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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Bi-atrial thrombus straddling a patent foramen ovale with bilateral embolization: A therapeutic challenge

Abhishek Dattani1,2, Kassem Safwan1, Mohammedimran Ansari1

  • 1Department of Cardiology, Glenfield Hospital, Leicester, UK.

Echocardiography (Mount Kisco, N.Y.)
|December 6, 2021
PubMed

Insights

A rare cardiac thrombus caused a stroke and pulmonary emboli in a 55-year-old male. This case highlights the need for multidisciplinary care in managing complex cardiovascular and neurological conditions.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Ischemic stroke is a major global health concern, with cardiac sources accounting for a significant proportion of cases.
  • Intra-cardiac thrombus formation can lead to embolic events, including stroke and pulmonary embolism.
  • Patent Foramen Ovale (PFO) is a potential pathway for paradoxical embolism.

Observation:

  • A 55-year-old male presented with acute ischemic stroke and bilateral pulmonary emboli.
  • Transesophageal echocardiography revealed an intra-cardiac thrombus straddling a patent foramen ovale.
  • The patient's clinical presentation posed a management dilemma due to the risk of hemorrhagic transformation.

Findings:

  • The intra-cardiac thrombus was identified as the source of both the ischemic stroke and pulmonary emboli.
  • Echocardiography proved crucial in visualizing the thrombus and its relationship with the PFO.
  • The case underscores the complexity of managing embolic events originating from cardiac sources.

Implications:

  • This case emphasizes the importance of a comprehensive diagnostic approach, including advanced imaging, in identifying the source of embolic strokes.
  • It highlights the challenges in managing patients with concurrent ischemic stroke and pulmonary embolism due to conflicting treatment risks.
  • The findings advocate for a multidisciplinary team approach involving cardiology, neurology, and other specialists to navigate complex clinical scenarios lacking clear treatment guidelines.

Keywords:
echocardiographystrokethrombus

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