Sabesan Vaishnavi, Acharya Ramesh, Murali Sandesh, Abolbashari Mehran, Ahmed Ibrahim
Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, The Hospitals of Providence Transmountain, El Paso, Texas, USA.
Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, The Hospitals of Providence Transmountain, El Paso, Texas, USA.
JACC Case Rep. 2025 Jul 30;30(21):104438. doi: 10.1016/j.jaccas.2025.104438.
Pulmonary embolism (PE) and ischemic stroke, particularly when associated with a patent foramen ovale (PFO), present complex management challenges that require careful consideration.
A 64-year-old man experienced recurrent ischemic strokes and acute PE, with complications including right ventricular strain and a small PFO with moderate shunting. He presented with dyspnea, hypoxia, and right-sided weakness. Imaging revealed bilateral PE and right ventricular strain. Initial management included intravenous unfractionated heparin and successful embolectomy, followed by long-term anticoagulation and antiplatelet therapy. Multidisciplinary discussions addressed the potential for PFO closure, which was postponed until Holter monitoring could rule out atrial fibrillation.
This case highlights the complexity of immediate stabilization with long-term management in patients with concurrent thromboembolic conditions. It underscores the potential importance of PFO closure in selected cases.
TAKE-HOME MESSAGES: A multidisciplinary approach is crucial in managing complex thromboembolic conditions, and PFO closure may benefit specific patients.
肺栓塞（PE）和缺血性卒中，尤其是与卵圆孔未闭（PFO）相关时，带来了需要仔细考量的复杂管理挑战。
一名64岁男性经历了复发性缺血性卒中和急性PE，并发症包括右心室劳损以及伴有中度分流的小PFO。他表现为呼吸困难、低氧血症和右侧肢体无力。影像学检查显示双侧PE和右心室劳损。初始治疗包括静脉注射普通肝素并成功进行栓子切除术，随后进行长期抗凝和抗血小板治疗。多学科讨论了PFO封堵的可能性，该操作推迟至动态心电图监测排除心房颤动后进行。
该病例凸显了同时患有血栓栓塞性疾病患者即刻稳定病情及长期管理的复杂性。它强调了在特定病例中PFO封堵的潜在重要性。
多学科方法对于管理复杂血栓栓塞性疾病至关重要，PFO封堵可能使特定患者受益。
