1/8. Endovascular treatment of multiple visceral artery paradoxical emboli with mechanical and pharmacological thrombolysis.PURPOSE: To report a case of paradoxical emboli to multiple visceral vessels treated with both mechanical (AngioJet device) and pharmacological (urokinase) thrombolysis. methods AND RESULTS: A 72-year-old man presented with a 48-hour history of symptomatic right renal ischemia, which was treated with heparinization. Five days later, an abrupt creatinine elevation prompted arteriography, which demonstrated thromboembolism of the superior mesenteric artery (SMA) and both renal arteries. The AngioJet aspiration device was employed to successfully remove the clot from the SMA; urokinase infusion restored flow to the left kidney. At the 16-month follow-up evaluation, the patient was normotensive without medication and had a stable creatinine (1.4 mg/dL). CONCLUSIONS: Because of its speed and minimal morbidity, the AngioJet device may be an attractive alternative to surgical embolectomy or pharmacological thrombolysis in highly selected cases of acute visceral artery thromboembolism.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/8. Percutaneous occlusion of patent foramen ovale in patients with paradoxical embolism.INTRODUCTION: A patent foramen ovale can be found in about one quarter of adults and in a small percentage it is a wide opening and may be associated with aneurysmal formation. The association between a wide patent foramen ovale and paradoxical embolism is well established. In such cases percutaneous closure is indicated, as an alternative to life-long anticoagulant therapy or surgery. Percutaneous closure is an attractive technique and is more advantageous than other methods. METHODOLOGY: We describe the first cases of percutaneous occlusion of patent foramen ovale performed in portugal, using the Amplatzer PFO occluder, in three female patients with documented cerebrovascular accidents due to paradoxical embolism. We also analyze the rationale for using this technique in such patients and its preliminary results. RESULTS: All three patients submitted to percutaneous occlusion of patent foramen ovale had a similar history of ischemic cerebrovascular accident. Transesophageal echocardiography showed a wide-open foramen ovale ranging from 9 to 12 mm, with spontaneous right-to-left shunt in all patients, and one of them also had an aneurysmal formation. Total procedure time ranged from 30 to 55 minutes and fluoroscopic time from 9 to 12 minutes. There were no complications and during the short follow up all patients are asymptomatic and free of recurrent events. CONCLUSIONS: Percutaneous closure of patent foramen ovale is a safe and promising technique in the prevention of recurrent systemic thromboembolism in appropriately selected patients. prospective studies comparing antithrombotic therapy or surgery with percutaneous closure should clarify its efficacy and therapeutic value.- - - - - - - - - - ranking = 0.5keywords = thromboembolism (Clic here for more details about this article) |
3/8. Acute neurological deficits in a young adult with cystic fibrosis.An abrupt onset of a neurological deficit is a rare occurrence in patients with cystic fibrosis (CF). As many CF patients have indwelling intravenous catheters, one of the complications may be deep venous thrombosis. Cerebral thromboembolism through an intracardiac shunt should be considered in CF patients who develop unexplained acute neurological deficits. We report on the case of a 19-year-old CF patient with insulin-dependent diabetes mellitus who was on oral contraceptives and had a Port-A-Cath(R) in place.The patient developed an acute neurological deficit after pulmonary function testing. Radiologic investigations of her head and neck were unremarkable, except for bilateral maxillary and ethmoid sinusitis. An electroencephalogram showed epileptiform discharges primarily from the right hemisphere. A transthoracic echocardiogram (TTE) revealed a small thrombus in the right atrium. A transesophageal echocardiogram (TEE) demonstrated a left-to-right shunt through a patent foramen ovale (PFO) that was not found by TTE. Extensive investigation to rule out congenital and acquired thrombophilia was negative. Treatment consisted of aspirin and discontinuation of oral contraceptives and vitamin k supplementation. Spontaneous complete recovery of the neurological deficits occurred within 24 hr after onset of symptoms.We conclude that paradoxical embolism should be in the differential diagnoses of CF patients who have indwelling intravenous catheters and who develop an unexplained stroke. An extensive investigation to rule out intracardiac abnormalities and thrombophilia should be considered. The risks and benefits of PFO closure vs. prophylactic anticoagulant and antiplatelet aggregation treatment in this group of patients should be carefully weighed.- - - - - - - - - - ranking = 0.5keywords = thromboembolism (Clic here for more details about this article) |
