Surgical Treatment for Massive Pulmonary Embolism and a Thrombus Crossing a Patent Foramen Ovale: Impending Paradoxical Embolism

A 47-year-old man was admitted to our institution complaining severe dyspnea. The ultrasound cardiograph showed marked dilatation of right ventricle, pulmonary hypertension estimated 56 mmHg and the floating thrombi of bilateral atrium. The enhanced CT revealed thrombosis of bilateral pulmonary arte...

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Published inJapanese Journal of Vascular Surgery Vol. 23; no. 5; pp. 878 - 881
Main Authors Ito, Fusahiko, Watanabe, Masazumi, Katsumata, Chieko
Format Journal Article
LanguageJapanese
Published JAPANESE SOCIETY FOR VASCULAR SURGERY 2014
特定非営利活動法人 日本血管外科学会
Subjects
impending paradoxical embolism
patent foramen ovale
pulmonary embolism
切迫奇異塞栓
卵円孔開存
急性肺塞栓症
Online AccessGet full text
ISSN0918-6778
1881-767X
DOI10.11401/jsvs.14-00015

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Abstract A 47-year-old man was admitted to our institution complaining severe dyspnea. The ultrasound cardiograph showed marked dilatation of right ventricle, pulmonary hypertension estimated 56 mmHg and the floating thrombi of bilateral atrium. The enhanced CT revealed thrombosis of bilateral pulmonary artery. An emergency operation was performed. The right atrium was opened under cardiac arrest and a tubular thrombus trapped in the patent foramen ovale was removed. Also massive fresh thrombi were removed from the bilateral main pulmonary artery. The patient discharged without symptoms. Early surgical treatment is necessary for avoiding paradoxical embolisms.
AbstractList A 47-year-old man was admitted to our institution complaining severe dyspnea. The ultrasound cardiograph showed marked dilatation of right ventricle, pulmonary hypertension estimated 56 mmHg and the floating thrombi of bilateral atrium. The enhanced CT revealed thrombosis of bilateral pulmonary artery. An emergency operation was performed. The right atrium was opened under cardiac arrest and a tubular thrombus trapped in the patent foramen ovale was removed. Also massive fresh thrombi were removed from the bilateral main pulmonary artery. The patient discharged without symptoms. Early surgical treatment is necessary for avoiding paradoxical embolisms. 要旨：近年本邦でも深部静脈血栓症（DVT）に続発する肺塞栓症（PE）症例の増加を認めているが，奇異性塞栓症の報告は稀である．症例は47 歳男性．呼吸苦を主訴に当院を受診．著明な低酸素血症を伴う頻脈，血圧低下，右下腿の浮腫を認めた．CT では両側主肺動脈の血栓症と右膝窩静脈の血栓像を認めた．心エコー上右室拡張を認め右室収縮期圧は56.4 mmHg と上昇．両心房内に血栓浮遊像を認めた．塞栓症を引き起こしうる左房内血栓とショック状態に至っている両側主肺動脈の急性肺動脈塞栓症（切迫奇異塞栓症：impending paradoxical embolism; IPE）に対して，両心房内と肺動脈の血栓摘除を施行した．左房内の血栓は開存卵円孔に右房内血栓の先端が陥入したものであった．術後血行動態および酸素化は正常化した．IPE は稀な病態であり，外科的血栓除去が予後改善につながった症例であるため文献的考察も加え報告する．
A 47-year-old man was admitted to our institution complaining severe dyspnea. The ultrasound cardiograph showed marked dilatation of right ventricle, pulmonary hypertension estimated 56 mmHg and the floating thrombi of bilateral atrium. The enhanced CT revealed thrombosis of bilateral pulmonary artery. An emergency operation was performed. The right atrium was opened under cardiac arrest and a tubular thrombus trapped in the patent foramen ovale was removed. Also massive fresh thrombi were removed from the bilateral main pulmonary artery. The patient discharged without symptoms. Early surgical treatment is necessary for avoiding paradoxical embolisms.
Author Ito, Fusahiko
Katsumata, Chieko
Watanabe, Masazumi
Author_FL 伊藤 聡彦
渡邊 正純
勝又 千英子
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特定非営利活動法人 日本血管外科学会
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References 3) Fauveau E, Cohen A, Bonnet N, et al. Surgical or medical treatment for thrombus straddling the patent foramen ovale: impending paradoxical embolism? Report of four clinical cases and literature review. Arch Cardiovasc Dis 2008;101: 637–644.
2) Myers PO, Bounameaux H, Panos A, et al. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest 2010;137:164–170.
6) 安藤太三，伊藤正明，應儀成二，他．肺血栓塞栓症およびに深部静脈血栓症の診断，治療，予防に関するガイドライン，2009 年改訂版．2009:1–67．http://www.j-circ.or.jp/guideline/pdf/JCS2009_andoh_h.pdf （参照：2014 年2月26 日）
1) Ranoux D, Cohen A, Cabanes L, et al. Patent foramen ovale: is stroke due to paradoxical embolism? Stroke 1993;24:31–34.
4) Chow BJ, Johnson CB, Turek M, et al. Impending paradoxical embolus: a case report and review of the literature. Can J Cardiol 2003;19:1426–1432.
5) Meacham RR, Headley AS, Bronze MS, et al. Impending paradoxical embolism. Arch Intern Med 1998;158:438–448.
References_xml – reference: 2) Myers PO, Bounameaux H, Panos A, et al. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest 2010;137:164–170.
– reference: 6) 安藤太三，伊藤正明，應儀成二，他．肺血栓塞栓症およびに深部静脈血栓症の診断，治療，予防に関するガイドライン，2009 年改訂版．2009:1–67．http://www.j-circ.or.jp/guideline/pdf/JCS2009_andoh_h.pdf （参照：2014 年2月26 日）
– reference: 4) Chow BJ, Johnson CB, Turek M, et al. Impending paradoxical embolus: a case report and review of the literature. Can J Cardiol 2003;19:1426–1432.
– reference: 3) Fauveau E, Cohen A, Bonnet N, et al. Surgical or medical treatment for thrombus straddling the patent foramen ovale: impending paradoxical embolism? Report of four clinical cases and literature review. Arch Cardiovasc Dis 2008;101: 637–644.
– reference: 1) Ranoux D, Cohen A, Cabanes L, et al. Patent foramen ovale: is stroke due to paradoxical embolism? Stroke 1993;24:31–34.
– reference: 5) Meacham RR, Headley AS, Bronze MS, et al. Impending paradoxical embolism. Arch Intern Med 1998;158:438–448.
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Snippet A 47-year-old man was admitted to our institution complaining severe dyspnea. The ultrasound cardiograph showed marked dilatation of right ventricle, pulmonary...
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SubjectTerms impending paradoxical embolism
patent foramen ovale
pulmonary embolism
切迫奇異塞栓
卵円孔開存
急性肺塞栓症
Title Surgical Treatment for Massive Pulmonary Embolism and a Thrombus Crossing a Patent Foramen Ovale: Impending Paradoxical Embolism
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