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Boussaadani BE, Mayoussi S, Zergoune N, Hara L, Amine EC, Raissouni Z. [Uncommon cause of acute coronary syndrome : Paradoxical embolism]. Ann Cardiol Angeiol (Paris) 2024; 73:101721. [PMID: 38262255 DOI: 10.1016/j.ancard.2023.101721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/09/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024]
Abstract
Coronary artery embolism is an uncommon cause of myocardial infarction (MI). Among several etiologies of coronary embolism, we mention a very rare cause which is the paradoxical embolism via patent foramen ovale (PFO). It interests generally youngest people without cardiac risk factors. We report three cases who presented ST-elevation MI (STEMI) due to paradoxical embolism with high risk PFO that can justify embolic infarction. The aim of this article is to define the high risk PFO, to establish causal link between PFO and embolic events and to guide therapeutic management.
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Affiliation(s)
| | - Salma Mayoussi
- Service de cardiologie du CHU de Tanger, Université Abdelmalek Essaadi, Maroc
| | - Nabil Zergoune
- Service de cardiologie du CHU de Tanger, Université Abdelmalek Essaadi, Maroc
| | - Loubna Hara
- Service de cardiologie du CHU de Tanger, Université Abdelmalek Essaadi, Maroc
| | - Ech-Chenbouli Amine
- Service de cardiologie du CHU de Tanger, Université Abdelmalek Essaadi, Maroc
| | - Zainab Raissouni
- Service de cardiologie du CHU de Tanger, Université Abdelmalek Essaadi, Maroc
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2
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Li YS, Li YC. Simultaneous acute limb ischemia related to acute Leriche syndrome and pulmonary embolism without existing patent foramen ovale: a case report. BMC Cardiovasc Disord 2021; 21:465. [PMID: 34565333 PMCID: PMC8474774 DOI: 10.1186/s12872-021-02272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aortoiliac occlusion disease, also called Leriche syndrome, is characterized by atherothrombotic obliteration of the aortic bifurcation and bilateral common iliac arteries; typically, it has a chronic presentation. Pulmonary embolism is more related to venous thromboembolism rather than arterial thromboembolic events. Therefore, cases of simultaneous acute Leriche syndrome and pulmonary embolism are rare. Existing intracardiac right-to-left shunt were detected in most previous cases. Herein, we present the first likely documented case wherein acute Leriche syndrome and pulmonary embolism occurred simultaneously without a patent foramen ovale. CASE PRESENTATION A 58-year-old man with hyperlipidemia and coronary artery disease presented with a 4-h history of bilateral lower limb numbness. He was a heavy smoker with a history of stroke. Computed tomography angiography revealed pulmonary embolism and aortoiliac artery occlusion. Although a massive thrombus straddled the bilateral pulmonary arteries, orthopnea was his only presentation, without right ventricle failure. Cyanosis of the affected limbs was noted, and muscle strength in both limbs had regressed to grade 1. Owing to acute limb ischemia, he underwent an emergency operation to salvage the limbs. On postoperative day 5, the general condition of both the legs improved; the muscle strength improved to grade 4. He was then transferred to the general ward and enoxaparin was continued. Computed tomography angiography was repeated to evaluate the pulmonary embolism on postoperative day 8; the thrombus remained lodged in the bilateral main pulmonary arteries. Owing to persistent orthopnea and chest tightness with intermittent tachycardia, he underwent a staged operation for the pulmonary embolism on postoperative day 13. During the surgery, intraoperative transesophageal echocardiography showed no patent foramen ovale or an existing right-to-left shunt. Postoperatively, he was closely monitored in the intensive care unit for 3 days and then transferred to the general ward for 10 days. A final computed tomography angiography performed on postoperative day 18 revealed thrombus resolution. He was then discharged on postoperative day 30 without any in-hospital complications. CONCLUSION We present a case that might be the first documented report of acute Leriche syndrome co-occurring with pulmonary embolism without an existing patent foramen ovale.
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Affiliation(s)
- Ying-Sheng Li
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
| | - Ying-Ching Li
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
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3
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Mridha N, Ward E, Hayman S, Dahiya A, Prasad S. Paradoxical embolism through patent foramen ovale as a cause of myocardial infarction. Med J Aust 2021; 215:68-69.e1. [PMID: 34145590 DOI: 10.5694/mja2.51140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Naim Mridha
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Griffith University, Gold Coast, QLD, Australia
| | - Eloise Ward
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Samual Hayman
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Arun Dahiya
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Griffith University, Gold Coast, QLD, Australia
| | - Sandhir Prasad
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
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4
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Banana Y, Rezziki A, Kallel O, Rasras H, Bazid Z, El Ouafi N, El Mahi O, Benzirar A. Multiple paradoxical embolisms revealing a patent foramen ovale in a patient with deep venous thrombosis: A case report. Ann Med Surg (Lond) 2021; 66:102426. [PMID: 34141413 PMCID: PMC8187935 DOI: 10.1016/j.amsu.2021.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/16/2021] [Accepted: 05/22/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Paradoxical embolism is a rare medical phenomenon. Depending on the site of embolisation, it can cause different symptoms. Although rare, mesenteric ischemia can reveal paradoxical embolism, and the embolisation of two different sites is rarely described in the literature. Case presentation We report the observation of a patient with a table associating an acute mesenteric ischemia and an acute ischemia of the upper limb; whose the etiological assessment revealed a deep venous thrombosis of the lower limbs complicated by pulmonary embolism. Clinical discussion These paradoxical embolisms occurred through a patent foramen ovale. The diagnosis of the patent foramen ovale in this patient was revealed by transthoracic echocardiography, with bubble test. The patient benefited from an embolectomy of the superior mesenteric artery and an embolectomy using fogarty catheter by approching humeral artery at the elbow crease with good postoperative evolution. The patient was put on long-term anticoagulation with Acenocoumarol (because of low socio-economic level of our patient). We didn't recommended the closure of the PFO because of the small size of the shunt and especially because the patient refuses that procedure. Conclusion Paradoxical embolism remains a pathology rarely mentioned by clinicians, although it can engage the functional and vital prognosis of the patient, hence the interest of a good cardiac evaluation in any patient with embolic ischemia. PFO is most often asymptomatic but it can cause manifestations with variable degrees of severity. If it is not earyl diagnosed, or negligated, it can be life-threatining Paradoxical embolism is a pathological condition that requires a multidiscplinary management.
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Affiliation(s)
- Youssef Banana
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Abdellah Rezziki
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Oussama Kallel
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Hammam Rasras
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Zakariae Bazid
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Omar El Mahi
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Adnane Benzirar
- Department of Vascular Surgery, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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5
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Jolobe O. Wide-ranging clinical spectrum of paradoxical embolism. Postgrad Med J 2021; 98:958-966. [PMID: 34006630 DOI: 10.1136/postgradmedj-2020-139691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
The purpose of this review is to raise the index of suspicion for paradoxical embolism among generalists. The review is based solely on anecdotal reports compiled from EMBASE, MEDLINE, Googlescholar and Pubmed. Search terms were 'paradoxical embolism', 'pulmonary embolism' and 'pulmonary arteriovenous malformations'. What emerged was that right-to-left paradoxical embolism could occur with or without concurrent pulmonary embolism, and also with and without proof of the presence of an 'embolus-in-transit'. Potential sites of single or multiple systemic involvement included the central nervous system, the coronary circulation, renal arterial circulation, splenic circulation, the mesenteric circulation and the limbs. In many cases, the deep veins of the lower limbs were the source of thromboembolism. In other cases, thrombi originated from an atrial septal aneurysm, from a central venous line, from a haemodialysis-related arterio-venous shunt, from a popliteal vein aneurysm, internal jugular vein, superior vena cava, from a pulmonary arteriovenous malformation, from tricuspid valve endocarditis (with and without pulmonary embolism) and from the right atrium, respectively. Stroke was by far the commonest systemic manifestation of paradoxical embolism. Some strokes were attributable to pulmonary arteriovenous malformations with or without coexistence of intracardiac shunts. Clinicians should have a high index of suspicion for paradoxical embolism because of its time-sensitive dimension when it occurs in the context of involvement of the intracranial circulation, coronary circulation, mesenteric circulation, and peripheral limb circulation.
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6
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Harmand P, Bechu M, Bounes V. Emboles artériels multiples sur foramen ovale perméable. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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7
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Van der Giessen H, Wilson LC, Coffey S, Whalley GA. Review: Detection of patient foramen ovale using transcranial Doppler or standard echocardiography. Australas J Ultrasound Med 2020; 23:210-219. [PMID: 34765407 PMCID: PMC8411673 DOI: 10.1002/ajum.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 11/07/2022] Open
Abstract
A patent foramen ovale (PFO) is a common remnant of fetal circulation present in up to 25% of the worldwide adult population. Paradoxical embolism occurs when venous blood crosses the PFO into the arterial system, bypassing the pulmonary circulation. This allows for the direct passage of microemboli into cerebral blood vessels, increasing the risk of cryptogenic stroke. This review investigates the current diagnostic procedures used to detect and grade a PFO, including transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE) and transcranial Doppler (TCD). Only a few studies have directly compared the use of TTE with TCD for PFO detection but several have compared TTE and TCD independently against the clinical gold standard TOE. Known pitfalls of TTE and TCD are also discussed, including the difficulty of differentiating between intracardiac shunts and intrapulmonary shunts. This review also discusses methods to optimise imaging, such as performing an adequate Valsalva manoeuvre, the role of abdominal compression and the choice of the injection site for the contrast agent and how these may increase the diagnostic success of detecting a right-to-left shunt when prompted by a clinician.
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Affiliation(s)
- Hanna Van der Giessen
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Luke C Wilson
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Sean Coffey
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Gillian A Whalley
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
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8
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Ji J, Tian Y, Chen L, Li B. Intraoperative venous air embolism in the non-cardiac surgery-the role of perioperative echocardiography in a case series report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:798. [PMID: 32647723 PMCID: PMC7333140 DOI: 10.21037/atm-20-497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Venous air embolism (VAE) is commonly one of the iatrogenic complications associated with divergent high-risk surgeries. In this case-series report, we presented a series of VAE cases in our institute during the last 6 consecutive years. There were total of nine cases suspected to be VAE according the clinical symptom and signs, of which seven cases were definitively diagnosed VAE using transthoracic echocardiography (TTE). We also reported two presumptive cases of paradoxical VAE during hepatectomy in this case series, furthermore, the cause, complications and hazards secondary to paradoxical VAE were discussed as well. All cases had an uneventful recovery from VAE with the assistance of TTE as well as other therapeutic management of VAE, except one neurosurgical patient died from postoperative hemorrhagic stroke per se. Therefore, VAE or paradoxical air embolism can occur during various non-cardiac operations and the significance of perioperative ultrasound should be emphasized in the treatment of VAE.
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Affiliation(s)
- Jingjing Ji
- Department of Anesthesia, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Graduate School of Nanjing University Medical School, Nanjing 210008, China
| | - Yali Tian
- Department of Anesthesia, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Graduate School of Nanjing University Medical School, Nanjing 210008, China
| | - Luning Chen
- Department of Anesthesia, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.,Graduate School of Nanjing University Medical School, Nanjing 210008, China
| | - Bingbing Li
- Department of Anesthesia, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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9
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Jolobe OMP. Paradoxical embolism as a cause of renal and/or splenic infarction. QJM 2020; 113:442-443. [PMID: 31681946 DOI: 10.1093/qjmed/hcz284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Boumaaz M, Asfalou I, Hamami A, Raissouni M, Lakhal Z, Benyass A. Myocardial Infarction Caused by an Enclosed Thrombus in a Patent Foramen Ovale. J Saudi Heart Assoc 2020; 32:204-207. [PMID: 33154917 PMCID: PMC7640573 DOI: 10.37616/2212-5043.1039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 11/20/2022] Open
Abstract
Paradoxical embolism in coronary artery is a rarely diagnosed clinical entity. In the majority of reported cases; the diagnostic of this pathology is « presumptive » based on certain criteria. It can be considered "proven" when the embolus is found lodged in the abnormal communication between the venous and arterial circulation; which is very rare. We herein report a case of myocardial infarction caused by a proven paradoxical coronary embolism through a patent foramen ovale. The authors highlight through this paper the contribution of echocardiography and particularly trans-esophageal echocardiography, especially if performed soon after presentation, for early diagnosis.
