经食管超声心动图作为即将发生反常栓塞的最后防线：一例报告

Transesophageal echocardiography as the final defense in impending paradoxical embolism: a case report.

作者信息

Chen Zhuangyuan, Chen Mingjing, Song Haibo, Chan Yauwai

机构信息

Department of Anesthesiology, The University of Hongkong-Shenzhen Hospital, Shenzhen, 518053, Guangdong, People's Republic of China.

Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.

出版信息

J Cardiothorac Surg. 2025 Apr 18;20(1):212. doi: 10.1186/s13019-025-03386-x.

DOI:10.1186/s13019-025-03386-x

PMID:40251667

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12007277/

Abstract

BACKGROUND

Impending paradoxical embolism (IPDE) involves venous thrombi crossing a patent foramen ovale, posing high risks of systemic embolization.

CASE PRESENTATION

A 64-year-old male was admitted to the operation theater due to heart failure symptoms, with the original plan of undergoing atrial mass resection and mitral valve replacement. Intra-operative transesophageal echocardiography (TEE) diagnosed the patient with IPDE and acute pulmonary embolism. And this critical diagnosis immediately altered the surgical decision-making process, which included pulmonary artery thrombectomy. The successful treatment of this case was significantly attributed to the intraoperative TEE examination, which provided essential real-time diagnostic information guiding the surgical approach. This case highlighted the importance of intra-operative TEE in management of IPDE for surgical planning.

CONCLUSIONS

TEE is the final defense in IPDE. To optimize surgical outcomes and avert misdiagnosis, routine utilization of intraoperative TEE is highly recommended for similar cases.

摘要

背景

即将发生的矛盾栓塞（IPDE）涉及静脉血栓穿过未闭卵圆孔，存在发生全身栓塞的高风险。

病例介绍

一名64岁男性因心力衰竭症状入院，原计划进行心房肿物切除和二尖瓣置换术。术中经食管超声心动图（TEE）诊断该患者患有IPDE和急性肺栓塞。这一关键诊断立即改变了手术决策过程，其中包括肺动脉血栓切除术。该病例的成功治疗很大程度上归功于术中TEE检查，它提供了指导手术方法的重要实时诊断信息。该病例突出了术中TEE在IPDE手术规划管理中的重要性。