Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale
Abstract Background A paradoxical embolism arises when a venous thrombus passes through a cardiac right to left shunt and enters the arterial circulation. This can manifest as cardiovascular ischemia, cerebrovascular insults, increased right ventricular pressure, and/or volume overload leading to si...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-12-01
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| Series: | The Cardiothoracic Surgeon |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43057-022-00089-0 |
| _version_ | 1797973465164152832 |
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| author | Jevaughn S Davis Jessica Zvara K. Gage Parr |
| author_facet | Jevaughn S Davis Jessica Zvara K. Gage Parr |
| author_sort | Jevaughn S Davis |
| collection | DOAJ |
| description | Abstract Background A paradoxical embolism arises when a venous thrombus passes through a cardiac right to left shunt and enters the arterial circulation. This can manifest as cardiovascular ischemia, cerebrovascular insults, increased right ventricular pressure, and/or volume overload leading to signs and symptoms of heart failure. While rare, paradoxical emboli carry high mortality and morbidity if diagnosis is missed and/or treatment is delayed. Transesophageal echocardiography can be diagnostic. Initial treatment revolves around anticoagulation and/or thrombolysis to prevent clot propagation. However, for clots in transit, emergent surgical removal is often necessary. Anesthetic induction can be tricky given the potential for rapid deterioration and the need to avoid increased right sided pressures and further clot migration. Case presentation In this report, we present a 72-year-old obese female with a history of hypertension, hyperlipidemia, gout, and diabetes found to have a paradoxical embolism caught in transit, trapped in a patent foramen ovale, and managed surgically. We describe the role of intraoperative transesophageal echocardiography in successfully treating this patient. Conclusions TEE plays an important role in the diagnosis and management of paradoxical PE. It can detect right and left heart thrombi and intracardiac shunts , can help in the successful closure of intracardiac shunts, and can impact intraoperative surgical decision making. |
| first_indexed | 2024-04-11T04:04:46Z |
| format | Article |
| id | doaj.art-0267c75488f347b5907931633921a463 |
| institution | Directory Open Access Journal |
| issn | 2662-2203 |
| language | English |
| last_indexed | 2024-04-11T04:04:46Z |
| publishDate | 2022-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Cardiothoracic Surgeon |
| spelling | doaj.art-0267c75488f347b5907931633921a4632023-01-01T12:27:51ZengSpringerOpenThe Cardiothoracic Surgeon2662-22032022-12-013011610.1186/s43057-022-00089-0Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovaleJevaughn S Davis0Jessica Zvara1K. Gage Parr2Department of Anesthesiology and Critical Care, George Washington School of Medicine and Health SciencesDepartment of Anesthesiology and Critical Care, George Washington School of Medicine and Health SciencesDepartment of Anesthesiology and Critical Care, George Washington School of Medicine and Health SciencesAbstract Background A paradoxical embolism arises when a venous thrombus passes through a cardiac right to left shunt and enters the arterial circulation. This can manifest as cardiovascular ischemia, cerebrovascular insults, increased right ventricular pressure, and/or volume overload leading to signs and symptoms of heart failure. While rare, paradoxical emboli carry high mortality and morbidity if diagnosis is missed and/or treatment is delayed. Transesophageal echocardiography can be diagnostic. Initial treatment revolves around anticoagulation and/or thrombolysis to prevent clot propagation. However, for clots in transit, emergent surgical removal is often necessary. Anesthetic induction can be tricky given the potential for rapid deterioration and the need to avoid increased right sided pressures and further clot migration. Case presentation In this report, we present a 72-year-old obese female with a history of hypertension, hyperlipidemia, gout, and diabetes found to have a paradoxical embolism caught in transit, trapped in a patent foramen ovale, and managed surgically. We describe the role of intraoperative transesophageal echocardiography in successfully treating this patient. Conclusions TEE plays an important role in the diagnosis and management of paradoxical PE. It can detect right and left heart thrombi and intracardiac shunts , can help in the successful closure of intracardiac shunts, and can impact intraoperative surgical decision making.https://doi.org/10.1186/s43057-022-00089-0Transesophageal echocardiographyPatent foramen ovaleParadoxical embolusThrombus in transitAnesthetic managementCase report |
| spellingShingle | Jevaughn S Davis Jessica Zvara K. Gage Parr Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale The Cardiothoracic Surgeon Transesophageal echocardiography Patent foramen ovale Paradoxical embolus Thrombus in transit Anesthetic management Case report |
| title | Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale |
| title_full | Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale |
| title_fullStr | Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale |
| title_full_unstemmed | Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale |
| title_short | Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale |
| title_sort | anesthetic management and the role of tee in the entrapment of a paradoxical embolus by a patent foramen ovale |
| topic | Transesophageal echocardiography Patent foramen ovale Paradoxical embolus Thrombus in transit Anesthetic management Case report |
| url | https://doi.org/10.1186/s43057-022-00089-0 |
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