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Affiliation(s)
- Meriem Boumaaz
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Iliyasse Asfalou
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Amine Hamami
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Maha Raissouni
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Zouhair Lakhal
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Aatif Benyass
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
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11
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Arfaras-Melainis A, Palaiodimos L, Mojadidi MK. Transcatheter Closure of Patent Foramen Ovale: Randomized Trial Update. Interv Cardiol Clin 2019; 8:341-356. [PMID: 31445719 DOI: 10.1016/j.iccl.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A patent foramen ovale (PFO) is found in about one-quarter of all adults, but the prevalence increases to approximately half of those with a history of a so-called cryptogenic stroke. The true efficacy of PFO closure for prevention of recurrent paradoxical embolism has been debated for years, as the early 3 randomized trials did not show a statistically significant benefit of PFO closure over standard-of-care medical therapy. However, 3 recent randomized trials along with the long-term follow-up data from the largest early trial demonstrated superiority of device closure for secondary stroke prevention.
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Affiliation(s)
- Angelos Arfaras-Melainis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA 23298, USA
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12
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Anyfantakis D, Karona P, Kastanaki P, Kourakos A, Kastanakis M. Multiorgan paradoxical embolism in an elderly female with a patent foramen ovale: a case report. Med Pharm Rep 2019; 92:83-86. [PMID: 30957092 PMCID: PMC6448492 DOI: 10.15386/cjmed-1031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/05/2018] [Accepted: 06/27/2018] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Dimitrios Anyfantakis
- Primary Care Department, Primary Health Care Centre of Kissamos, Chania, Crete, Greece
| | - Paraskevi Karona
- First Department of Surgery, Saint George General Hospital of Chania, Crete, Greece
| | - Pagona Kastanaki
- First Department of Surgery, Saint George General Hospital of Chania, Crete, Greece
| | - Athanasios Kourakos
- First Department of Surgery, Saint George General Hospital of Chania, Crete, Greece
| | - Miltiades Kastanakis
- First Department of Surgery, Saint George General Hospital of Chania, Crete, Greece
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13
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Abusnina W, Megri M, Edris B, El-Hamdani M. Arterial embolism in a patient with pulmonary embolism and patent foramen ovale. Proc (Bayl Univ Med Cent) 2019; 32:256-258. [PMID: 31191146 DOI: 10.1080/08998280.2019.1576460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022] Open
Abstract
Paradoxical embolization is an uncommon but devastating complication of pulmonary embolism and continues to be frequently missed. Although the prevalence of patent foramen ovale is 25% to 30%, the risk of paradoxical embolism is <2% of all arterial ischemia. Paradoxical embolism is infrequent but can involve almost any artery of the body. Here, we present a case of a 65-year-old woman with paradoxical systemic arterial embolism secondary to deep venous thrombosis and pulmonary embolism in the presence of patent foramen ovale. High suspicion for paradoxical embolism is needed in the event of unexplained arterial occlusion. Awareness of this complication with prompt recognition and treatment could serve to preclude significant disability and death.
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Affiliation(s)
- Waiel Abusnina
- Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest Virginia
| | - Mohammed Megri
- Division of Pulmonary/Critical Care and Sleep Medicine, University of Kentucky Medical CenterLexingtonKentucky
| | - Basel Edris
- Department of Cardiovascular Disease, Joan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest Virginia
| | - Mehiar El-Hamdani
- Department of Cardiovascular Disease, Joan C. Edwards School of Medicine, Marshall UniversityHuntingtonWest Virginia
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14
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Palaiodimos L, Kokkinidis D. Questions on Percutaneous Patent Foramen Ovale Closure for Secondary Stroke Prevention: The Heads of the Lernaean Hydra. Cardiology 2019; 144:50-52. [DOI: 10.1159/000501231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/19/2022]
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15
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Khani M, Bayat F, Rohani A, Pishgahi M. Paradoxical Embolism in a Patient with Patent Foramen Ovale; a Case Report. EMERGENCY (TEHRAN, IRAN) 2018; 6:e50. [PMID: 30584566 PMCID: PMC6289151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patent foramen ovale (PFO) is usually asymptomatic; however, it could be quite dangerous for patients with right side clot in which thrombus can transmit the PFO and paradoxically emboli to systemic circulation. Here we present a patient with ankle fracture and paradoxical embolus to the brain, who was successfully treated with emergent thrombectomy, inferior vena cava (IVC) filter placement and anticoagulation therapy. Despite the high rate of mortality in these patients, fortunately our patient survived with surgical treatment.
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Affiliation(s)
- Mohammad Khani
- Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fariba Bayat
- Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Atoosheh Rohani
- Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran.,Corresponding author: Atoosheh Rohani; Department of cardiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Pishgahi
- Department of Cardiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Alkhalil M, Cahill TJ, Boardman H, Choudhury RP. Concomitant pulmonary embolism and myocardial infarction due to paradoxical embolism across a patent foramen ovale: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2017; 1:ytx010. [PMID: 31020069 PMCID: PMC6177106 DOI: 10.1093/ehjcr/ytx010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/29/2017] [Indexed: 01/21/2023]
Abstract
Concomitant acute myocardial infarction (MI) and pulmonary embolism (PE) is exceedingly rare. However, establishing the diagnosis early is essential, since delay in treating the patient may lead to a potential fatal outcome. Right ventricular (RV) infarction in the setting of inferior ST-segment elevation MI (STEMI), coupled with acute massive PE confers particular risk due acute RV failure and low cardiac output, threatening survival. We report a rare case of concomitant PE and inferior STEMI in a 43-year-old woman with a history of acute chest pain. She was haemodynamically compromised, with Type I respiratory failure but lack of signs of heart failure. Early recognition of dual pathologies prompted administration of thrombolytic therapy and simultaneous right coronary artery thrombectomy to treat PE and STEMI. Prompt clinical diagnosis and delivery of targeted therapies adapted for the specific clinical presentation may have averted fatal outcome.
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Affiliation(s)
- Mohammad Alkhalil
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.,Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Thomas J Cahill
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Henry Boardman
- Department of Cardiology, Oxford Heart Centre, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.,Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
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17
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Geng J, Tian HY, Zhang YM, He S, Ma Q, Zhang JB, Liu Y, Tian H, Zhang D, Meng Y. Paradoxical embolism: A report of 2 cases. Medicine (Baltimore) 2017; 96:e7332. [PMID: 28658147 PMCID: PMC5500069 DOI: 10.1097/md.0000000000007332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Paradoxical embolism (PDE) refers to direct passage of venous thrombi into the arterial circulation through an arteriovenous shunt. PATIENT CONCERNS Case 1 presented with initial symptoms of shock and cerebral infarction. Case 2 developed middle cerebral artery occlusion during angiography. DIAGNOSES 2 cases were diagnosed as PDE. INTERVENTIONS They received thrombolytic therapy and anticoagulant therapy. OUTCOMES The patients had recovery. LESSONS This report highlights the myriad clinical manifestations of PDE and underlines the importance of meticulous history taking and physical examination for early diagnosis.
