Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Right and left heart thrombus in transit through patent foramen ovale presenting with intermediate-high risk pulmonary embolism
Session:
Casos Clinicos
Speaker:
Marco de Campos Beringuilho
Congress:
CPC 2020
Topic:
---
Theme:
---
Subtheme:
---
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Marco Beringuilho; Tiago Pinto Silva; Manuela Gouveia Silva; Hagen Kalhbau; João Baltazar Ferreira; Daniel Candeias Faria; Miguel Borges Dos Santos; Ana Valente Santos; Pedro Coelho; José Fragata
Abstract
<p><u><strong>Case presentation</strong></u>: A 28 year-old white male presented to the emergency department with 4 days of fever, malaise and mild left pleuritic chest pain. Serologic evidence of Influenza B infection was detected and the patient was admitted to the infectious disease ward to undergo a course of oseltamivir. There is an history of right inferior limb superficial vein thrombosis 6 months prior to admission, treated for 3 months with Rivaroxaban. Social history was positive for smoking but no other cardiovascular risk factors were evident. In the first night of admission there was sudden onset of polypnea, dessaturation, hypotension and tachycardia. Arterial blood gases revealed hypoxaemia and hypocapnia. ECG documented a sinus tachycardia and S1Q3T3 pattern. Chest x-ray was unrevealing. First D dimer of 14000ng/mL. A pulmonary CT angiography was performed confirming extensive bilateral pulmonary embolism with multiple contrast defects in the lobar and segmental arteries. The patient was transferred to the cardiac intensive care unit and the initial transthoracic echocardiogram revealed a dilated right ventricle with systolic dysfunction, McConnell’s sign, septal D-shape, and the presence of a large filiform mobile mass in the right atria with extension to the left atria though patent foramen ovale. The diagnosis of intermediate-high risk pulmonary embolism was made and because of the impending paradoxical embolism from both the atria it was assumed there was no condition nor indication for fibrinolysis and an heparin perfusion was started. The patient was put on fluid resuscitation and the case was discuss with the cardiac surgery. The decision of transfer to the cardiac surgery unit and perform urgent surgical thromboembolectomy was made. At the cardiothoracic surgery department, the patient was submitted to bilateral pulmonary thromboembolectomy, intra-auricular thrombus excision and closure of the patent foramen ovale. The surgery was uneventful. Extubation was performed after 15h. The control transthoracic echocardiogram revealed no cardiac masses and the control pulmonary CT angiography revealed bilateral pulmonary embolism with no thrombus on the pulmonary arteries. Discharge was given 15 days post-op under Rivaroxaban.</p> <p><u><strong>Discussion</strong></u>: Thrombus in transit through patent foramen ovale presenting with extensive pulmonary embolism is a rare yet challenging situation. The optimal approach to the management of these patients has yet to be ascertained. Current pulmonary embolism guidelines recognise this entity but are omissive in which strategy should be pursued. We present this case of a right and left atria thrombus in transit trough a patent foramen ovale with a risk of paradoxical embolism in which the decision for medical therapy bridging to urgent surgical thromboembolectomy had a favourable outcome.</p>
Slides
Video
Our mission: To reduce the burden of cardiovascular disease
Visit our site
