[Paradoxical embolisms after pulmonary embolism. 6 cases]

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Paradoxical emboli present a diagnostic challenge, particularly when associated with pulmonary embolism.
• Identifying the source and mechanism of emboli is critical for effective patient management.
• The foramen ovale is a potential pathway for paradoxical embolism.

Purpose of the Study:

• To investigate the role of foramen ovale thrombus in patients experiencing paradoxical emboli.
• To evaluate the outcomes of medical versus surgical management in these cases.
• To highlight the diagnostic utility of echocardiography in identifying foramen ovale abnormalities.

Main Methods:

• Case series of 6 patients with paradoxical emboli and pulmonary embolism.
• Contrast echocardiography to assess foramen ovale patency and intraluminal thrombus.
• Review of treatment strategies including surgical embolectomy and anticoagulant therapy.
• Follow-up assessment for recurrent embolic events.

Main Results:

• Two patients had thrombus encrusted in the foramen ovale; four had a patent foramen ovale.
• One patient with foramen ovale thrombus underwent surgical embolectomy and died post-operatively.
• Another patient with foramen ovale thrombus died suddenly before surgery.
• The remaining four patients treated with anticoagulation showed no recurrent emboli during follow-up (3-37 months).

Conclusions:

• The presence of thromboembolic disease and systemic ischemic events warrants strong consideration of paradoxical embolus.
• Echocardiography is essential for detecting thrombus within the foramen ovale.
• Medical management with anticoagulation appears effective in selected cases without foramen ovale thrombus.