The Heart Surgery Forum, Volume 8, Issue 1

Impending Paradoxical Embolism across a Patent Foramen Ovale: Case Report

Minoo N. Kavarana, MD, Todd Boice, Laman A. Gray, MD

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA

ABSTRACT

We describe a case of impending paradoxical embolism in a 43-year-old male patient with pulmonary embolism. Transesophageal echocardiography revealed a thromboembolus straddling a patent foramen ovale. The patient underwent emergency removal of the intracardiac clot with closure of the patent foramen ovale. A postoperative work-up for a hypercoagulable state revealed a protein-S deficiency and bilateral lower extremity deep vein thromboses. A Greenfield inferior vena cava filter was inserted, anticoagulation was performed, and warfarin treatment was continued after the patient was discharged home.

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