title: Paradoxical embolization in TIPS: take a closer look to the heart.
abstract: No definitive indications are provided in the literature for pre-TIPS patient workup, which is often limited to prevent the incidence of refractory hepatic encephalopathy or unacceptable deterioration of liver function. Concerning cardiologic workup, efforts are generally limited at excluding ventricular failure or porto pulmonary hypertension. The cases presented herein focus the attention of the readers on the possible occurrence of post-TIPS paradoxical embolization in the presence of a patent foramen ovale, frequently recognized in adult population. In conclusion, although this complication has been already reported in literature, in the present manuscript we concentrate on possible additional risk factors which may allow to identify a subset of patients with a higher likelihood to experience paradoxical embolization following TIPS. Another important line of information presented herein is the feasibility of percutaneous closure of a patent foramen ovale before TIPS deployment in the presence of portal vein thrombosis and possibly with additional risk factors.
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vizzutti
authors.affiliation: Department of Radiology Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rega
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Arena
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Roberto Giulio
authors.initials: RG
authors.lastname: Romanelli
authors.affiliation: Heart and Vessels Department. Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meucci
authors.affiliation: Heart and Vessels Department. Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Barletta
authors.affiliation: Department of Internal Medicine, University of Modena and Reggio, Modena, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Schepis
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Aris
authors.initials: A
authors.lastname: Tsalouchos
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Laffi
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Marra
mesh_terms: D000368:Aged; D019320:Embolism, Paradoxical; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D054092:Foramen Ovale, Patent; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications