Complete Surgical Correction for Impending Paradoxical Embolism with Pulmonary Embolism, Tricuspid Regurgitation, and Atrial Flutter

Authors

  • Madhankumar Kuppuswamy
  • Antonios Kourliouros
  • George Sutherland
  • Mazin Sarsam

DOI:

https://doi.org/10.1532/HSF98.20081089

Abstract

Impending paradoxical embolism through a patent foramen ovale with concomitant pulmonary embolism is a rare entity that requires urgent treatment. We present the case of a 74-year-old woman with acute pulmonary embolism and atrial flutter and with echocardiographic features of impending paradoxical embolism through the patent foramen ovale and tricuspid regurgitation. We performed an open pulmonary embolectomy with removal of thrombus from both atria, closure of the patent foramen ovale, a right-sided modified Maze procedure, and De Vega's tricuspid annuloplasty. The patient made a satisfactory recovery. Surgical management is preferable in this setting because it provides the opportunity to correct any associated cardiac abnormalities.

References

Aboyans V, Lacroix P, Ostyn E, Cornu E, Laskar M. 1998. Diagnosis and management of entrapped embolus through a patent foramen ovale. Eur J Cardiothorac Surg 14:624-8.nChow BJ, Johnson CB, Turek M, Burwash IG. 2003. Impending paradoxical embolus: a case report and review of the literature. Can J Cardiol 19:1426-32.nde Belder MA, Tourikis L, Leech G, Camm AJ. 1992. Risk of patent foramen ovale for thromboembolic events in all age groups. Am J Cardiol 69:1316-20.nDecousus H, Leizorovicz A, Parent F, et al. 1998. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 338:409-15.nFarfel Z, Shechter M, Vered Z, Rath S, Goor D, Gafni J. 1987. Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli-in-transit with emphasis on management. Am Heart J 113:171-8.nFowkes FJ, Price JF, Fowkes FG. 2003. Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur J Vasc Endovasc Surg 25:1-5.nMeacham RR 3rd, Headley AS, Bronze MS, Lewis JB, Rester MM. 1998. Impending paradoxical embolism. Arch Intern Med 158:438-48.nOzgul U, Golbasi Z, Gulel O, Yildirim N. 2006. Paradoxical and pulmonary embolism due to a thrombus entrapped in a patent foramen ovale. Tex Heart Inst J 33:78-80.nTheologou T, Tewari P, Pointon K, Mitchell IM. 2007. Pulmonary thromboembolism with floating thrombus trapped in patent foramen ovale. Ann Thorac Surg 84:2104-6.n

Published

2008-12-15

How to Cite

Kuppuswamy, M., Kourliouros, A., Sutherland, G., & Sarsam, M. (2008). Complete Surgical Correction for Impending Paradoxical Embolism with Pulmonary Embolism, Tricuspid Regurgitation, and Atrial Flutter. The Heart Surgery Forum, 11(6), E378-E379. https://doi.org/10.1532/HSF98.20081089

Issue

Section

Article