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Affiliation(s)
- Jie Geng
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Hong-yan Tian
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Yan-min Zhang
- Section of Pediatric Cardiology, Heart Center, Northwest Women's and Children's Hospital
| | - Sai He
- Department of Breast Cancer, Shaanxi Provincial Tumor Hospital, Xi’an, Shaanxi, PR China
| | - Qiang Ma
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Jun-bo Zhang
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Ya Liu
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Hua Tian
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Dan Zhang
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Yan Meng
- Department of Peripheral Vascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University
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Zhang HL, Liu ZH, Luo Q, Wang Y, Zhao ZH, Xiong CM. Paradoxical embolism: Experiences from a single center. Chronic Dis Transl Med 2017; 3:123-128. [PMID: 29063065 PMCID: PMC5627697 DOI: 10.1016/j.cdtm.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To present our treatment experiences and the follow-up data of patients with paradoxical embolism (PDE). METHODS The clinical characteristics, management, and follow-up data of all included patients who were diagnosed with PDE at Fuwai Hospital from January 1994 to October 2015 were recorded. RESULTS Twelve patients were included; all had a pulmonary embolism, and 8 had deep venous thrombosis. The artery embolisms involved the cerebral artery (7 patients), renal artery (2 patients), mesentery artery (2 patients), popliteal artery (1 patient), descending aorta thrombus (1 patient), and thrombus-straddled patent foramen ovale (PFO) (1 patient). PFO was found in 3 cases. One patient underwent thrombectomy and PFO closure; Six patients received thrombolysis; and 3 patients were implanted with a vena cava filter. Long-term anticoagulation with warfarin was recommended for each patient. One patient died from ventricular fibrillation despite cardiopulmonary resuscitation. Eleven patients were discharged with improvements. No late mortality occurred in 8 patients with a complete follow-up of 10.6-17.7 years. One had a recurrent deep venous thrombosis. No patient had a recurrent pulmonary or arterial embolism. Two patients changed their treatment from warfarin to aspirin; others remained on warfarin. Only 1 case had an occasional gum bleeding. CONCLUSIONS PDE treatment including thrombolysis, anticoagulation, and embolectomy should be individualized. We recommend long-term anticoagulation therapy to prevent the recurrence of PDE, especially to those with an intracardiac communication or persistent risk factors for re-thrombosis.
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Affiliation(s)
- Hong-Liang Zhang
- Center for Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhi-Hong Liu
- Center for Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qin Luo
- Center for Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yong Wang
- Center for Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhi-Hui Zhao
- Center for Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chang-Ming Xiong
- Center for Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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19
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Hakim FA, Kransdorf EP, Abudiab MM, Sweeney JP. Paradoxical coronary artery embolism - a rare cause of myocardial infarction. Heart Views 2015; 15:124-6. [PMID: 25774255 PMCID: PMC4348985 DOI: 10.4103/1995-705x.151089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence.
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Affiliation(s)
- Fayaz A Hakim
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Evan P Kransdorf
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Muaz M Abudiab
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
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20
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Neisius U, Northridge DB, Cruden NL, Denvir MA. Myocardial infarction associated with patent foramen ovale and paradoxical embolism: A case series. Int J Cardiol 2015; 180:34-7. [DOI: 10.1016/j.ijcard.2014.11.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
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21
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Hayıroğlu Mİ, Bozbeyoğlu E, Akyüz Ş, Yıldırımtürk Ö, Bozbay M, Bakhshaliyev N, Renda E, Gök G, Eren M, Pehlivanoğlu S. Acute myocardial infarction with concomitant pulmonary embolism as a result of patent foramen ovale. Am J Emerg Med 2015; 33:984.e5-7. [PMID: 25656332 DOI: 10.1016/j.ajem.2014.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/14/2014] [Indexed: 02/08/2023] Open
Abstract
Acute myocardial infarction (MI) and pulmonary embolism canal one lead to life-threatening conditions such as sudden cardiac death and congestive heart failure. We discuss a case of a 74-year-old man presented to the emergency department with acute dyspnea and chest pain. Acute anterior MI and pulmonary embolism concomitantly were diagnosed. Primary percutaneous coronary intervention performed because of preliminary acute anterior MI diagnosis. Transthoracic echocardiography was performed to determine further complications caused by acute MI because patient had a continuous tachycardia and dyspnea although hemodynamically stable. Transthoracic echocardiography revealed a thrombus that was stuck into the patent foramen ovale with parts in right and left atria. Anticoagulation therapy was started; neither fibrinolytic therapy nor operation was performed because of low survey expectations of the patient's recently diagnosed primary disease stage IV lung cancer. Patient was discharged on his 20th day with oral anticoagulation and antiagregant therapy.
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Affiliation(s)
- Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey.
| | - Emrah Bozbeyoğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Şükrü Akyüz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Özlem Yıldırımtürk
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Bozbay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Nijad Bakhshaliyev
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Emir Renda
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Gülay Gök
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Eren
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Seçkin Pehlivanoğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
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22
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Saremi F, Emmanuel N, Wu PF, Ihde L, Shavelle D, Go JL, Sánchez-Quintana D. Paradoxical Embolism: Role of Imaging in Diagnosis and Treatment Planning. Radiographics 2014; 34:1571-92. [DOI: 10.1148/rg.346135008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Smith JG, Koul S, Roijer A, Holmqvist J, Keussen I, Cwikiel W, Ohlin B, Erlinge D. Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 2:131-6. [PMID: 24222822 DOI: 10.1177/2048872613486336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/24/2013] [Indexed: 12/15/2022]
Abstract
Patent foramen ovale (PFO) is present in approximately 25% of the general population. PFO is characterized by intermittent shunting of blood from the right to the left atrium, especially in the context of increased right-sided filling pressures, with risk of paradoxical embolism. We describe a 69-year-old woman presenting with acute chest pain, severe dyspnoea, and acute inferolateral ST-segment elevation on the electrocardiogram. The patient was diagnosed with myocardial infarction and failure of the right cardiac ventricle, which was considered to be secondary to extensive pulmonary embolism leading to increased filling pressures and paradoxical coronary embolism. The patient underwent emergent percutaneous interventions with coronary thrombus extraction and pulmonary thrombus fragmentation and local thrombolysis. The patient was free of symptoms at follow up 6 months later and echocardiography showed substantially improved right ventricular function. We discuss issues related to the diagnosis, treatment, and secondary prevention for patients with concomitant pulmonary and coronary arterial thrombosis.
