[Paradoxical embolisms after pulmonary embolism. 6 cases]

Among a series of 6 patients who had paradoxical emboli after pulmonary embolus, thrombus was encrusted in the foramen ovale in 2 while contrast echocardiography showed a free foramen ovale in the 4 others. Surgical embolectomy was performed in 1 of the patients with a thrombus in the foramen ovale. This patient died in the post-operative period and the second patient died suddenly before the indication for surgery had been established. The 4 other patients were treated medically with anticoagulant therapy. After a follow-up of 37, 33, 32 and 3 months respectively none of these patients has developed recurrent emboli. The association of a thromboembolic disease and a systemic ischaemic event should strongly suggest the diagnosis of paradoxical embolus. Echocardiography is required to determine whether the foramen ovale is free or harbours a thrombus.