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Updated: Aug 22, 2026

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Thrombus in Transit Through a Patent Foramen Ovale: A Clinical Conundrum
Catherine Jane Stewart1, Esme Dunne1, James Mark Jones2
1Department of Adult Congenital Heart Disease, Royal Victoria Hospital, Belfast, United Kingdom.
Background:
Thrombus in transit through a patent foramen ovale (PFO) is a rare clinical entity that can be associated with concurrent pulmonary embolization and lead to cryptogenic stroke.
Case Summary:
A 56-year-old patient presenting with shortness of breath and chest pain was diagnosed with large bilateral pulmonary emboli. Computed tomography demonstrated thrombus in the right atrium. Transthoracic echocardiogram demonstrated a large burden of thrombus in transit trapped in a PFO. After multidisciplinary discussion, emergency surgical thrombectomy and PFO closure were carried out successfully.
Discussion:
There are no current guidelines for management of a thrombus of this nature, but potential options include anticoagulation, thrombolysis, and mechanical or surgical thrombectomy. Previous case reviews have found that surgical embolectomy in low-moderate risk surgical patients resulted in fewer embolic events and a lower mortality rate. Compelling imaging of this phenomenon is presented.
Take-Home Messages:
Management decisions by a multidisciplinary team need to be on an individual case-to-case basis considering individual bleeding risk, surgical risk, and available expertise. Surgical thrombectomy with PFO closure has shown in a review of previous case studies to have an overall lower associated mortality and embolic risk.
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Pulmonary Embolism I: Introduction
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Hemorrhagic Stroke ll: Pathophysiology
