Incidental finding of thrombus in patent foramen ovale in patient with major pulmonary embolism

Alarcón Pérez, L.; Novoa Lago, E.; Irabien Ortiz, Á.; Hortal Iglesias, J.

doi:10.1016/j.redare.2017.12.002

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The only other history of interest was obesity and recent 1-week admission for hyperthermia. Pulmonary embolism (PE) was suspected, so an angio-CT was performed. The findings confirmed the diagnosis of massive PE, and anticoagulation was initiated. In view of the patient's progressive worsening, transthoracic echocardiography was performed, which revealed as an incidental finding a large thrombus straddling a patent foramen ovale (PFO). Due to the high risk of paradoxical embolism, the patient was transferred to our hospital for urgent surgical embolectomy.Intraoperative transoesophageal echocardiography showed a thrombus that extended from the right (RA) to the left atrium (LA) passing through the PFO (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and entering both ventricles in diastole (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After opening the RA, a thrombus originating in the inferior vena cava and entering the LA through the PFO was removed. After closing the PFO by direct suture, the main pulmonary artery was opened and the thrombus entering both pulmonary arteries was removed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The patient made good progress, and there were no signs of thrombosis on CT and Doppler ultrasound, and no abnormal coagulation parameters were found in the thrombophilia study.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The presence of PFO in patients with PE is an indicator of poor prognosis. It is associated with an increase in early mortality and cardiovascular complications, due to the risk of developing a right-to-left shunt and the passage of embolic material through the PFO, causing paradoxical embolisms. This is why this entity must be treated immediately, preferably by surgical embolectomy." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Alarcón Pérez L, Novoa Lago E, Irabien Ortiz Á, Hortal Iglesias J. Hallazgo incidental de trombo en foramen oval permeable en un paciente con tromboembolismo pulmonar masivo. Rev Esp Anestesiol Reanim. 2018;65:122–123." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 838 "Ancho" => 975 "Tamanyo" => 72339 ] ] "descripcion" => array:1 [ "en" => "Mid oesophageal view showing interatrial septum and thrombus passing from the RA to the LA through the PFO." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 914 "Ancho" => 975 "Tamanyo" => 82605 ] ] "descripcion" => array:1 [ "en" => "Mid-oesophageal long axis view of the aortic valve showing the thrombus in the left ventricle." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1109 "Ancho" => 975 "Tamanyo" => 171255 ] ] "descripcion" => array:1 [ "en" => "Fragments of the thrombus surgically removed." ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000002/v1_201802090832/S2341192917302019/v1_201802090832/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000002/v1_201802090832/S2341192917302019/v1_201802090832/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917302019?idApp=UINPBA00004N"]

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Revista Española de Anestesiología y Reanimación (REDAR) -the Spanish Journal of Anesthesiology and Resuscitation- is the scientific body of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy. This is a monthly journal (10 issues) that publishes scientific articles of all areas within its specialty: clinical anesthesia, resuscitation-intensive medicine and critical care, diagnosis and treatment of acute and chronic pain, urgent care and emergencies and studies on basic science and related fields. The journal accepts work in both Spanish and English.

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Vol. 65. Issue 2.

Pages 122-123 (February 2018)

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