Key result
In a patient with high-risk pulmonary embolism, mechanical thromboaspiration was complicated by an embolus jailed in a patent foramen ovale, which was successfully managed with open cardiac surgery.
Case Report (n=1)
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Transesophageal echocardiography is crucial for identifying unexpected complications like a floating thrombus jailed in a PFO after mechanical thromboaspiration for high-risk pulmonary embolism, which may require surgical bail-out.
BACKGROUND: Venous thromboembolism represents the third most frequent acute cardiovascular syndrome worldwide. Its clinical manifestations are deep vein thrombosis and/or pulmonary embolism. Despite a considerable mortality, diagnosis is often missed. CASE PRESENTATION: We report the management of a female patient with high-risk pulmonary thromboembolism treated initially with thromboaspiration, complicated by embolus jailing in a patent foramen ovale. In this situation, left cardiac chambers and systemic circulation were jeopardized by this floating embolus. CONCLUSIONS: High-risk pulmonary embolism requires reperfusion strategy but sometimes mechanical thromboaspiration may be not fully successful; transesophageal echocardiography led to a prompt diagnosis of this unexpected finding; in this very particular case, open surgery represented a bail-out procedure to avoid cerebral and systemic embolism.
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Rizza et al. (2022) conducted a case report in High-risk pulmonary thromboembolism and patent foramen ovale (n=1). Percutaneous thromboaspiration and open cardiac surgery was evaluated. In a patient with high-risk pulmonary embolism, mechanical thromboaspiration was complicated by an embolus jailed in a patent foramen ovale, which was successfully managed with open cardiac surgery.
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