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Massive pulmonary embolism and paradoxical migration during surgical embolectomy: role of transesophageal echocardiogram.
MedLine Citation:
PMID:  20014172     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Patent foramen ovale (PFO) in the setting of venous thromboembolism is associated with paradoxical embolization. We describe a patient who presented with pulmonary embolism, underwent pulmonary embolectomy, and postoperatively developed paradoxical embolization to the lower extremity.A 27-year-old African American male presented to the hospital with shortness of breath and midsternal chest pain along with neck vein distention. A CT scan with contrast showed the presence of a saddle embolus in both pulmonary arteries. The next day, the patient developed right ventricular failure and hypotension. The patient was taken to the operating room for a pulmonary embolectomy. Postoperatively, the patient developed acute left lower extremity ischemia. The origin of the embolus was suspected to be cardiac. A transesophageal echocardiogram (TEE) revealed thrombus on the mitral valve and a PFO with right to left shunt. At this point vascular surgery for revascularization of the left lower extremity was performed. Two days later, the patient was taken for a repeat cardiac surgery and the left-sided thrombus was removed along with a closure of the PFO.This case signifies the importance of complete TEE and a search for PFO in patients with massive pulmonary embolism especially prior to surgical embolectomy because hemodynamic disturbances of pulmonary embolism and surgical embolectomy may cause migration of the thrombus from the right side to the left side of the heart.
Authors:
Haroon Chughtai; Jose Basora; Kamrul Khan; Jyoti Matta
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  33     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E20-2     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Wiley Periodicals, Inc.
Affiliation:
Jersey City Medical Center-Medicine, Jersey City, New Jersey, USA.
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