4/8. A case of pregnancy with a history of paradoxical brain embolism.brain embolisms in younger persons are rare but are often caused by a paradoxical embolism, the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. A 27-year-old pregnant woman presented with hemiplegia that had been treated with an antiplatelet agent since the occurrence of a paradoxical brain embolism via the pulmonary arteriovenous fistula. A tendency of hypercoagulation is generally observed during pregnancy, so a patient with this condition has a strong risk factor for venous thromboembolism during pregnancy and even more so for arterial thromboembolism under the intense strain of labor, which is much stronger than that of the valsalva maneuver. This case had been controlled well with an antiplatelet agent and an anticoagulant while the levels of coagulation and fibrinolytic factors were monitored and was followed by a successful pregnancy outcome.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
5/8. Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman.A 19 year old pregnant woman presented to the coronary care unit with an acute anterior myocardial infarction. She was treated with primary percutaneous transluminal coronary angioplasty of the proximal left anterior descending coronary artery. Ultrasound examination showed patent foramen ovale (PFO) and atrial septal aneurysm. The patient was a heterozygote carrier of factor v Leiden. Despite the lack of a clear clue, it was considered that the pathophysiological cause of this infarction was a paradoxical embolus in the left coronary artery. Pregnancy and factor v Leiden carriership are associated with increased risk of venous thromboembolism and the association between PFO and atrial septal aneurysm is a strong risk factor for systemic embolisation.- - - - - - - - - - ranking = 0.5keywords = thromboembolism (Clic here for more details about this article) |
6/8. Paradoxical peripheral embolism coincident with acute pulmonary thromboembolism.Paradoxical embolism may occur in patients with acute pulmonary thromboembolism, when patent foramen ovale (PFO) coexists with pulmonary hypertension (right-left shunt). There have been few case reports of paradoxical embolism in peripheral arteries coincident with acute pulmonary thromboembolism. Here, we describe a case of paradoxical peripheral embolism associated with PFO complicated by acute pulmonary thromboembolism. The patient had severe peripheral ischemia due to a massive thrombus and was treated successfully by peripheral thrombectomy, thrombolysis, implantation of a permanent inferior vena cava filter and anticoagulation.- - - - - - - - - - ranking = 3.5keywords = thromboembolism (Clic here for more details about this article) |
7/8. Paradoxical and pulmonary embolism due to a thrombus entrapped in a patent foramen ovale.A 70-year-old woman, with a history of recent thromboembolic stroke, was admitted to our hospital because of sudden dyspnea due to pulmonary thromboembolism. Transthoracic echocardiography revealed a tubular thrombus entrapped in a patent foramen ovale. Transesophageal echocardiography confirmed this finding and also revealed an atrial septal aneurysm. Because her cerebral status contraindicated surgical intervention, medical therapy with heparin and warfarin was started. Follow-up transthoracic echocardiography, performed 3 weeks after the initiation of therapy, revealed complete resolution of the thrombus. Medical therapy can be an alternative to surgical therapy in high-risk patients who have entrapped thrombi.- - - - - - - - - - ranking = 0.5keywords = thromboembolism (Clic here for more details about this article) |
8/8. Impending paradoxical embolism.The advent of echocardiography has led to the more frequent discovery of impending paradoxical embolism. Paradoxical embolism should be considered whenever there is an arterial embolism from an unidentified source in the presence of a concomitant venous thromboembolic phenomenon. patients with paradoxical embolism present with neurological abnormalities or features suggesting arterial embolism. Annually, paradoxical embolism may account for up to 47,000 strokes in the united states, and a patent foramen ovale has been reported in up to 35% of the normal population. Events that give rise to pulmonary hypertension may result in a right-to-left shunt through a patent foramen ovale allowing a venous thromboembolism access to the arterial circulation. Herein we report a case of impending paradoxical embolism and review the pertinent literature.- - - - - - - - - - ranking = 0.5keywords = thromboembolism (Clic here for more details about this article) |