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Affiliation(s)
- J Gustav Smith
- Lund University, Lund, Sweden ; Skåne University Hospital, Lund, Sweden
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24
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Tang L, Fang Z, Zhou S. Paradoxical embolism causing acute embolic events in a patient with hereditary thrombophilia. Herz 2013; 40:314-7. [DOI: 10.1007/s00059-013-3994-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/19/2013] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
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25
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Ferreira AR, Freitas A, Magno P, Oliveira Soares A, Farto e Abreu P, Neves JP, Gil VM. Acute coronary syndrome of paradoxical origin. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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26
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Ferreira AR, Freitas A, Magno P, Oliveira Soares A, Farto e Abreu P, Neves JP, Gil VM. Acute coronary syndrome of paradoxical origin. Rev Port Cardiol 2013; 32:817-21. [DOI: 10.1016/j.repc.2013.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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Management of the Stroke Patient with Patent Foramen Ovale: New Insights and Persistent Questions in the Wake of Recent Randomized Trials. Curr Atheroscler Rep 2013; 15:338. [DOI: 10.1007/s11883-013-0338-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Attenhofer Jost CH, Connolly HM, Scott CG, Burkhart HM, Ammash NM, Dearani JA. Increased risk of possible paradoxical embolic events in adults with ebstein anomaly and severe tricuspid regurgitation. CONGENIT HEART DIS 2013; 9:30-7. [PMID: 23601093 DOI: 10.1111/chd.12068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Determine incidence and risk factors for possible paradoxical embolic events in patients who have Ebstein anomaly with severe tricuspid regurgitation. DESIGN Retrospective study of clinical and imaging data. SETTING Tertiary care center. PATIENTS Patients undergoing clinical evaluation and echocardiography prior to cardiac surgery for Ebstein anomaly (1975-2010) performed at age ≥ 40 years. RESULTS Mean age of 128 patients (81 female) was 53 ± 9 years. All had severe tricuspid regurgitation. Twenty-four (19%) had previous cardiac surgery (at <40 years), including 17 for interatrial shunt closure. Most (112 [88%]) had New York Heart Association functional class III/IV heart failure; 84 (66%) had interatrial shunting (58 had an atrial septal defect and 29 had a patent foramen ovale [3 had both]). During their lifetime, 29 patients (23%) had a history of ≥1 possible paradoxical embolic events (stroke or transient ischemic attack, brain abscess, or myocardial infarction). The best predictors of preoperative possible paradoxical embolic events were an atrial septal defect (P = .002) and older age at surgery (P = .007). There was no association of possible paradoxical embolic events with cardiovascular risk factors (hypertension, dyslipidemia, smoking, or family history of coronary artery disease) (all P ≥ .3) or atrial fibrillation (P = .69). Median age at occurrence of paradoxical embolism was 49 (range, 1.5-74 years). CONCLUSIONS Possible paradoxical embolic events are common in adults with Ebstein anomaly and severe tricuspid regurgitation and are strongly associated with atrial septal defect. In patients with atrial septal defect or patent foramen ovale, shunt closure should be considered to reduce risk of possible paradoxical embolic events.
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29
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Piechowski-Jozwiak B, Bogousslavsky J. Stroke and Patent Foramen Ovale in Young Individuals. Eur Neurol 2013. [DOI: 10.1159/000342900] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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30
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Marriott K, Manins V, Forshaw A, Wright J, Pascoe R. Detection of right-to-left atrial communication using agitated saline contrast imaging: experience with 1162 patients and recommendations for echocardiography. J Am Soc Echocardiogr 2012; 26:96-102. [PMID: 23072711 DOI: 10.1016/j.echo.2012.09.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Right-to-left shunting via a patent foramen ovale (PFO) has a recognized association with embolic events in younger patients. The use of agitated saline contrast injection (ASCi) for detecting atrial shunting is well documented, but the optimal technique is not well described. The purpose of this study was to assess the efficacy and safety of transthoracic echocardiographic (TTE) ASCi for the assessment of right-to-left atrial communication in a large cohort of patients. METHODS A retrospective review was undertaken of 1,162 consecutive patients who underwent TTE ASCi, of whom 195 had also undergone clinically indicated transesophageal echocardiography. ASCi shunt results were compared with color flow imaging, and the role of provocative maneuvers (PM) was assessed. RESULTS Four hundred three TTE studies (35%) had paradoxical shunting seen during ASCi. Of these, 48% were positive with PM only. There was strong agreement between TTE ASCi and reported transesophageal echocardiographic findings (99% sensitivity, 85% specificity), with six false-positive and two false-negative results. In hindsight, the latter were likely due to suboptimal right atrial opacification and the former to transpulmonary shunting. TTE color flow imaging was found to be insensitive (22%) for the detection of a PFO compared with TTE ASCi. CONCLUSIONS TTE color flow imaging is too insensitive for PFO screening. TTE ASCi, however, is simple and highly accurate for the detection of right-to-left atrial communication, on the proviso that a dedicated protocol, including correctly implemented PM, is followed. It is recommended that TTE ASCi with PM be considered the primary diagnostic tool for the detection of PFO in clinical practice.
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Affiliation(s)
- Kate Marriott
- Hearts 1st, Greenslopes Private Hospital, Greenslopes, Australia.
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31
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Double-edged sword in the heart: trapped deep venous thrombus in a patent foramen ovale. Blood Coagul Fibrinolysis 2012; 23:673-5. [PMID: 22918040 DOI: 10.1097/mbc.0b013e328357b380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Trapped thrombus in a patent foramen ovale is a rare condition. Echocardiography is the main tool for diagnosis and for determination of the treatment to choose. There are a number of treatment options for trapped deep venous thrombus in a patent foramen ovale, including surgical thrombectomy, thrombolytics, and anticoagulant therapy. All patients should be evaluated individually, because the systemic and pulmonary thromboembolism risk of all treatment options is like a 'double-edged sword'. Here, we report a case of a patient with trapped thrombus in the patent foramen ovale detected by echocardiography, and successfully treated with surgical thrombectomy under extracorporeal circulation.
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32
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Kujime S, Hara H, Enomoto Y, Yoshikawa H, Itaya H, Noro M, Suzuki M, Nakamura M, Sugi K. A case of paradoxical embolic ST-segment elevation myocardial infarction triggered by sleep apnea. Intern Med 2012; 51:1851-5. [PMID: 22821099 DOI: 10.2169/internalmedicine.51.7069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This report describes an obese 39-year-old man who experienced ST-segment elevation myocardial infarction with total thrombotic occlusion of the right coronary artery. Culprit vessel flow was improved by aspiration. Data suggested that myocardial infarction had resulted from paradoxical embolus via a patent foramen ovale triggered by the Mueller maneuver, which had induced negative intrathoracic pressure following an acute increase of right-heart volume in the context of obesity and sleep-disordered breathing (SDB). Obesity is increasing among younger populations and it represents a risk for SDB and thrombosis. Thus, this mechanism should be included within the differential diagnosis for myocardial infarction in young patients.
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Affiliation(s)
- Shingo Kujime
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Japan.
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33
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Jamiel A, Alsaileek A, Ayoub K, Omran A. Paradoxical embolism in acute myocardial infarction in a patient with congenital heart disease. Heart Views 2012; 13. [PMID: 23181181 PMCID: PMC3503354 DOI: 10.4103/1995-705x.102156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a young male with severe pulmonary stenosis, hypoplastic right ventricle, and atrial septal defect. Acute embolic myocardial infarction, followed by cardiac arrest, occurred during hospitalization after Glenn operation. The therapeutic challenges are discussed. Insufficient anticoagulation therapy during the postoperative period was a possible contributing factor leading to embolic myocardial infarction.
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Affiliation(s)
- Abdelrahman Jamiel
- Cardiac Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, KSA,Address for correspondence: Abdelrahman Jamiel, Cardiac Sciences (code 1413), King Abdulaziz Medical City, National Guard Health Affairs Riyadh, 11426,KSA. E-mail:
| | - Ahmed Alsaileek
- Cardiac Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, KSA
| | - Kamal Ayoub
- Cardiac Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, KSA
| | - Ahmad Omran
- Cardiac Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, KSA
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34
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Fang ZF, Tang L, Zhou SH. Ischemic stroke caused by paradoxical embolism after an unsuccessful transcatheter atrial septal defect closure procedure: a word of caution. Pediatr Cardiol 2012; 33:366-9. [PMID: 22120514 PMCID: PMC3264878 DOI: 10.1007/s00246-011-0150-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 06/15/2011] [Indexed: 11/28/2022]
Abstract
Transcatheter device closure of atrial septal defect (ASD) has become a well-accepted alternative to surgical repair. Serious complications of transcatheter ASD closure are rare, but when they occur, devastating consequences may result. Herein, we present the case of a 4-year-old girl who had an ischemic stroke caused by a presumptive paradoxical embolism after an unsuccessful transcatheter ASD procedure and in whom subsequent venous color Doppler showed deep venous thrombosis (DVT) of the right lower extremity. The risk factors that predisposed to paradoxical cerebral embolism and DVT in this patient are discussed, and the literature is reviewed.
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Affiliation(s)
- Zhen-fei Fang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011 China
| | - Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011 China
| | - Sheng-hua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011 China
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35
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Abstract
Sclerotherapy has been associated with 13 published cases of stroke since 1994. Four earlier reports implicated liquid sclerosants while nine recent cases have followed foam sclerotherapy. This adverse event represents a very rare complication of a very popular procedure. Ten of the 13 reported patients recovered completely with no long-term sequelae. A right-to-left shunt and in particular a patent foramen ovale (PFO) was the most consistent risk factor. Paradoxical gas emboli were observed in the brain-supplying or the intra-cranial arteries of five patients with an immediate onset of stroke after foam sclerotherapy. Paradoxical clot embolism was suspected in three patients with a delayed onset of stroke and concurrent venous thrombosis. In the remaining five cases, which included two cases with an immediate onset after liquid sclerotherapy, no specific cause was identified. Patients with a past history of cryptogenic stroke or a long life history of recurrent classic migraine attacks (with aura) have a higher risk of neurological adverse events and may benefit from preoperative screening and percutaneous closure of PFO.
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Affiliation(s)
- K Parsi
- Phlebology Research Laboratory, Sydney Skin and Vein Clinic; University of New South Wales, Sydney, Australia
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36
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Erharhaghen J, Bartz M, Di Giovanni S, Melms A, Haarmeier T, Sieverding L. An unusual location of deep venous thrombosis associated with ischemic stroke and persistent foramen ovale. Case Rep Neurol 2011; 3:160-4. [PMID: 21829401 PMCID: PMC3150870 DOI: 10.1159/000330376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Up to 40% of ischemic strokes have no known cause (cryptogenic). The prevalence of persistent foramen ovale (PFO) amongst patients with cryptogenic stroke (CS) is twice as high as that of the normal population, therefore suggesting a causal relationship between the two entities. However, PFO by itself is not sufficient to cause stroke, as an embolic source is needed. This source is often unknown, making the causal relationship between CS and PFO hard to demonstrate. The most frequent, although still seldom, identifiable cause of embolism in an otherwise cryptogenic stroke associated with PFO is a deep venous thrombosis (DVT) of the lower extremities. Here, we present a unique case of brachiocephalic venous DVT associated with PFO and ischemic stroke in a young patient. As the search for DVT in patients with PFO and stroke is often limited to the lower extremities, this case may suggest that an unspecified number of DVTs are overlooked. Our report lends support to paradoxical embolism as a mechanism of stroke in patients with PFO and does, at least in selected cases, suggest a more detailed search for DVT beyond the lower extremities.
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Affiliation(s)
- J Erharhaghen
- Department of Neurology, University of Tuebingen, Tuebingen, Germany
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37
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Vyas A, Singh A, Vyas P, Kranis M, Pacifico L, Bojar R. A rare case of simultaneous pulmonary and paradoxical emboli with a thrombus straddling a patent foramen ovale. J Cardiol Cases 2011; 4:e47-e49. [PMID: 30532868 DOI: 10.1016/j.jccase.2011.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 05/15/2011] [Accepted: 05/23/2011] [Indexed: 11/28/2022] Open
Abstract
Background Paradoxical embolism is a rare event and the exact contribution of patent foramen ovale in stroke is unclear. Intracardiac thrombi or 'embolus-in-transit' are associated with high mortality. Acutely elevated pulmonary arterial pressure due to pulmonary embolism or Valsalva maneuver make foramen ovale patent and promote right to left migration of intraatrial clot. A large thrombus trapped during its passage produces impending paradoxical embolism, which though proposed, is documented very rarely in live patients. This is a high-risk situation. Surgical embolectomy, like our case, has shown to have better outcomes in overall patient survival. Case A 66-year-old female with acute left main cerebral artery infarct and acute bilateral pulmonary embolism. In initial assessment, lower extremities venous Doppler study revealed left leg deep venous thrombosis and transthoracic echocardiogram showed a long biatrial clot straddling through patent foramen ovale and a right-to-left interatrial shunt. After heparinization and inferior vena caval filter placement, she underwent successful surgical embolectomy along with closure of patent foramen ovale with subsequent uneventful recovery. Conclusion 'Embolus in transit' is a high-risk situation and should be actively searched for in patients of pulmonary embolism and stroke. We recommend surgical embolectomy over other treatment modalities in such situations.
