaushik N Parsha ◽  
Sean I Savitz
Keyword(s):  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Young Group ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Old Patients ◽  
Vein Thrombosis ◽  
Multivariable Regression ◽  
Deep Vein

Introduction: Cryptogenic stroke may result from paradoxical embolism through a patent foramen ovale (PFO). However, the association between deep vein thrombosis (DVT) and cryptogenic stroke has not been proven. The objective of our study is to compare the incidence of DVT in young and old patients who presented with acute ischemic stroke and were found to have a PFO. Method: We conducted a single-centre retrospective study from January 2014-December 2018. Patients over the age of 18 with ischemic stroke and PFO, who underwent magnetic resonance venography (MRV) of the pelvis and venous doppler ultrasonography (VDU) for assessment of DVT were included. Primary endpoint was the incidence of DVT in patients that were age ≤ 60 (young group) compared to those age > 60 (old group). We further analyzed the incidence of DVT in cryptogenic stroke vs determined origin; and based on the Risk of Paradoxical Embolism (ROPE) score. Results: We included 327 patients: 200 were young (Y) and 127 were old (O). Incidence of DVT was similar for patients in Y versus those in O group (7% vs 8%). A significantly higher ROPE score ≥ 6 was seen in the Y group (71% vs 9%; p<0.001). However, there was no difference in the incidence of DVT in patients with high (9%) or low ROPE scores (8%); OR 0.75, 95% CI (0.32-1.76) p=0.517. Among cryptogenic stroke with high ROPE score and young, incidence of DVT was (7% vs 9%) in determined origin; OR 0.74, 95% CI (0.28-1.96) p=0.557. MRV pelvis detected a clot in 5% of all patients. In a multivariable regression analysis; age, gender, and presence of PFO was not associated with the incidence of DVT. Length of stay and mRS at day 7 were the same between Y and O groups. Conclusions: Detection of DVT was not associated with PFO, high ROPE scores or cryptogenic strokes. Our data indicate an over-reliance of testing for DVT, particularly MRV pelvis with contrast, in patients with PFO. Clinical studies are needed to identify other factors predictive of DVT in patients with ischemic stroke and PFO.

Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

2020 ◽  
Vol 18 (2) ◽  
pp. 135-150
Author(s):  
Harsha S. Nagarajarao ◽  
Chandra P. Ojha ◽  
Archana Kedar ◽  
Debabrata Mukherjee
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Narrow Channel ◽  
Paradoxical Embolism ◽  
Current Evidence ◽  
Foramen Ovale ◽  
The Right ◽  
The Relationship ◽  
Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

scholarly journals Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

Open Medicine ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 10-13
Author(s):  
Junko Yamaguchi ◽  
Akihiro Noda ◽  
Akira Utagawa ◽  
Atsushi Sakurai ◽  
Kosaku Kinoshita
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Cerebral Embolism ◽  
Foramen Ovale ◽  
Pediatric Case ◽  
Pediatric Critical Care ◽  
Vein Thrombosis ◽  
Side Pressure ◽  
Deep Vein

AbstractHerein, we report a pediatric case of acute paradoxical cerebral embolism complicated by serious acute pulmonary embolism that was caused by an extremely small patent foramen ovale (PFO). The patient had no medical history suggestive of any other reason.Paradoxical cerebral embolism may occur even with an extremely small PFO because of the increased right-side pressure of the heart and a resulting right-to-left shunt from the acute pulmonary embolism. Although pediatric cases of pulmonary embolism are rare, when diagnosed, clinicians should consider the risk of a concurrent paradoxical cerebral embolism resulting from a latent PFO. The possibility of PFO should be assessed extremely carefully in pediatric critical care by checking for a thrombogenesis tendency and the existence of deep vein thrombosis in the patient.

scholarly journals May-Thurner Syndrome as a Rare Cause of Paradoxical Embolism in a Patient with Patent Foramen Ovale

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Dominika M. Zoltowska ◽  
Guramrinder Thind ◽  
Yashwant Agrawal ◽  
Vishal Gupta ◽  
Jagadeesh Kumar Kalavakunta
Keyword(s):  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Patent Foramen Ovale ◽  
Iliac Vein ◽  
Paradoxical Embolism ◽  
Common Iliac Vein ◽  
Foramen Ovale ◽  
Anatomical Variant ◽  
Vein Thrombosis ◽  
Ischemic Attack

May-Thurner syndrome is an underrecognized anatomical variant that can lead to increased propensity for venous thrombosis in the lower extremities. We present a case of a 67-year-old female who presented with transient ischemic attack. Initial workup including CT scan of the head, MRI scan of the head, and magnetic resonance angiogram of the head and neck was unremarkable. A transthoracic echocardiogram with bubble study was also normal. Subsequently, a transesophageal echocardiogram was performed that revealed a patent foramen ovale with right-to-left shunt. Lower extremity duplex venous ultrasound showed no evidence of deep vein thrombosis. However, magnetic resonance venogram of the pelvis showed compression of the left common iliac vein just after its origin suggestive of May-Thurner syndrome. Hence, May-Thurner syndrome was recognized as the probable source of paradoxical embolism causing transient ischemic attack in this patient.

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