De Dominicis E, Boschello M, Trevisan G, De Nardis R
Servizio Autonomo di Cardiologia, Ospedale Civile di Arzignano, Vioenza.
G Ital Cardiol. 1995 Jun;25(6):733-6.
We describe the case of a 67-year-old patient, who had a stroke with subsequent right hemiparesis two years before coming under our observation. Afterwards he had no more pathological manifestation until he had sudden dyspnoea and marked cyanosis, following a prolonged immobilization due to intervention for slipped disc. Symptomatology regressed rapidly, and few hours later, the patient came under our observation in relatively fair conditions. Echocardiography evidenced moderate enlargement of right heart cavities; by subcostal view we visualized the presence of thrombotic material crossing the foramen ovale. Color Doppler showed moderate tricuspid regurgitation. Pulmonary artery systolic pressure was estimated about 55 mm Hg. The patient was immediately anticoagulated firstly by heparin, and secondly by warfarin, maintaining good clinical conditions. After a treatment of two more weeks he could be discharged with prescription of indefinite anticoagulation. Before discharge an echo examination showed the thrombus was no longer present. Pulmonary systolic pressure was estimated about 40 mm Hg. This is one of the rare cases of direct visualization of impending paradoxical embolus documented in the cardiologic literature.
我们描述了一名67岁患者的病例，该患者在接受我们观察的两年前发生中风，随后出现右侧偏瘫。此后，他没有更多的病理表现，直到因椎间盘突出症接受干预而长期卧床后，突然出现呼吸困难和明显发绀。症状迅速消退，几小时后，患者在相对良好的状态下接受了我们的观察。超声心动图显示右心腔中度扩大；通过肋下视图，我们看到有血栓物质穿过卵圆孔。彩色多普勒显示中度三尖瓣反流。估计肺动脉收缩压约为55毫米汞柱。患者立即首先用肝素抗凝，其次用华法林抗凝，临床状况良好。经过两周多的治疗，他可以出院，并开具了无限期抗凝的处方。出院前的超声检查显示血栓不再存在。估计肺动脉收缩压约为40毫米汞柱。这是心脏病学文献中记录的罕见的直接观察到即将发生反常栓塞的病例之一。
