title: Surgical treatment of impending paradoxical embolization associated with pulmonary embolism in a patient with heterozygosis of factor V Leiden.
abstract: We report an unusual case of impending paradoxical embolization in a 69-year-old woman heterozygote carrier of factor V Leiden mutation. The patient presented to the emergency room with the clinical scenario of massive pulmonary embolism. Serial echocardiographic examinations revealed a large thrombus in the right atrium floating via a patent foramen ovale into the left atrium. Anticoagulation therapy was started. After 72 h, due to the unresolved thrombus, the patient underwent surgical treatment consisting of complete excision of the thrombus, closure of the foramen ovale, and pulmonary embolectomy. No in-hospital complications were noted. At 1-year follow-up, the patient is doing well on long-term anticoagulation treatment free of thromboembolic events.
authors.affiliation: aU.O. UTIC-Cardiologia - Ospedale San Luca Vallo della Lucania, Vallo della Lucania bS.C. Cardiochirurgia, Dipartimento Medico-Chirurgico - Torre Cuore - Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno cPoliclinico San Donato - IRCSS - San Donato Milanese, San Donato Milanese, Milan, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.forename: Antonello
authors.initials: A
authors.lastname: Panza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bottiglieri
authors.forename: Rocco
authors.initials: R
authors.lastname: Leone
authors.forename: Gennaro
authors.initials: G
authors.lastname: Provenza
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gregorio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Benedetto
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D020016:Activated Protein C Resistance / Q000150:complications / Q000175:diagnosis / Q000235:genetics*; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D017128:Embolectomy; D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005165:Factor V / Q000235:genetics*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis; D006579:Heterozygote; D006801:Humans; D009154:Mutation; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017131:Thrombectomy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V