title: Impending paradoxical embolism across a patent foramen ovale: case report.
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.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville School of, Medicine, Louisville, Kentucky 40202, USA. mkavarana@att.net
authors.forename: Minoo N
authors.initials: MN
authors.lastname: Kavarana
authors.forename: Todd
authors.initials: T
authors.lastname: Boice
authors.forename: Laman A
authors.initials: LA
authors.lastname: Gray
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000601:surgery; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D018455:Protein S Deficiency / Q000150:complications; D011655:Pulmonary Embolism / Q000150:complications*; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin