Surgical Embolectomy for a Clot-in-Transit Located in a Patent Foramen Ovale: A Case Report

Area of Science:

• Cardiology
• Pulmonary Medicine
• Vascular Surgery

Background:

• Pulmonary embolism (PE) is a critical manifestation of venous thromboembolism, where clots obstruct pulmonary arteries, potentially causing respiratory failure.
• Patent foramen ovale (PFO) is a common heart defect where an opening between atria persists post-birth, sometimes leading to paradoxical embolism.

Observation:

• A 30-year-old female presented with sudden dyspnea and hemodynamic instability.
• Transesophageal echocardiogram revealed a pulmonary embolism crossing a patent foramen ovale.
• The patient experienced significant decompensation upon anesthesia induction.

Findings:

• A pulmonary embolism in transit was identified at the interatrial septum via a PFO.
• Surgical pulmonary embolectomy and PFO closure were performed urgently.
• The case demonstrated a PE-in-transit causing hemodynamic collapse following positive pressure ventilation.

Implications:

• This case underscores the importance of recognizing concurrent PFO and PE.
• Surgical embolectomy proved beneficial in this complex, massive PE with paradoxical embolism.
• Early surgical intervention is critical for patients with massive PE and PFO presenting with hemodynamic compromise.