Cor Vasa 2012, 54(9-10):e314-e322 | DOI: 10.1016/j.crvasa.2012.08.001

A case of pulmonary thromboembolism with synchronous and metachronous paradoxical embolism through the patent foramen ovale - a case report

Miloslav Pirkla,b,*, Andrej Myjavecc, Tomáš Daněka, Miloš Černýa
a Oddělení cévní chirurgie, Chirurgická klinika, Pardubická krajská nemocnice, a. s., Pardubice, Česká republika
b Fakulta zdravotnických studií Univerzity Pardubice, Pardubice, Česká republika
c Kardiologické oddělení, Interní klinika, Pardubická krajská nemocnice, a. s., Pardubice, Česká republika

Autoři ve svém sdělení prezentují raritní případ po sobě jdoucí a synchronní plicní embolie a paradoxních embolizací do velkého oběhu. Ačkoli paradoxní embolie jsou relativně vzácnou příčinou ischemie v jakékoliv lokalizaci, musí se na tuto nosologickou jednotku pomýšlet vždy, když je nejasný původ tromboembolie, zejména v těch případech, kde je v předchorobí známa plicní embolie nebo je sonograficky verifikována končetinová flebotrombóza. V akutní fázi léčby je základem chirurgické nebo endovaskulární zajištění reperfuze ischemického orgánu a v dalším čase pak zajištění prevence další embolizační příhody především okluzí patentního foramen ovale.

Keywords: Akutní mezenterická ischemie; Embolie bifurkace aorty paradoxní embolie; Otevřené foramen ovale

Received: May 8, 2012; Revised: July 30, 2012; Accepted: August 1, 2012; Published: September 1, 2012  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Pirkl M, Myjavec A, Daněk T, Černý M. A case of pulmonary thromboembolism with synchronous and metachronous paradoxical embolism through the patent foramen ovale - a case report. Cor Vasa. 2012;54(9-10):e314-322. doi: 10.1016/j.crvasa.2012.08.001.
Download citation

