Acute pulmonary embolism in a young female with inherited thrombophilic disorder and large thrombus through a patent foramen ovale

<p>Nowadays, the treatment of patent foramen ovale (PFO) after acute pulmonary embolism (PE) remains matter of speculation. Absence of both randomized trials and recommendations in current international guidelines complicate the decisions making in such patients. In the present manuscript we discuss about the reasons for which PFO should be closed after acute PE.</p>

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

Open Medicine ◽

10.1515/med-2019-0002 ◽

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.

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Pathophysiology of acute pulmonary embolism

ESC CardioMed ◽

10.1093/med/9780198784906.003.0657 ◽

2018 ◽

pp. 2756-2758

Author(s):

Dieuwertje Ruigrok ◽

Anton Vonk Noordegraaf

Keyword(s):

Pulmonary Embolism ◽

Patent Foramen Ovale ◽

Acute Pulmonary Embolism ◽

Vascular Occlusion ◽

The Other ◽

Mechanical Obstruction ◽

Foramen Ovale ◽

Compensatory Mechanisms ◽

Acute Increase ◽

The Right

Acute right ventricular (RV) failure and impaired gas exchange (mainly hypoxaemia) can be two important issues clinicians are confronted with in patients with acute pulmonary embolism. An acute increase in RV afterload due to mechanical obstruction and vasoconstriction is the crucial factor starting a cascade with compensatory mechanisms, RV dilatation, RV ischaemia, and inflammation ultimately leading to RV dysfunction/failure. On the other hand, vascular occlusion leads to redistribution of pulmonary perfusion to regions with relative overperfusion causing profound hypoxaemia. Less commonly, shunting occurs due to atelectasis or due to opening of a patent foramen ovale, causing refractory hypoxaemia. Understanding these mechanisms is crucial in making the right treatment decisions when faced with a patient with acute pulmonary embolism and haemodynamic or respiratory instability.

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Floating Thrombus Entrapped in a Patent Foramen Ovale Complicating Acute Pulmonary Embolism

Anesthesiology ◽

10.1097/00000542-200510000-00030 ◽

2005 ◽

Vol 103 (4) ◽

pp. 895-897 ◽

Cited By ~ 2

Author(s):

Espeel Benoˆit ◽

Vinciane Crispin ◽

Bénédicte Fraselle ◽

Brice Payen ◽

Hugues Versailles

Keyword(s):

Pulmonary Embolism ◽

Patent Foramen Ovale ◽

Acute Pulmonary Embolism ◽

Foramen Ovale ◽

Floating Thrombus

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Stroke and refractory hypoxaemia: complications of pulmonary embolism

BMJ Case Reports ◽

10.1136/bcr-2021-244284 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244284

Author(s):

Mafalda Sá Pereira ◽

Rita Homem ◽

Tiago Judas ◽

Francisca Delerue

Keyword(s):

Pulmonary Embolism ◽

Risk Stratification ◽

Mortality Risk ◽

Cardiovascular Mortality ◽

Patent Foramen Ovale ◽

Acute Pulmonary Embolism ◽

Multidisciplinary Approach ◽

Foramen Ovale ◽

History Of Surgery ◽

History Of

Acute pulmonary embolism is one of the main causes of cardiovascular mortality. Treatment should be guided according to mortality risk stratification, but an individualised and multidisciplinary approach is often required. Concomitant persistent hypoxaemia can be present in cases of intracardiac shunt. In this report, we describe a 46-year-old woman with a history of surgery, presenting with pulmonary embolism with refractory hypoxaemia and simultaneous ischaemic stroke. Fibrinolysis was successfully performed, and the patient made a full recovery. Additional investigations identified a patent foramen ovale, which was later closed. She had no recurrent thrombotic events.

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