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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Thrombus in Transit through Patent Foramen Ovale

Hassan Baydoun1, Iskander Barakat1, Elie Hatem2

  • 1Department of Medicine, Staten Island University Hospital, NY 10305, USA.

Case Reports in Cardiology
|May 15, 2014
PubMed

Insights

A rare thrombus passing through a patent foramen ovale (PFO) can cause paradoxical embolism. Surgery is often best for low-risk patients, while anticoagulation suits those with high surgical risk or small PFOs.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Paradoxical embolism via a patent foramen ovale (PFO) is rare.
  • Thrombi in transit are often identified post-mortem due to their transient nature.

Purpose of the Study:

  • To report a case of a thrombus straddling a PFO diagnosed via echocardiography and treated surgically.
  • To review existing literature on thrombi in transit through PFOs.

Main Methods:

  • Case report and comprehensive literature review.
  • Analysis of 88 previously reported cases.

Main Results:

  • Surgery demonstrated fewer recurrent embolic events compared to thrombolysis and anticoagulation.
  • Anticoagulant therapy is a viable alternative for high-risk surgical patients or those with small PFOs.
  • Thrombolysis was associated with the highest mortality rates.

Conclusions:

  • No definitive treatment consensus exists for thrombi in transit through PFOs.
  • Surgery is recommended for patients not at high surgical risk.
  • A treatment algorithm is proposed based on clinical scenarios, weighing surgery, anticoagulation, and thrombolysis.

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