Kallel O, Charmake D, Chergui I, El Ouafi N, Ismaili N
Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.
Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco.
Ann Med Surg (Lond). 2021 Feb 23;63:102188. doi: 10.1016/j.amsu.2021.102188. eCollection 2021 Mar.
Paradoxical emboli (PDE) represent less than 2% of all arterial emboli, that is why they are considered as a rare event. We notice that the upper limb ischemia is very exceptional as part of a paradoxical embolism. This case presentation can help in considering the diagnosis the PFO as one of the most important risk factors of paradoxical embolism.
Here, we present a rare case of a 69-year-old woman with paradoxical systemic arterial embolism, presented by an acute ischemia of the upper limb, secondary to deep venous thrombosis and pulmonary embolism in the presence of patent foramen ovale, treated with long-term anticoagulation with rivaroxiban 20 mg/day, because of the mutation of the Factor II whish indicate already the anticoagulation.
Echocardiographic techniques such as transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), or transcranial echocardiography (TCE) are the principal tools used to detect PFO. There are no clear consensus on the treatment of PDE. Presenting symptoms largely depend upon the location of the embolus, necessitating a different approach for each patient, but There is essentially three therapeutic options: surgical embolectomy, thrombolysis, and anticoagulation.
PFO closure is, today, a standardized and safe intervention, but the indication stay individualized to each patient.
反常栓塞（PDE）在所有动脉栓塞中占比不到2%，正因如此，它们被视为罕见事件。我们注意到上肢缺血作为反常栓塞的一部分非常罕见。本病例报告有助于将卵圆孔未闭（PFO）的诊断视为反常栓塞最重要的危险因素之一。
在此，我们呈现一例罕见病例，一名69岁女性患有反常性体循环动脉栓塞，表现为上肢急性缺血，继发于深静脉血栓形成和肺栓塞，同时存在卵圆孔未闭，因凝血因子II突变提示已需抗凝，故采用利伐沙班20mg/天进行长期抗凝治疗。
超声心动图技术，如经胸超声心动图（TTE）、经食管超声心动图（TEE）或经颅超声心动图（TCE）是用于检测PFO的主要工具。对于PDE的治疗尚无明确共识。出现的症状很大程度上取决于栓子的位置，因此需要针对每个患者采取不同的方法，但基本上有三种治疗选择：手术取栓、溶栓和抗凝。
如今，PFO封堵是一种标准化且安全的干预措施，但适应证仍需针对每个患者个体化确定。
