Impending paradoxical embolism, patent foramen ovale and pregnancy. Case report

  • Carlos Eduardo Laverde-Sabogal a. Intensive Care Unit, Hospital Universitario San Ignacio, Bogotá, Colombia. b. Department of Internal Medicine, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
  • July Vianneth Torres-González Pulmonology Unit, Department of Internal Medicine, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
Keywords: Foramen Ovale; Patent; Embolism; Paradoxical; Pulmonary Embolism; Pregnant Women; Thrombosis

Abstract

Objectives:

A clinical case and an updated literature review on impending paradoxical embolism are discussed, describing their incidence, etiology, and pathophysiology.

Materials and methods:

Revised by the Service of Clinical Ethics of our hospital, this is a case of a 37-year-old woman with 27 weeks of gestation who consulted because of progressive apnea leading to functional class IV/IV; her ICU management and outcomes are discussed. The bibliography used were searched from PubMed, SciELO, and Bireme.

Results:

Impending paradoxical embolism is a rare condition and few cases have been reported in Ibero-America. The condition has a significant impact on a young and otherwise healthy population, with high morbidity and mortality for both the baby and the mother. An association with several cardiovascular and neurological conditions has been suggested.

Conclusions:

The association between patent foramen ovale and impending paradoxical embolism is rare. Its occurrence during pregnancy is even more insignificant. The existing treatment evidence to date is weak, apparently in favor of surgical management rather than thrombolysis and anticoagulation alone, further avoiding the recurrence of the disease.

References

1. Erkut B, Kocak H, Becit N, et al. Massive pulmonary embolism complicated by a patent foramen ovale with straddling thrombus: report of a case. Surg Today 2006;36:528-533.
2. Cruz-Gonzalez I, Solis J, Inglessis-Azuaje I, et al. Patent foramen ovale: current state of the art. Rev Esp Cardiol 2008;61:738-751.
3. Parunov LA, Soshitova NP, Ovanesov MV, et al. Epidemiology of venous thromboembolism (VTE) associated with pregnancy. Birth Defects Res C Embryo Today 2015;105:167-184.
4. Myers PO, Bounameaux H, Panos A, et al. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest 2010;137:164-170.
5. Myers PO, Fassa AA, Panos A, et al. Life-threatening pulmonary embolism associated with a thrombus straddling a patent foramen ovale: report of a case. J Card Surg 2008;23:376-378.
6. Mathew R, Roy WE. Paradoxical massive pulmonary embolism with a straddling thrombus across a patent foramen ovale. Intensive Care Med 2014;40:891-892.
7. Debonnaire P, Onsea K, Desmet W. Straddling thrombus through a patent foramen ovale secondary to saddle embolism. Acta Clin Belg 2011;66:243.
8. Jaramillo MH. Patent foramen ovale and cryptogenic stroke. Echocardiography role and state of the art. Rev Colomb Cardiol 2008;15:8.
9. Mayorga LE, Clavijo C. Imminent paradoxical embolism evidenced by echocardiography in patientswith patent foramen ovale. Rev Colomb Cardiol 2008;15:3.
10. Olivencia L, Soto JM, Martin de la Fuente P. Paradoxical embolism through permeable foramen ovale coincident with pulmonary embolism. Med Intensiva 2012;36:450-451.
11. Padilla Pérez AI, de la Torre Fernández de Vega J, Carballo Lorenzo J, Padrón Pérez E. Ischemic Stroke in secondary pospartum to paradoxical embolism. Rev Chil Ostet Ginecol 2010;75:4.
12. Miranda A, Franco S, Uribe W, Duque M, Femenía F, Baranchuk A. High-risk massive pulmonary thromboembolism associated with patent foramen ovale. Medicina 2012;72:2.
13. Reyes L, Muñoz L, CE, M. Pulmonary embolectomy and cardfiopul-monary bypass during pregnancy. Rev Colomb Anestesiol 2013; 41:4.
14. Offin MD, Menachem J, Squillante C, et al. Association among hypoxemia, patent foramen ovale, and mediastinal germ cell tumor: a case report. Ann Intern Med 2015;163:243-244.
15. Mintz R, Brody K. Impending paradoxical embolism: a case report. J Emerg Med 2013;45:19-21.
16. Nemoto A, Kudo M, Yamabe K, et al. Successful surgical treatment for a thrombus straddling a patent foramen ovale: a case report. J Cardiothorac Surg 2013;8:138.
17. Fauveau E, Cohen A, Bonnet N, et al. Surgical or medical treatment for thrombus straddling the patent foramen ovale: impending paradoxical embolism? 18. Report of four clinical cases and literature review. Arch Cardiovasc Dis 2008;101:637-644.
How to Cite
1.
Laverde-Sabogal CE, Torres-González JV. Impending paradoxical embolism, patent foramen ovale and pregnancy. Case report. Colomb. J. Anesthesiol. [Internet]. 2018 Jan. 1 [cited 2024 Apr. 20];46(1):79-83. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/333

Downloads

Download data is not yet available.
Published
2018-01-01
How to Cite
1.
Laverde-Sabogal CE, Torres-González JV. Impending paradoxical embolism, patent foramen ovale and pregnancy. Case report. Colomb. J. Anesthesiol. [Internet]. 2018 Jan. 1 [cited 2024 Apr. 20];46(1):79-83. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/333
Section
Case Report / Case Series

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code