危及生命的肺栓塞与跨卵圆孔未闭血栓相关：病例报告
Life-threatening pulmonary embolism associated with a thrombus straddling a patent foramen ovale: report of a case.
作者信息
Myers Patrick O, Fassa Amir-Ali, Panos Aristotelis, Licker Marc, Bounameaux Henri, Zender Herve O, Kalangos Afksendiyos
机构信息
Division of Cardiovascular Surgery, Geneva University Hospital, Geneva, Switzerland.
出版信息
J Card Surg. 2008 Jul-Aug;23(4):376-8. doi: 10.1111/j.1540-8191.2007.00542.x. Epub 2008 Jul 1.
BACKGROUND AND AIM
A biatrial thrombus straddling a patent foramen ovale (PFO) is rare. The optimal management is controversial. This report offers an additional report and brief review of the literature.
CASE REPORT
A 72-year-old female presented with paroxysmal dyspnea. Transthoracic echocardiography showed distended right heart cavities, pulmonary artery hypertension, and a thrombus in the right atrium passing through the PFO into the left atrium. Urgent surgical embolectomy confirmed an 11.5 cm serpentine biatrial thrombus and allowed PFO closure and bilateral pulmonary embolectomy. Postoperative recovery was uneventful.
CONCLUSIONS
The risk of systemic embolization during thrombolytic or heparin treatment for biatrial thrombus makes most authors recommend surgical or interventional thrombectomy and PFO closure. Given the limited number of cases, there is no evidence that any of the treatment strategies provide a better survival.
背景与目的
横跨卵圆孔未闭（PFO）的双侧心房血栓较为罕见。最佳治疗方案存在争议。本报告提供了一份补充报告并对相关文献进行简要综述。
病例报告
一名72岁女性因阵发性呼吸困难就诊。经胸超声心动图显示右心腔扩张、肺动脉高压，以及右心房内的血栓经卵圆孔未闭进入左心房。紧急外科取栓术证实存在一条11.5厘米的蜿蜒双侧心房血栓，并进行了卵圆孔未闭封堵及双侧肺动脉取栓术。术后恢复顺利。
结论
双侧心房血栓进行溶栓或肝素治疗时发生全身栓塞的风险使得大多数作者推荐采用外科或介入性血栓切除术及卵圆孔未闭封堵术。鉴于病例数量有限，尚无证据表明任何一种治疗策略能带来更好的生存率。
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