92995_ActaCardio_64-6_14_09-3918
11-12-2009
Acta Cardiol 2009; 64(6): 803-804
11:49
Pagina 803
doi: 10.2143/AC.64.6.2044746
803
FOCUS A giant thromboembolus captive in a patent foramen ovale
Tomas HOLUBEC1, MD; Jan VOJACEK1, MD, PhD; Pavel FRANC2, MD 1Department
of Cardiac Surgery, Charles University Prague, Faculty of Medicine and University Hospital Hradec Kralove; 2Department of Internal Medicine, Chrudim Hospital, Chrudim, Czech Republic.
A 69-year-old man was admitted to our department presenting with an acute pulmonary thromboembolism and a snake-shaped embolus captive in the patent foramen ovale (PFO) extending from the right atrium through the left atrium into the mitral valve ostium and the left ventricle (fig. 1A, B). An emergency operation was indicated due to the morphology of the thromboembolus and the fact that its localization carried a high risk of both systemic and pulmonary embolism. Surgical extraction of the thromboembolus on cardio-pulmonary bypass followed (fig. 1C, D).
The postoperative course was complicated by serious right heart failure resulting from another massive pulmonary embolism. A pulmonary embolectomy (Trendelenburg operation) was performed but the patient died due to irreversible right heart failure. The autopsy confirmed the presence of a massive, fresh pulmonary embolism.
Conflict of interest: none declared.
Fig.∞∞1A. – Transoesophageal echocardiography (basal short-axis view) demonstrating the snake-shaped thromboembolus captive in the patent foramen ovale. The greater part of thromboembolus was found in the right atrium. RA = right atrium; LA = left atrium; Ao = aorta; IS = interatrial septum. Fig.∞∞1B. – Transoesophageal echocardiography (mid-oesophageal long-axis view) demonstrating the thromboembolus coming out of the left atrium through the mitral valve into the left ventricle. RV = right ventricle; LV = left ventricle; LA = left atrium; Ao = aorta; MV = mitral valve.
Address for correspondence: Jan Vojacek, MD, PhD, Department of Cardiac Surgery, Charles University Prague, Faculty of Medicine and University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic. E-mail:
[email protected] Received 8 September 2009; accepted for publication 22 September 2009.
92995_ActaCardio_64-6_14_09-3918
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11-12-2009
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Pagina 804
T. Holubec et al.
Fig.∞∞1C. – An intraoperative view of the opened right atrium showing the snake-shaped embolus coming out of the inferior vena cava into the patent foramen ovale. Fig.∞∞1D. – The extracted thromboembolus measured 17∞∞cm.
