Temporary IVC filtration before patent foramen ovale closure in a patient with paradoxic embolism.
Pulmonary embolism (PE) and associated acute peripheral ischemia suggest the diagnosis of paradoxic embolism. The most common intracardiac defect associated with paradoxic emboli is a patent foramen ovale (PFO). Therapeutic options include anticoagulation, thrombolysis, inferior vena cava (IVC) filtration, and closure of the intracardiac defect. The authors discuss the diagnosis and treatment of a young female athlete who presented with massive PE complicated by a paradoxic embolus to the right subclavian artery. Systemic and catheter-directed thrombolysis, IVC filtration, and percutaneous closure of a PFO were performed in an effort to return the patient to the level of competitiveness she desired.
Lewis-Carey
Mary Beth
MB
Department of Vascular and Interventional Radiology, Stanford University Medical Center, Room H3648, 300 Pasteur Drive, Stanford, California 94305-5642, USA. mbcarey@stanford.edu
Kee
Stephen T
ST
Feinstein
Jeffrey A
JA
D000293:Adolescent; D006328:Cardiac Catheterization / Q000295:instrumentation*; D019320:Embolism, Paradoxical / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D016306:Vena Cava Filters