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Affiliation(s)
- Ashish Vyas
- Department of Neurology, NYU Hospitals, New York, NY, USA
| | - Aniruddha Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Priyanka Vyas
- Department of Internal Medicine, Reading Hospital, Reading, PA, USA
| | - Mark Kranis
- Department of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Luigi Pacifico
- Department of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Robert Bojar
- Department of Cardiothoracic surgery, Saint Vincent Hospital, Worcester, MA, USA
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Ménager C, Bui HT, Rubin S, Nazeyrollas P, Metz D. [Coronary embolism due to an adherent right atrium thrombus through a patent foramen ovale]. Ann Cardiol Angeiol (Paris) 2011; 62:438-41. [PMID: 21664600 DOI: 10.1016/j.ancard.2011.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 05/01/2011] [Indexed: 11/18/2022]
Abstract
This observation relates to the discovery of native coronary paradoxical embolism secondary to thrombus adherent to the right atrium through a patent foramen ovale (PFO). A patient of 64 years, with a history of mitral regurgitation not followed, was hospitalized for acute respiratory distress due to a mitral insufficiency (MI) with a ruptured chordae and pulmonary embolism. Coronary angiography was performed and revealed two typical images of coronary embolism associated to a non-atheromatous coronary tree. The patient underwent a mitral valve replacement. After the establishment of cardiopulmonary bypass, adherent fibrin and cruoric thrombus of the right atrium and a PFO were found. The analysis of the valves did not reveal any arguments for infective endocarditis. A CT scan, performed as the patient remained unconscious after surgery, showed several cerebral infarcts. Paradoxical embolism coronary was diagnosed in front of the combination of adherent thrombus in the right atrium, pulmonary embolism and systemic coronary and cerebral embolism with a PFO. Coronary embolism rarely happens. It is mainly due to three causes: iatrogenic origin in most cases, direct causes due to micro emboli, particularly from infectious endocarditis and paradoxical embolic origin. There are two types of right atrial thrombus; the most common is the mobile thrombus from the peripheral venous system. The other one, which is more rare, is the adherent thrombus, which occurs in situ. Coronary embolism of paradoxical origin represents a small proportion of the causes of coronary embolism. However, this diagnosis must be considered.
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Affiliation(s)
- C Ménager
- Service de cardiologie, CHU Robert-Debré, rue du Général-Koenig, 51090 Reims cedex, France.
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Paradoxical embolism into coronary arteries - unusual cause of acute myocardial infarction. COR ET VASA 2011. [DOI: 10.33678/cor.2011.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Dalen JE, Stein PD, Matta F. Patent foramen ovales and cryptogenic strokes: another look. Am J Med 2011; 124:2-3. [PMID: 20961523 DOI: 10.1016/j.amjmed.2010.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 07/26/2010] [Indexed: 10/18/2022]
Affiliation(s)
- James E Dalen
- College of Medicine, University of Arizona, Tucson, USA
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41
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Ali Ebrahimi H, Hamzeaie Moghadam A, Aredestani E. Evaluation of patent foramen ovale in young adults with cryptogenic stroke. ARYA ATHEROSCLEROSIS 2011; 7:74-7. [PMID: 22577450 PMCID: PMC3347844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 07/25/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stroke is a leading cause of death and long-term disability worldwide. Although a minority of ischemic strokes in the community affect younger adults, up to 40% of acute ischemic strokes in young adults are cryptogenic in nature, that is, no cause is determined. Underlying pathologies of stroke of unknown cause are multiple, including patent foramen ovale (PFO). The PFO is the most common defect of atrial septum of the heart. This study evaluated the frequency of PFO in brain stroke with unknown etiology in patients younger than 50 years of age in Kerman. METHODS This cross-sectional study was done in Shafa Medical Center of Kerman University of Medical Sciences in 2008. For detection of the PFO, we used agitated saline test with transcranial Doppler sonography in brain stroke patients with unknown etiology and also a control group (normal persons). RESULTS PFO was found in 53% of patients. No significant difference was observed between sexes. The rate in the control group was 20%. Patients with large PFO had 2 or more attacks of stroke. Subjects in the control group did not have large PFO. CONCLUSION One of the most important underlying causes in young adults with cryptogenic stroke is PFO. It is better to prescribe antiplatelet drugs in patients with the first attack of stroke, but as for patients with recurrent stroke, closure of PFO must be considered.
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Affiliation(s)
- Hossein Ali Ebrahimi
- MD, Professor, Kerman Neurosciences Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Akbar Hamzeaie Moghadam
- MD, Professor, Kerman Neurosciences Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Esmaeel Aredestani
- MD, Neurologist, Kerman Neurosciences Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Goslar T, Podbregar M. Acute ECG ST-segment elevation mimicking myocardial infarction in a patient with pulmonary embolism. Cardiovasc Ultrasound 2010; 8:50. [PMID: 21106090 PMCID: PMC3002912 DOI: 10.1186/1476-7120-8-50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 11/24/2010] [Indexed: 11/30/2022] Open
Abstract
Pulmonary embolism is a common cardiovascular emergency, but it is still often misdiagnosed due to its unspecific clinical symptoms. Elevated troponin concentrations are associated with greater morbidity and mortality in patients with pulmonary embolism. Right ventricular ischemia due to increased right ventricular afterload is believed to be underlying mechanism of elevated troponin values in acute pulmonary embolism, but a paradoxical coronary artery embolism through opened intra-artrial communication is another possible explanation as shown in our case report.
