Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Cryptogenic Stroke Associated with Patent Foramen Ovale Coexisting with Pulmonary Embolisms, Deep Vein Thromboses, and Renal Artery Infarctions

  • Park, Moon-Sik (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Park, Jong-Pil (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Yun, So-Hee (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Lee, Jae-Un (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Kim, Joong-Keun (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Lee, Na-Eun (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Song, Ji-Eun (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Lee, Shin-Eun (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • John, Sung-Hee (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Lim, Ji-Hyun (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Rhew, Jay-Young (Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center)
  • Published : 2012.12.31
⟨ Previous Next ⟩

Abstract

A paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt, and is commonly related to patent foramen ovale (PFO). However, coexisting pulmonary embolisms, deep vein thromboses (DVT), and multipe systemic arterial embolisms, associated with PFO, are rare. Here, we report a patient who had a cryptogenic ischemic stroke, associated with PFO, which is complicated with a massive pulmonary thromboembolism, DVT, and renal infarctions, and subsequently, the patient was treated using a thrombolytic therapy.

Keywords

References

  1. Webster MW, Chancellor AM, Smith HJ, et al. Patent foramen ovale in young stroke patients. Lancet 1988;2:11-2.
  2. Lechat P, Mas JL, Lascault G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988;318:1148-52. https://doi.org/10.1056/NEJM198805053181802
  3. Oh BH, Park SW, Choi YJ, et al. Prevalence of the patent foramen ovale in young patients with ischemic cerebrovascular disease: transesophageal contrast echocardiographic study. Korean Circ J 1993;23:217-22.
  4. Clergeau MR, Hamon M, Morello R, Saloux E, Viader F, Hamon M. Silent cerebral infarcts in patients with pulmonary embolism and a patent foramen ovale: a prospective diffusion-weighted MRI study. Stroke 2009;40:3758-62. https://doi.org/10.1161/STROKEAHA.109.559898
  5. Pelletier M, Bugeaud R, Ibrahim R, Morency G, Kouz S. Successful thrombolysis of a stroke with a pulmonary embolism in a young woman. J Emerg Med 2010;39:443-8. https://doi.org/10.1016/j.jemermed.2009.02.033
  6. Cramer SC, Rordorf G, Maki JH, et al. Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) Study. Stroke 2004;35:46-50.
  7. Lim DS, Jeong ES, Jung JS, et al. A case of paradoxical renal embolism through patent foramen ovale. Korean J Nephrol 2011;30:667-70.
  8. Caretta G, Robba D, Bonadei I, et al. Multiorgan paradoxical embolism consequent to acute pulmonary thromboembolism with patent foramen ovale: a case report. Cases J 2009;2:8358. https://doi.org/10.4076/1757-1626-2-8358
  9. Kouskov OS, Nichols DJ, O'Hearn DJ. Paradoxical arterial embolism involving both upper extremities in a patient with pulmonary embolism and a patent foramen ovale. Clin Appl Thromb Hemost 2011;17:E98-101. https://doi.org/10.1177/1076029610387123
  10. Tanislav C, Puille M, Pabst W, et al. High frequency of silent pulmonary embolism in patients with cryptogenic stroke and patent foramen ovale. Stroke 2011;42:822-4. https://doi.org/10.1161/STROKEAHA.110.601575
  11. Thomas DV, Bynevelt M, Price R. Paradoxical embolization via a patent foramen ovale following acute pulmonary embolism. Australas Radiol 2005;49:501-4. https://doi.org/10.1111/j.1440-1673.2005.01480.x
  12. Augustinos P, Ouriel K. Invasive approaches to treatment of venous thromboembolism. Circulation 2004;110(9 Suppl 1):I27-34. https://doi.org/10.1161/01.CIR.0000140900.64198.f4
  13. Guo S, Roberts I, Missri J. Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report. J Med Case Reports 2007;1:104. https://doi.org/10.1186/1752-1947-1-104
  14. Dao CN, Tobis JM. PFO and paradoxical embolism producing events other than stroke. Catheter Cardiovasc Interv 2011;77:903-9. https://doi.org/10.1002/ccd.22884
  15. Konstantinides S, Geibel A, Kasper W, Olschewski M, Blumel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation 1998;97:1946-51. https://doi.org/10.1161/01.CIR.97.19.1946
  16. Khairy P, O'Donnell CP, Landzberg MJ. Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review. Ann Intern Med 2003;139:753-60. https://doi.org/10.7326/0003-4819-139-9-200311040-00010
  17. Windecker S, Wahl A, Nedeltchev K, et al. Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke. J Am Coll Cardiol 2004;44:750-8. https://doi.org/10.1016/j.jacc.2004.05.044

Cited by

  1. Clinical conundrum: concomitant high-risk pulmonary embolism and acute ischemic stroke vol.27, pp.4, 2012, https://doi.org/10.1007/s10140-020-01772-7