Cor Vasa 2019, 61(1):85-89 | DOI: 10.1016/j.crvasa.2018.02.004

Rare cause of recurrent systemic embolism in a middle-aged woman with undiagnosed lung A-V malformation

Blažej Rácz^a,b, Aleš Linhart^a, Jan Bělohlávek^a, Vladimír Mikulenka^c, Robert Šachl^d, Petr Vařejka^a

^a II. interní klinika kardiologie a angiologie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha

^b Interní oddělení, Nemocnice Slaný, Slaný

^c II. chirurgická klinika kardiovaskulární chirurgie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha

^d Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha, Česká republika

We report a case of the recurrent systemic embolism in a 48-year-old woman without previous medical history. Gradual clinical development revealed a combination of rare anatomical and pathological findings. The first manifestation of the disease in the patient was repeated systemic embolization in the left arm requiring repeated surgical embolectomy in a very short time sequence. In a parallel search for a possible source, clinically silent pulmonary embolism, patent foramen ovale and significant vascular A-V malformation in the left lung were diagnosed. In the subsequent period, there was an unexpected event of an acute massive myocardial infarction, again of embolization origin. The source of embolization in the left coronary artery was surprisingly discovered in the ascending aorta. The following text details the course of this patient's illness. The case also points out that despite the maximum and well-timed diagnostic and extensive therapeutic options of modern cardiology and interdisciplinary cooperation, there are still rare and surprising cases of patients with hypercoagulable conditions where the cause of morbidity cannot be fully explained. Despite the maximum effort and therapy, it is difficult to avert any further complications of such condition.

Keywords: Ascending aorta, A-V malformation, Cardiovascular surgery, ECMO, Limb ischemia, Pulmonary embolism, Systemic embolism, Thrombus

Published: March 21, 2019  Show citation