Paradoxical embolism in bilateral total knee arthroplasty: a case report.
Paradoxical embolism is defined as venous thrombosis causing systemic embolization through a right-to-left shunt. We, herein, report a case of bilateral total knee arthroplasty and developed paradoxical embolism caused by patent foramen ovale. A sixty-two-year-old female had a simultaneous, total knee arthroplasty for primary osteo-arthritis. A pulmonary emboli was suspected on the thirteenth post operative day. Two days later, acute arterial insufficiency at her leg was suspected. An embolectomy and intra-operative tranesophageal echocardiogram was performed. It showed patent foramen ovale (PFO) 2-3 mm. Five days after embolectomy, she developed infarction lesion at the right occipital area. The foramen ovale was closed with a closure device nineteen days later. The patient eventually could walk using a walker. She was discharged thirty-six days after the operation.
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Suksan
S
Tangsataphorn
Keerati
K
Chareancholvanich
D001157:Arterial Occlusive Diseases / Q000209:etiology; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D017128:Embolectomy; D019320:Embolism, Paradoxical / Q000209:etiology*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications; D006801:Humans; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D011150:Popliteal Artery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed