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Emergent pulmonary thromboembolectomy and atrial septal aneurysmectomy for intracardiac impending paradoxical embolism: An en bloc approach to prevent clot embolism and facilitate repair


1 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
2 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
3 Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA

Correspondence Address:
Allan M Klompas
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St. SW, Rochester - 55905, MN
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_186_20

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Year : 2021  |  Volume : 24  |  Issue : 4  |  Page : 476-478

 

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Although a patent foramen ovale (PFO) is relatively common, confirmed reports of thrombus entrapped within a PFO are uncommon. Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic anticoagulation (e.g., heparin), systemic thrombolysis, or surgical thrombectomy. We present a case of IPE diagnosed with intraoperative transesophageal echocardiography (TEE) as well as a novel en bloc approach to atrial septal aneurysmectomy to minimize embolism and facilitate repair of the interatrial septum. Timely use of intraoperative TEE may aid in diagnosis and help guide the surgical approach to minimize embolic risk with an IPE.






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1 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
2 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
3 Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA

Correspondence Address:
Allan M Klompas
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St. SW, Rochester - 55905, MN
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_186_20

Rights and Permissions

Although a patent foramen ovale (PFO) is relatively common, confirmed reports of thrombus entrapped within a PFO are uncommon. Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic anticoagulation (e.g., heparin), systemic thrombolysis, or surgical thrombectomy. We present a case of IPE diagnosed with intraoperative transesophageal echocardiography (TEE) as well as a novel en bloc approach to atrial septal aneurysmectomy to minimize embolism and facilitate repair of the interatrial septum. Timely use of intraoperative TEE may aid in diagnosis and help guide the surgical approach to minimize embolic risk with an IPE.






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