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[Cardiogenic shock due to acute mitral dysfunction after deep venous thrombosis]
1Medizinische Klinik III, Werner Forssmann Krankenhaus, Eberswalde. p.r.wacker@t-online.de
Der Internist
|May 19, 2004
Summary
Routine examination and closure of a patent foramen ovale during open surgical embolectomy for pulmonary embolism is not standard practice. This case highlights a potential risk of paradoxical embolism following initial treatment.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Open surgical embolectomy is a critical intervention for massive pulmonary embolism.
- The role of routine foramen ovale examination and closure during embolectomy remains unstudied.
- Existing literature lacks case reports addressing this specific surgical consideration.
Observation:
- A 74-year-old female with deep venous thrombosis developed a massive pulmonary embolism.
- Six days post-successful surgical embolectomy, she experienced cardiogenic shock due to a large thrombus traversing a patent foramen ovale.
- This thrombus extended from the right atrium to the left atrium and ventricle, indicating paradoxical embolism.
Findings:
- Immediate surgical embolectomy successfully removed a 40-50 cm cardiac thrombus.
- Post-cardiac mass removal, the patient presented with acute right leg ischemia.
- A second embolectomy removed a 10 cm thrombus from the right external iliac artery, with no evidence of concurrent pulmonary embolism.
Implications:
- This case suggests a potential complication of paradoxical embolism in patients with patent foramen ovale after pulmonary embolism surgery.
- It raises the question of whether routine foramen ovale assessment and potential closure should be considered during surgical embolectomy.
- Further investigation is warranted to determine the optimal management strategy for patent foramen ovale in this patient population.