Key result
Emergent pulmonary embolectomy and patent foramen ovale closure failed to prevent mortality, as the patient developed refractory cardiogenic shock and died 48 hours postoperatively.
Why the study?
Thrombus-in-transit across a patent foramen ovale is a rare, life-threatening condition requiring rapid recognition and multidisciplinary management.
Case Report (n=1)
No
This case highlights the critical importance of multimodality imaging, particularly echocardiography, in the rapid recognition of thrombus-in-transit across a patent foramen ovale to guide time-sensitive multidisciplinary management.
Refractory cardiogenic shock despite embolectomy and PFO closure signals high mortality risk; leaves open optimal timing and support strategies in thrombus-in-transit.
Thrombus-in-transit (TIT) across a patent foramen ovale (PFO) is a rare but life-threatening phenomenon that can result in paradoxical systemic embolism.Simultaneous deep venous thrombosis, pulmonary embolism (PE), and an intracardiac shunt create a critical scenario requiring rapid recognition.We report an 83-year-old woman with recurrent venous thromboembolism who presented with progressive dyspnea, pleuritic chest pain, and lower-extremity swelling.Laboratory evaluation revealed leukocytosis of 13.6 ×10⁹/L, thrombocytopenia of 67 ×10⁹/L, creatinine of 1.42 mg/dL, lactate of 2.57 mmol/L, and D-dimer of 32.53 µg/mL.Arterial blood gas analysis showed a pH of 7.47, pCO₂ of 23 mmHg, and pO₂ of 57.8 mmHg.CT pulmonary angiography demonstrated extensive bilateral pulmonary emboli with a left atrial filling defect, while echocardiography revealed a large mobile thrombus crossing a PFO with severe right ventricular dysfunction.The patient underwent emergent pulmonary embolectomy with PFO closure and left atrial appendage ligation but developed refractory cardiogenic shock and multiorgan failure despite venoarterial extracorporeal membrane oxygenation support and died 48 hours later.This case emphasizes the critical role of multimodality imaging in rapidly identifying TIT across a PFO and guiding time-sensitive multidisciplinary management.
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Ramalingam et al. (2026) conducted a case report in Thrombus-in-transit across a patent foramen ovale with massive pulmonary embolism (n=1). Emergent pulmonary embolectomy with PFO closure and left atrial appendage ligation was evaluated on Patient survival. Emergent pulmonary embolectomy and patent foramen ovale closure failed to prevent mortality, as the patient developed refractory cardiogenic shock and died 48 hours postoperatively.
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