What is the clinical evidence from this study?

Study design: Case Report. Population: Pulmonary embolism with intracardiac thrombus entrapped in a patent foramen ovale (n=1). Intervention: Surgical embolectomy with simultaneous PFO closure. Primary outcome: Clinical outcome and clot removal.

What does this research mean for the field?

Surgical embolectomy achieves successful clinical outcomes while minimizing systemic embolization risk in patients presenting with extensive pulmonary and intracardiac thrombus entrapped across a patent foramen ovale. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To outline clinical reasoning and decision-making for managing extensive pulmonary embolism accompanied by an intracardiac thrombus straddling a patent foramen ovale.

July 26, 2026CureusOpen Access

Entrapment of Pulmonary and Intracardiac Thrombus Through Patent Foramen Ovale: A Case Report

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Key result

Surgical embolectomy with simultaneous PFO closure successfully clears extensive cardiopulmonary thrombus.

Why the study?

To share the clinical reasoning and special considerations in choosing a surgical treatment pathway for managing extensive pulmonary and intracardiac thrombus extending through a patent foramen ovale.

Key Points

To outline clinical reasoning and decision-making for managing extensive pulmonary embolism accompanied by an intracardiac thrombus straddling a patent foramen ovale.
Clinical and diagnostic workup of a 29-year-old male presenting with chest pain, dyspnea, D-dimer >10 µg/mL, serial troponin elevations, and right ventricular strain.
Bedside and formal echocardiography performed to evaluate clot morphology prior to planned catheter-directed thrombectomy.
Intervention conversion to open surgical embolectomy, pulmonary arteriotomy with thrombectomy, and simultaneous closure of the patent foramen ovale.
Bedside echocardiography identified an extensive mobile thrombus straddling the patent foramen ovale and both atrioventricular valves, prompting cancellation of catheter-directed intervention due to systemic embolization risk.
Emergent surgical intervention successfully extracted the entire clot en bloc and closed the patent foramen ovale, preventing paradoxical embolism and cerebrovascular events.
Postoperative echocardiography at two days confirmed complete clot clearance with persistent right ventricular dysfunction, and the patient was discharged on Coumadin.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

1 29-year-old man with intermediate-high risk pulmonary embolism and an intracardiac thrombus entrapped in a patent foramen ovale.

Intervention

Emergent surgical pulmonary embolectomy with simultaneous closure of PFO, intracardiac embolectomy, and pulmonary arteriotomy with thrombectomy.

Outcome

Clinical outcome and clot removal

Surgical embolectomy is a viable and potentially life-saving intervention for patients with acute pulmonary embolism and clot-in-transit through a patent foramen ovale, avoiding the fragmentation risks of catheter-directed therapies.

Limitations

Single case report
Lack of research evidence and guidelines for this specific presentation
Rarity of occurrence and dearth of research evidence for this specific presentation

Implication

Supports surgical embolectomy with PFO closure in select PE with clot-in-transit; hypothesis-generating and requires validation in larger studies.

Abstract

We report a case of a 29-year-old man with no significant medical history presenting with pulmonary embolism (PE). The pulmonary thrombus was extensive and connected to the intracardiac thrombus, which further extended through the patent foramen ovale (PFO) over into the systemic side. We decided to pursue surgical embolectomy, resulting in an excellent outcome for our patient. Other approaches, such as systemic anticoagulation and catheter-directed interventions, were considered but not adopted given the risk of systemic embolization. A bedside echocardiogram before catheter-directed intervention timely guided us to pursue the surgical approach. In considering and discussing current evidence-based approaches, we share the clinical reasoning and special considerations in our approach and decision for choosing a surgical treatment pathway for the management of this patient.

Discussion

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Published by Cureus · CC BY

Cite This Study

Siddiqui et al. (2026) conducted a case report in Pulmonary embolism with intracardiac thrombus entrapped in a patent foramen ovale (n=1). Surgical embolectomy with simultaneous PFO closure was evaluated on Clinical outcome and clot removal. Surgical embolectomy with simultaneous PFO closure successfully removed an extensive pulmonary and intracardiac thrombus, preventing systemic embolization in a 29-year-old man.

synapsesocial.com/papers/6a65a6b5d3aea3239cd77ec5 https://doi.org/10.7759/cureus.113300

View Full Paper

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Implication

Supports surgical embolectomy with PFO closure in select PE with clot-in-transit; hypothesis-generating and requires validation in larger studies.

Entrapment of Pulmonary and Intracardiac Thrombus Through Patent Foramen Ovale: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Entrapment of Pulmonary and Intracardiac Thrombus Through Patent Foramen Ovale: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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