TRIPLE JEOPARDY: DVT, PULMONARY EMBOLISM, AND STROKE IN A PATIENT WITH PATENT FORAMEN OVALE

TOPIC: Cardiothoracic Surgery TYPE: Fellow Case Reports INTRODUCTION: Patent foramen ovale (PFO) has been linked to serious conditions such as cryptogenic stroke.We herein describe a case of multiple PFO-related embolic events arising in single patient secondary venous clot straddling the PFO. CASE PRESENTATION: 65-year-old male with no past medical history presented sudden onset numbness originating left arm, which woke him up from sleep. His symptoms gradually progressed involve his upper extremity, forcing seek immediate attention. On arriving at Emergency Department, had resolved residual neurological deficits.Patient reported recent prolonged travel.His Vitals were Temperature 98F, Pulse 100/min, respiratory rate 20 breaths/min and blood pressure 132/85 mm Hg, Oxygen saturation 94% on 2L supplemental oxygen. physical examination was unremarkable.His EKG revealed normal sinus rhythm.Laboratory work including complete count, metabolic panel troponins within limits, except for markedly elevated D-dimer levels.Initial CT head showed acute abnormalities.On further workup, MRI Brain multifocal ischemic infarcts bilateral parietal lobes right cerebellar peduncle. A scan chest sub-segmental pulmonary embolism. lower extremity ultrasound deep thrombosis proximal veins thigh. The subsequently underwent trans-esophageal echocardiogram, demonstrated 6 cm inter-atrial thrombus projecting into atrium.Without delay, started anticoagulation while cardiac surgery consult obtained. After consultation team, intracardiac thrombectomy closure PFO using bovine patch.He ultimately discharged systemic oral anticoagulation. DISCUSSION: Venous thromboembolism (VTE) can occur conjunction stroke, PFO.Our unique occurrence clinically silent leading embolization provoked DVT prior cardiovascular or events. In patients presenting paradoxical embolism concomitant PFO, there should be very low threshold investigating DVT. While are clear-cut guidelines regarding clinical management these patients, multi-disciplinary approach surgical needs employed treat patients. Future prospective studies required characterize continuum appropriate each. CONCLUSIONS: Our illustrated rare but important sequale We emphasize use multidisciplinary cases REFERENCE #1: Windecker S, Stortecky Meier B. Paradoxical Embolism. Journal American College Cardiology. 2014;64(4):403-415. #2: Aggeli C, Verveniotis A, Andrikopoulou E, Vavuranakis Toutouzas K, Tousoulis D. Echocardiographic features PFOs embolism: complicated puzzle. International Cardiovascular Imaging. 2018;34(12):1849-1861. doi:10.1007/s10554-018-1406-1 #3: Zietz Sutter R, De Marchis GM. Deep Vein Thrombosis Pulmonary Embolism Among Patients With Cryptogenic Stroke Linked Foramen Ovale-A Review Literature. Frontiers neurology. 2020;11:336. doi:10.3389/fneur.2020.00336 DISCLOSURES: No relevant relationships by Moiz Ali, source=Web Response Hamna Shahbaz, Imran tarrar,