Hornof Josef, Čermák Ondřej
Vnitr Lek. 2021 Spring;67(2):114-118.
Patent foramen ovale is a persisting communication between the left and right atrium, present in approximately 25% of population, usually asymptomatic. Under normal conditions there is either no blood flow or a hemodynamically nonsignificant left-to-right shunt between the atria. However, increased right atrium pressure, as it is in pulmonary embolism, can make PFO a right-to-left shunt and poses a risk of paradoxical systemic embolism, including the risk of ischemic stroke. Here we report a case of a patient presenting with venous thromboembolism provoked by a recent polytrauma. We identified a large thrombus stuck in patent foramen ovale - an impending paradoxical embolism. Both surgical intervention and systemic thrombolysis were contraindicated so the patient was administered an anticoagulation treatment with unfractionated heparin and warfarin. By frequent echocardiography we were able to monitor complete resolution of the thrombus by 6 months from the diagnosis, with no systemic embolism.
卵圆孔未闭是左心房和右心房之间持续存在的通道，约25%的人群中存在，通常无症状。在正常情况下，心房之间要么没有血流，要么存在血流动力学上无显著意义的从左向右分流。然而，如在肺栓塞时，右心房压力升高可使卵圆孔未闭成为从右向左分流，并带来反常性全身栓塞的风险，包括缺血性中风的风险。在此，我们报告一例近期多发伤引发静脉血栓栓塞的患者。我们发现一个大血栓卡在卵圆孔未闭处——即将发生反常栓塞。手术干预和全身溶栓均为禁忌，因此给予患者普通肝素和华法林抗凝治疗。通过频繁的超声心动图检查，我们能够监测到血栓在诊断后6个月时完全溶解，且未发生全身栓塞。