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Affiliation(s)
- Tomaž Goslar
- Clinical Department for Internal Intensive Care, University Medical Center Ljubljana, Slovenia
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Miller S, Causey MW, Schachter D, Andersen CA, Singh N. A case of limb ischemia secondary to paradoxical embolism. Vasc Endovascular Surg 2010; 44:604-8. [PMID: 20675331 DOI: 10.1177/1538574410374656] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Paradoxical embolism is rarely considered a cause for acute limb ischemia. Although patent foramen ovales (PFOs) are often seen in young patients with stroke, clinicians may not consider evaluation for PFOs in young patients with acute peripheral ischemia. We present a 47-year-old patient presenting with lower extremity ischemia secondary to paradoxical embolism. This case highlights the importance of evaluating for paradoxical embolism in otherwise-unexplained cases of acute limb ischemia.
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Affiliation(s)
- Seth Miller
- Department of General Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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44
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Agarwal SK, Binbrek AS, Thompson JA, Siddiqui SAP. Massive pulmonary embolism and acute limb ischaemia in a patient of hereditary spherocytosis and patent foramen ovale. Heart Lung Circ 2010; 19:742-4. [PMID: 20619736 DOI: 10.1016/j.hlc.2010.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 01/09/2010] [Accepted: 05/20/2010] [Indexed: 11/19/2022]
Abstract
Paradoxical embolism accounts for 2% of patients who present with acute arterial embolism of extremities. We report a case of a 41 year-old male with hereditary spherocytosis who presented to the emergency department with acute limb ischaemia and pulmonary embolism. On further evaluation, he was found to have patent foramen ovale (PFO) and deep vein thrombosis (DVT), leading to paradoxical embolism. The purpose of this report is to emphasise that in a patient presenting with acute limb ischaemia without an obvious systemic arterial embolic source, an evaluation for a right-to-left shunting lesion, especially PFO, should be performed.
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Affiliation(s)
- S K Agarwal
- Rashid Hospital, PO Box 4545, Dubai, United Arab Emirates.
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45
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Patel RV, Stygall J, Harrington J, Newman SP, Haddad FS. Cerebral microembolization during primary total hip arthroplasty and neuropsychologic outcome: a pilot study. Clin Orthop Relat Res 2010; 468:1621-9. [PMID: 19838644 PMCID: PMC2865620 DOI: 10.1007/s11999-009-1140-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 10/02/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intraoperative cerebral microembolization occurs in a substantial proportion of patients undergoing THA. Historically, postoperative cognitive dysfunction has been attributed to different factors, including anesthesia, but the influence of the surgery has not been thoroughly examined. QUESTIONS/PURPOSES We conducted a prospective, controlled clinical trial to assess intraoperative cerebral microembolization during THA and neuropsychologic outcome. METHODS The presence of a patent foramen ovale (PFO) also was investigated, using transcranial Doppler, to determine whether this affected cerebral microembolic incidence and load and whether microemboli occurred as a result of specific surgical activity. Forty-five patients were recruited who underwent THA and neuropsychologic assessment; a battery of tests was administered preoperatively and at 6 weeks and 6 months postoperatively. RESULTS Overall, patients showed improvement in total neuropsychologic change scores at both postoperative intervals. The incidence of cerebral microembolization for THA was 23%. The prevalence of PFO was 37%. PFO did not appear to influence microemboli load or incidence. More microemboli were seen during femoral component insertion and impaction. CONCLUSIONS Intraoperative cerebral microembolization occurs in a substantial proportion of patients during THA recorded by transcranial Doppler. The microemboli load is low and is not influenced by the presence of PFO. Certain surgical activities seem responsible for greater cerebral microemboli generation. However, neuropsychologic outcome was not affected postoperatively by microemboli or other operative or patient variables.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/psychology
- Cognition Disorders/diagnosis
- Cognition Disorders/epidemiology
- Cognition Disorders/etiology
- Female
- Foramen Ovale, Patent/complications
- Foramen Ovale, Patent/diagnostic imaging
- Foramen Ovale, Patent/epidemiology
- Humans
- Incidence
- Intracranial Embolism/diagnostic imaging
- Intracranial Embolism/epidemiology
- Intracranial Embolism/etiology
- Male
- Middle Aged
- Neuropsychological Tests
- Osteoarthritis, Hip/surgery
- Pilot Projects
- Prevalence
- Prospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
- Ultrasonography, Doppler, Transcranial
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Affiliation(s)
- Rahul V Patel
- Department of Trauma & Orthopaedics, University College London Hospitals Trust, Flat 3, 39 Priory Terrace, NW6 4DG London, UK.
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Thrombus Entrapped in a Patent Foramen Ovale: A Potential Source of Pulmonary and Systemic Embolism. Heart Lung Circ 2010; 19:58-60. [DOI: 10.1016/j.hlc.2008.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 10/08/2008] [Accepted: 12/11/2008] [Indexed: 11/23/2022]
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47
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Murthy A, Shea M, Karnati PK, El-Hajjar M. A rare case of paradoxical embolism causing myocardial infarction: Successfully aborted by aspiration alone. J Cardiol 2009; 54:503-6. [DOI: 10.1016/j.jjcc.2009.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 02/13/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
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Multiorgan paradoxical embolism consequent to acute pulmonary thromboembolism with patent foramen ovale: a case report. CASES JOURNAL 2009; 2:8358. [PMID: 19918422 PMCID: PMC2769432 DOI: 10.4076/1757-1626-2-8358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 08/17/2009] [Indexed: 11/08/2022]
Abstract
Paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt. It is a relatively rare phenomenon, representing about 2% of all cases of arterial embolism. We report a case of a 79-years-old woman admitted to hospital because of dyspnea and lower left limb pain. CT scan revealed multiple thrombi to kidney, lower limb and superior mesenteric artery during acute pulmonary embolism. Echocardiogram documented a patent foramen ovale with a right-to-left shunt. The patient was treated with thrombolytic therapy and heparin with progressive improvement of symptoms and resolution of pulmonary embolism and peripheral thrombosis. Patent foramen ovale closure was not performed because a life-long anticoagulation therapy was necessary, a tunnel-type patent foramen ovale may increases difficulty in realizing device implantation and there are no clear evidence-based guidelines to date addressing treatment in presence of a patent foramen ovale.
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English J, Smith W. Cardio-embolic stroke. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:719-749. [PMID: 18804677 DOI: 10.1016/s0072-9752(08)93036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Joey English
- Department of Neurology, University of California, San Francisco, CA 94143, USA
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50
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Kaladji A, Gérard F, Audinet C, Cardon A. Embolie paradoxale et ischémie digestive. ACTA ACUST UNITED AC 2008; 33:247-9. [DOI: 10.1016/j.jmv.2008.07.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 07/02/2008] [Indexed: 11/16/2022]
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