What is the clinical evidence from this study?

Study design: Case Report. Population: Massive pulmonary embolism with thrombus-in-transit straddling a patent foramen ovale (n=1). Intervention: Conservative management with anticoagulation. Primary outcome: Resolution of intracardiac thrombus and normalization of right ventricular function.

What question did this study set out to answer?

To describe the conservative management and resolution of an intracardiac thrombus-in-transit straddling a patent foramen ovale in a patient with acute massive pulmonary embolism.

September 15, 2026European Heart Journal Supplements

Massive Pulmonary Embolism With Thrombus–in–transit Straddling a Patent Foramen Ovale: A Conservative Management Strategy

Q: What does this research mean for the field?

In selected hemodynamically stable patients with acute pulmonary embolism and a thrombus-in-transit straddling a patent foramen ovale, conservative management with intensive anticoagulation can be an effective and safe therapeutic strategy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Intensive anticoagulation completely resolves intracardiac thrombus and normalizes RV function in a hemodynamically stable patient.

Why the study?

Massive pulmonary embolism complicated by an intracardiac thrombus straddling a patent foramen ovale is a rare, life-threatening condition linked to high risks of systemic embolization and mortality.

Population

A 68-year-old woman with massive pulmonary embolism and thrombus straddling a patent foramen ovale

Design

Case report

Authors

MMM MalasisiAULSS 2 Marca Trevigiana TST SciarrettaAULSS 2 Marca Trevigiana MPM PossamaiAULSS 2 Marca Trevigiana

Discussion

Member takes

Implication

Hypothesis-generating for conservative anticoagulation in massive PE with thrombus-in-transit; prospective trials needed before clinical adoption.

Key Points

To describe the conservative management and resolution of an intracardiac thrombus-in-transit straddling a patent foramen ovale in a patient with acute massive pulmonary embolism.
Clinical, diagnostic, and imaging assessment of a 68-year-old woman using computed tomography pulmonary angiography, transthoracic echocardiography, and transesophageal echocardiography.
Conservative therapeutic management consisting of initial unfractionated heparin, transition to low-molecular-weight heparin, and long-term vitamin K antagonist therapy alongside serial echocardiographic follow-up.
Transesophageal echocardiography revealed a large, mobile, polylobulated thrombus straddling the interatrial septum across a patent foramen ovale and protruding into both atria.
Intensive conservative anticoagulation therapy led to the complete resolution of the intracardiac thrombus and normalization of right ventricular function.
Etiologic workup confirmed the presence of Factor V Leiden thrombophilia in the absence of underlying occult malignancy.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 68-year-old woman with massive pulmonary embolism and an intracardiac thrombus straddling a patent foramen ovale managed conservatively.

Intervention

Conservative management with anticoagulation (unfractionated heparin, followed by low-molecular-weight heparin, and subsequently transitioned to vitamin K antagonist therapy).

Outcome

Resolution of intracardiac thrombus and normalization of right ventricular function on serial echocardiographic follow-up.surrogate

Intensive anticoagulation with close imaging follow-up may be an effective and safe therapeutic strategy for hemodynamically stable patients with massive pulmonary embolism and thrombus-in-transit through a PFO.

Cite This Study

Malasisi et al. (2026) conducted a case report in Massive pulmonary embolism with thrombus-in-transit straddling a patent foramen ovale (n=1). Conservative management with anticoagulation was evaluated on Resolution of intracardiac thrombus and normalization of right ventricular function. Conservative management with intensive anticoagulation led to complete resolution of the intracardiac thrombus and normalization of right ventricular function in a hemodynamically stable patient.

synapsesocial.com/papers/6aa9017deed42882c1fc1944 https://doi.org/10.1093/eurheartjsupp/suag058.385

Topics

Pulmonary embolism

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Implication

Hypothesis-generating for conservative anticoagulation in massive PE with thrombus-in-transit; prospective trials needed before clinical adoption.

Massive Pulmonary Embolism With Thrombus–in–transit Straddling a Patent Foramen Ovale: A Conservative Management Strategy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Massive Pulmonary Embolism With Thrombus–in–transit Straddling a Patent Foramen Ovale: A Conservative Management Strategy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

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