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A Journal on Surgery

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Chirurgia 2012 August;25(4):281-2

language: English

Migrating thrombus trapped in a patent foramen ovale: an unusual case successfully treated by isolated oral anticoagulant therapy

Nicolò F., Grego S., Gislao V., Nardi P., Polisca P., Chiariello L.

Department of Cardiac Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy


Atrial masses are either benign (usually myxoma), or malignant (usually metastatic) vegetations and thrombi. Thrombi could be migratory, usually from lower limb venous thrombosis, or local, mainly caused by atrial fibrillation. Migration of thrombi from the veins of the lower limbs can give rise to pulmonary emboli within 24 hours. This is manifested as massive pulmonary embolism in 30% of cases, with a mortality rate of around 50%. Thrombus entrapped in a patent foramen ovale presenting with acute pulmonary embolism is a not frequent condition (4%) and despite all therapeutic options mortality rate remains high (21-45%). Treatment options include surgical embolectomy, invasive percutaneous embolectomy, which may be combined with thrombus aspiration and thrombolysis and heparin administration. These options may be combined with the placement of a filter in inferior vena cava. Here we report a case of a 77-years-old female with pulmonary embolism, causing a migrating thrombus trapped in patent foramen ovale, which was entirely resolved by oral anticoagulation.

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