Impending paradoxical embolism.
نویسنده
چکیده
To the Editor: The echocardiogram on the cover of the June 1, 1999, issue of Circulation is a beautiful illustration of an impending paradoxical embolism. Unfortunately, neither the text1 nor the key words of the article made any mention of this condition. Impending paradoxical embolism2 is a surgical emergency. This diagnosis would not have been possible before the advent of echocardiography. However, to diagnose paradoxical embolism, contrast echocardiography should be performed during and after a Valsalva maneuver.3 The mere establishment of the presence of a patent foramen ovale by either transthoracic or transesophageal echocardiography does not diagnose paradoxical embolism.4 A patent foramen ovale is a frequent finding in normal subjects—27.3% in a large autopsy series.5 Normally, a positive left-to-right atrium pressure gradient exists and, therefore, no interatrial shunt exists in either direction. It is only during a Valsalva maneuver or any condition that raises right atrial pressure such as in acute pulmonary embolism that a right-to-left shunt across the patent foramen ovale may result. That is the reason why, when requesting an echocardiogram to “rule out cardiogenic origin of systemic embolism,” one should specifically mention paradoxical embolism, which would not be detected by routine echocardiography without the use of contrast and the Valsalva maneuver.3
منابع مشابه
Impending paradoxical embolism: a rare but important diagnosis.
A man aged 50 presented with a history of a cerebrovascular accident and arterial embolism at two discrete peripheral sites. Echocardiography showed thrombus trapped in an interatrial site and impending paradoxical embolism was diagnosed. Treatment with heparin was started and the potentially embolic intracardiac material was removed at open heart surgery. The patient was treated with warfarin ...
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Surgical or Medical Treatment for Impending Paradoxical Embolism — Report of 4 Clinical Cases and Literature Review
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The diagnosis of impending paradoxical embolus by echocardiography is exceptional and its management remains unclear. Through a personal case, we performed an exhaustive review of the medical literature of this rare finding. Since the first report, only 43 cases have ever been reported. The superiority of transesophageal echocardiography is underlined. The clinical features are complex. The cla...
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عنوان ژورنال:
- Archives of internal medicine
دوره 158 15 شماره
صفحات -
تاریخ انتشار 1995