A Case of Impending Paradoxical Embolism in a Pregnant Patient with Pulmonary Thromboembolism

Yukie Shirasaki＊	Masakazu Matsuyama＊＊	Eisaku Nakamura＊
Hirohito Ishii＊	Kunihide Nakamura＊

（University of Miyazaki Hospital Cardiovascular Surgery＊, Miyazaki, Japan, and Miyazaki Prefectural Nobeoka Hospital＊＊, Nobeoka, Japan）

A 27-year-old woman who suffered loss of consciousness twice after left femoral pain in the 25th week of gestation was referred to the obstetrics and gynecology department of our hospital. A structure with an attachment on the atrial wall was found in both atria on echocardiography, leading us to suspect impending paradoxical embolism（IPE). Judging from the shape of the thrombus in the atria, we thought that there was a high possibility of further embolism although rescue of the baby was feasible via cesarean section, so we decided to carry out emergency surgery. After delivering the infant by cesarean section, we used a heart-lung machine to incise the right atrium under hypothermia and remove the thrombus. As intraoperative esophageal echocardiography showed embolization in the right pulmonary artery, we cut the right pulmonary artery and removed the emboli. After surgery, a femoral vein thrombus was observed on echocardiography of the lower extremity vein, and we inserted an inferior vena cava filter. The patient was discharged on the 16th postoperative day. The situation whereby a thrombus is trapped in the foramen ovale without embolism of the arterial system is the rare pathological condition known as IPE. As no cases of surgical thrombectomy to treat IPE arising from complications of pregnancy have been reported thus far, the case described herein fittingly augments the literature.

 

Jpn. J. Cardiovasc. Surg. 48:185-188（2019）

Keywords：impending paradoxical embolism;pregnancy;pulmonary thromboembolism