Paradoxical embolism following acute pulmonary embolism: diagnosis and outcome

We report on ten cases of paradoxical embolism that occurred following pulmonary embolism and emphasize the echocardiographic contribution. Two patients had a thrombus trapped in a foramen ovale. An embolectomy was performed on one of those patients and the outcome was post-operative death. The other patient died suddenly prior to planned surgery. The remaining eight had inter atrial communication or foramen ovale that were highly patent upon contrast echography. Two of them who presented cardiogenic shock died rapidly despite resuscitation measures. The remaining six patients were treated medically with anticoagulants and have experienced no recurrence of embolism after a mean follow up 34+/-31 months.