AP-HP, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, F-94010, France; Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, F-94010, France.
AP-HP, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, F-94010, France; Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, F-94010, France.
Am J Emerg Med. 2018 Aug;36(8):1527.e1-1527.e2. doi: 10.1016/j.ajem.2018.05.024. Epub 2018 May 20.
Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagnosis of massive pulmonary embolism that was lately confirmed by a multidetector CT-angiography. Anticoagulation therapy was rapidly complicated by a hemorrhagic transformation of the ischemic stroke leading to a fatal outcome. This case illustrates the double-edged circulatory effect of shunting across a patent foramen ovale in case of massive pulmonary embolism: it may have limited circulatory failure but caused in the meanwhile a fatal paradoxical brain embolism.
卵圆孔未闭在普通人群中较为常见。在发生大面积肺栓塞时，右心腔压力的突然增加可能导致该卵圆孔出现右向左分流，这可能与矛盾的结果相关。在此，我们报告了一例以癫痫发作为先兆的可逆性心脏骤停病例，随后在没有任何升压药的情况下血流动力学稳定。脑 CT 扫描显示局限性缺血性脑卒中。初始超声心动图评估显示急性肺源性心脏病和通过大的卵圆孔未闭的右向左心内分流，提示诊断为大面积肺栓塞，随后通过多排 CT 血管造影得到证实。抗凝治疗很快出现缺血性脑卒中的出血性转化，导致致命结局。本例说明了在发生大面积肺栓塞时卵圆孔未闭分流的双重循环效应：它可能限制了循环衰竭，但同时导致了致命的矛盾性脑栓塞。
