Paradoxical air embolism in patient with patent foramen ovale during liver transplant

Patent foramen ovale (PFO) has an approximate prevalence of 25% in the adult population, being normally an asymptomatic condition. During liver transplant (LT), a PFO can enable the passing of embolic material to systemic circulation and cause ischemic events. Prophylactic closing of a PFO is not currently indicated in patients who are to undergo LT. Close haemodynamic monitoring is recommended in this type of cases in order to diagnose a paradoxical embolism and give an adequate treatment if necessary. We present a case of a patient with a diagnosis of PFO who, during a LT, shows clinical findings compatible with a pulmonary and systemic embolism, requiring haemodynamic support and leaving a mild neurological sequelae at discharge.