The role of thrombolytic therapy in the management of paradoxical embolism.
Paradoxical emboli are considered a rare event, representing less than 2% of all arterial emboli. The most common intracardiac defect associated with paradoxical emboli is a patent foramen ovale. Most commonly, a pulmonary embolism is the cause of the acute increase in right atrial pressure leading to a reversal of intracardiac flow and passage of venous embolic material to the left heart. We present a patient with a pulmonary embolism and paradoxical emboli, and discuss therapeutic approach. We suggest that the treatment of choice for the patient with pulmonary embolism and non-limb-threatening acute ischemia due to a paradoxical emboli should be thrombolytic therapy and intracaval filter placement, followed by patent foramen ovale repair.
d'Audiffret
A
A
Department of Surgery, SUNY at Buffalo, New York, USA.
Shenoy
S S
SS
Ricotta
J J
JJ
Dryjski
M
M
D000368:Aged; D000792:Angiography; D019320:Embolism, Paradoxical / Q000188:drug therapy*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007866:Leg / Q000098:blood supply; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D016306:Vena Cava Filters
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator