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An Unusual Case of Cannula Obstruction Resulting from Venous Thromboembolism

Jessica E Ozdirik, Peter W Grant, Chaitu Cheruvu

    The Journal of Extra-Corporeal Technology
    |September 12, 2015
    PubMed

    Insights

    Patent foramen ovale (PFO) is linked to strokes and paradoxical embolisms. Prompt diagnosis and treatment of impending paradoxical embolism (IPDE) are critical for patient survival.

    Area of Science:

    • Cardiology
    • Neurology
    • Vascular Surgery

    Background:

    • Patent foramen ovale (PFO) is a common atrial septal defect in 25% of adults, often associated with cryptogenic cerebral strokes.
    • Deep vein thrombosis (DVT) or pulmonary embolism (PE) can lead to paradoxical systemic embolization through a PFO, especially with increased pulmonary pressure.

    Observation:

    • Impending paradoxical embolism (IPDE) diagnosis requires detecting DVT/PE with a right-to-left shunt via abnormal circulatory communication.
    • A case presented superior vena cava cannula obstruction from a paradoxical embolus traversing a PFO during cardiopulmonary bypass (CPB).

    Findings:

    • Treatment options for IPDE include anticoagulation, antiplatelet agents, thrombolysis, and surgical or transcatheter closure of the PFO.
    • Pulmonary embolectomy with CPB and deep hypothermia is a primary treatment for IPDE, carrying a 5% surgical mortality risk.
    • Despite optimal management, IPDE has an 18% mortality rate, underscoring the need for prompt diagnosis and intervention.

    Implications:

    • Early detection and management of IPDE are crucial to prevent systemic thromboembolization and strokes.
    • Understanding PFO-related risks during surgical procedures, particularly those involving CPB, is vital for patient safety.
    • This case highlights the importance of recognizing and managing paradoxical emboli, even during established surgical interventions.

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