Caught in the Fence: Thrombus Trapped Within Patent Foramen Ovale-Hybrid Transcatheter and Surgical Embolectomy

Clot-in-transit (CIT) and pulmonary embolism (PE) can lead to hemodynamic collapse and death. Thrombolysis or thrombectomy is often required and has been shown to decrease mortality.

This patient presented with saddle PE with severe respiratory distress and obstructive shock and later found to have a large clot trapped within the patent foramen ovale (PFO). He inadvertently required a transcatheter thrombectomy of a large PE followed by surgical embolectomy of the CIT from the PFO discovered afterward.

There is no consensus for treatment of CIT; however, this case presents an additional unique challenge with CIT trapped within the PFO. Hemodynamic stability attained following thrombectomy of PE likely contributed to a successful surgical outcome for this patient.

CIT trapped within the PFO in combination with large PE and hemodynamic instability can potentially be treated with transcatheter therapy prior to surgical embolectomy to optimize surgical success.