References

  1. S. Guo, I. Roberts, J. Missri, Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report, Journal of Medical Case Reports 1 (2007) 104-105. Go to original source... Go to PubMed...
  2. C.E. Tang, Paradoxical embolism: a rare life- and limb-threatening emergency, Canadian Journal of Emergency Medicine 6 (1) (2004) 40-44. Go to original source...
  3. B. Bentaarit, A.M. Duval, et al., Paradoxical embolism following thromboaspiration of an arteriovenous fistula thrombosis: a case report, Journal of Medical Case Reports 4 (2010) 345-347. Go to original source... Go to PubMed...
  4. J.M. Williamson, R.S. Dalton, J.F. Chester, Popliteal venous aneurysm causing pulmonary embolism and paradoxical embolisation in a patient with antiphospholipid syndrome, European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery 36 (2008) 227-229. Go to original source... Go to PubMed...
  5. B.A. Maron, P.S. Shekar, S.Z. Goldhaber, Paradoxical embolism, Circulation 122 (2010) 1968-1972. Go to original source... Go to PubMed...
  6. A. d'Audiffret, L. Pillai, M. Dryjski, Paradoxical emboli: the relationship between patent foramen ovale, deep vein thrombosis and ischaemic stroke, European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery 17 (1999) 468-471. Go to original source...
  7. P. Firt, J. Hejnal, I. Vaněk, Cévní chirurgie (Vascular Surgery), Nakladatelství Karolinum, Praha, 2006 54-59, 167-169.
  8. G.B. Zelenock, et al., Mastery of Vascular and Endovascular Surgery, Lippincott Williams & Wilkins, 2006 157-161, 293-301.
  9. G. Rigatelli, M. Giordan, et al, Incidence of extracerebral paradoxical embolisms in patients with intracardiac shunts. Cardiovascular Revascularization Medicine: including Molecular Interventions 8 (4) (2007) 248-250. Go to original source... Go to PubMed...
  10. M. Köcher, M. Černá, et al., Perzistující levostranná horní dutá žíla - možný zdroj paradoxní embolizace (Persistent left-sided upper vena cava - a potential source of paradoxical embolization), Česká radiologie 63 (2) (2009) 129-132.
  11. J. Popelová, Vrozené srdeční vady v dospělosti. Otevřené foramen ovale a paradoxní embolizace (Congenital heart disease in adulthood. Patent foramen ovale and paradoxical embolism), Grada Publishing, Praha, 2003 53-62.
  12. B.S. Rana, M.R. Thomas, et al., Echocardiographic evaluation of patent foramen prior to device closure, Journal of the American College of Cardiology: Cardiovascular Imaging, 3 (7) (2010) 749-760. Go to original source... Go to PubMed...
  13. J. Januška, Paradoxní embolizace - diagnostika a léčba patent foramen ovale (Paradoxical embolism - diagnosis and treatment of patent foramen ovale), Intervenční a akutní kardiologie 7 (1) (2008) 24-29.
  14. P.A. Calvert, B.S. Rana, et al., Patent foramen ovale: anatomy, outcomes, and closure, Nature Review, Cardiology 8 (3) (2011) 148-160. Go to original source... Go to PubMed...
  15. P.T. Hagen, D.G. Scholz, et al. Incidence and size of foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clinic Proceedings 59 (1984) 17-20. Go to original source... Go to PubMed...
  16. M.R. Di Tullio, Patent foramen ovale: echocardiographic detection and clinical relevance in stroke, Journal of American Society of Echocardiography 23 (2010) 144-155. Go to original source... Go to PubMed...
  17. I. Svobodová, J. Bělohlávek, et al. Indikace k uzávěru perzistujícího foramen ovale u nemocné s plicní hypertenzí a proběhlou paradoxní embolizací (Indications for closure of patent foramen ovale in patients with pulmonary hypertension and paradoxical embolism). Časopis lékařů českých 146 (4) (2007) 407-410. Go to PubMed...
  18. Y. Goueffic, T. Piffeteau, P. Patra, Acute Leriche syndrome due to paradoxical embolism, European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery 33 (2007) 220-222. Go to original source... Go to PubMed...
  19. L. Barclay, "Drive-by" PFO closure at Non-PFO cardiac surgery may up stroke risk.
  20. P. Kala, M. Poloczek, et al., Katetrizační uzávěr PFO a paradoxní systémová embolizace (Catether closure of PFO and paradoxical systemic embolism), Kardiologická revue 12 (2) (2010) 84-87.
  21. M. Reif, Foramen ovale patens v neurologii (Patent foramen ovale in neurology), Neurologie pro praxi 3 (2007) 175-178.
  22. N.R. Clarke, J. Timperley, et al., Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts, European Journal of Echocardiography: The Journal of the Working Group on Echocardiography of the European Society of Cardiology 5 (2004) 176-181. Go to original source... Go to PubMed...
  23. H.W. Schuchlenz, W. Weihs, et al., The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events, American Journal of Medicine 109 (6) (2000) 456-462. Go to original source... Go to PubMed...
  24. G. Giacalone, M.A. Abbas, et al. Prevention strategies for cardioembolic stroke: present and future perspectives, The Open Neurology Journal 4 (2010) 56-63. Go to original source...
  25. S. Wood, CLOSURE I: No Overall Benefit, No Reduction in Stroke or TIA With PFO Closure
  26. M. Hudec, J. Januška, et al., Sledování pacientů po uzávěru foramen ovale patens Amplatzovým okluderem (Monitoring patients after patent foramen ovale closure by Amplatzer occluder), Cor et Vasa 51 (3) (2009) 195-201. Go to original source...
  27. N.S.Shah. Patent foramen ovale. http://emedicine.medscape.com/article/156863-treatment
  28. TASC II
  29. S. Acosta, M. Bjark, Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population, European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery 267 (2003) 179-183. Go to original source... Go to PubMed...
  30. M.D. Morasch, W.H. Pearce, J.S.T. Yao, Surgery of the Aorta and Its Body Branches, People's Medical Publishing House, USA, 2010 553-570.
  31. M. Krajíček, J.H. Peregrin, M. Roček, P. Šebesta, Chirurgická a intervenční léčba cévních onemocnění (Surgical and interventional treatment ofvascular diseases), Grada Publishing, Praha, 2007 169-172, 273-277.
  32. J. Páral, Z. Šubrt, P. Lochman, et al., Peroperační diagnostika ischemie střeva za použití fluoresceinu a ultrafialového světla (Intraoperative diagnosis of intestinal ischemia using fluorescein and ultraviolet light), Rozhledy v chirurgii 88 (2009) 590-594. Go to PubMed...
  33. M.S. Edwards, G.S. Cherr, T.E. Graven, et al., Acute occlusive mesenteric ischemia: surgical management and outcomes, Annals of Vascular Surgery 17 (2003) 72-79. Go to original source... Go to PubMed...




Cor et Vasa

You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.