Discontinuous-flow plasmapheresis and patent foramen ovale: a possible cause of paradoxical embolism.
A 68-year-old woman was admitted for a subacute polyradiculoneuropathy and submitted to PE. A central right jugular venous access was placed after the third PE procedure due to a failing peripheral blood access. During the fourth PE, performed with a discontinuous-flow system (continuous-flow used for 3 procedures), she developed multiple embolic ischemic lesions in the left middle cerebral artery (MCA) territory. A thorough cerebrovascular screening showed only a patent foramen ovale (PFO). In our case, a possible increase of the right atrium blood pressure induced by the positive flux of the discontinuous-flow PE could have been responsible for a paradoxical embolism through the PFO. Plasma exchange (PE) is used in several neurologic disorders. It is commonly thought to be a relatively safe procedure. However, a number of adverse events may occur: paradoxical embolism has not been reported to occur.
Vicenzini
Edoardo
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V Chair of Neurology, Department of Neurological Sciences, University of Rome La Sapienza, Viale dell' Universita 30, 00185 Rome, Italy. edoardo.vicenzini@uniroma1.it
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D000368:Aged; D001794:Blood Pressure; D002408:Catheters, Indwelling; D019320:Embolism, Paradoxical / Q000209:etiology*; D005260:Female; D006325:Heart Atria; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000628:therapy*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology*; D007601:Jugular Veins; D010951:Plasma Exchange / Q000009:adverse effects* / Q000379:methods; D011129:Polyradiculoneuropathy / Q000150:complications / Q000628:therapy