Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
Department of ICU, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
J Cardiothorac Surg. 2024 Mar 19;19(1):137. doi: 10.1186/s13019-024-02606-0.
Paradoxical embolism is a rare cause of acute arterial occlusion. This phenomenon arises when embolic material travels from the venous system crosses an abnormal shunt such as patent foramen ovale, atrial septal defects, ventricular septal defects, or pulmonary arteriovenous malformations, into the arterial system. Impending paradoxical embolism refers to the presence of an entrapped thrombus in the patent foramen ovale.
We report a case of a 68-year-old female patient who presented with an impending paradoxical embolism, alongside both concomitant pulmonary embolism and myocardial infarction with ST-segment elevation. Swiftly addressed through emergency cardiac surgery and systemic anticoagulation, the patient's condition was effectively treated.
While the ideal treatment strategy for impending paradoxical embolism remains a topic of debate due to limited and inconclusive evidence, emergent open surgery should be contemplated in patients as it signifies a critical clinical emergency.
反常栓塞是急性动脉闭塞的罕见原因。当栓子物质从静脉系统穿过异常分流（如卵圆孔未闭、房间隔缺损、室间隔缺损或肺动静脉畸形）进入动脉系统时，就会出现这种现象。即将发生的反常栓塞是指卵圆孔未闭中存在被困血栓。
我们报告了一例 68 岁女性患者，她同时患有即将发生的反常栓塞、肺栓塞和 ST 段抬高型心肌梗死。通过紧急心脏手术和全身抗凝治疗迅速处理，患者的病情得到有效治疗。
尽管由于证据有限且不明确，对于即将发生的反常栓塞的理想治疗策略仍存在争议，但对于此类患者，应考虑紧急开放手术，因为这代表着一种严重的临床急症。
