Surgical treatment of high-risk pulmonary embolism associated with paradoxical embolism, complicated by acute cerebrovascular accident

The article presents a case of successful surgical treatment of pulmonary embolism in a patient with a high risk of early cardiac death on the background of paradoxical embolism complicated by acute cerebrovascular accident. Cryptogenic acute cerebrovascular accident in combination with severe progressive right ventricular failure on the background of pulmonary embolism causes serious difficulties in making decisions regarding treatment tactics in these patients. Intracardiac localization of thromboemboli, threatened by the development of recurrent pulmonary embolism, as well as paradoxical embolism, requires immediate implementation of a differential diagnostic complex aimed at verifying the pathophysiological mechanism of the disease, which largely determines the effectiveness of the treatment. The analysis of the available literature data, given in the work, as well as the analysis of the clinical case, make it possible to develop a tactical algorithm in this group of patients and to determine the indications for open heart surgery.

1. Medvedev A.P., Fedorov S.A., Trofimov N.A., Tselousova L.M. ERRORS IN THE DIAGNOSIS AND TREATMENT OF PULMONARY EMBOLISM. // Cardiology and Cardiovascular Surgery. 2021;14(1):54-59.(InRuss.). https://doi.org/10.17116/kardio20211401154.

2. Medvedev A.P., Ivanov L.N., Shirokova O.R., Shirokov A.M., Kalinina M.L., Fedorov S.A., Jurasova E.V., Arzhanov N.B. THREATENING PARADOXICAL EMBOLISM, MASSIVE OCCLUSION OF THE PULMONARY ARTERY: RISK STRATIFICATION, TREATMENT TACTICS. // Angiology and vascular surgery.(InRuss.). 2019;25(2):158-164. https://doi.org/10.33529/ANGIO2019218

3. LarchikovaJu.V., `Erlih A.D., Smetanina I.N., ZheltovN.Ju. A CLINICAL CASE OF PARADOXICAL EMBOLISM THAT CAUSED ACUTE MYOCARDIAL INFARCTION AFTER DEEP VEIN THROMBOSIS. // Atherothrombosis.(InRuss.).2020;(2):161-168. https://doi.org/10.21518/2307-1109-2020-2-161-168.

4. Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, Felberg R, Herrmann H, Kar S, Landzberg M. CLOSURE OR MEDICAL THERAPY FOR CRYPTOGENIC STROKE WITH PATENT FORAMEN OVALE. // N Engl J Med. 2012;366:991–999. https://doi.org/10.1056/NEJMoa1009639

5. Cramer SC, Rordorf G, Maki JH, Kramer LA, Grotta JC, Burgin WS, Hinchey JA, Benesch C, Furie KL, Lutsep HL. INCREASED PELVIC VEIN THROMBI IN CRYPTOGENIC STROKE RESULTS OF THE PARADOXICAL EMBOLI FROM LARGE VEINS IN ISCHEMIC STROKE (PELVIS) STUDY. // Stroke. 2004;35:46–50. https://doi.org/10.1161/01.STR.0000106137.42649.AB.

6. Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. PATENT FORAMEN OVALE AND CRYPTOGENIC STROKE IN OLDER PATIENTS. // N Engl J Med. 2007; 357:2262–2268. https://doi.org/10.1056/NEJMoa071422

7. Silver M.D., Dorsey J.S. ANEURYSMS OF THE SEPTUM PRIMUM IN ADULTS. // Arch Pathol Lab Med. 1978; 102:62–65.

8. Shirani J, Zafari AM, Roberts WC. MORPHOLOGIC FEATURES OF FOSSA OVALIS MEMBRANE ANEURYSM IN THE ADULT AND ITS CLINICAL SIGNIFICANCE. // J Am Coll Cardiol. 1995;26(2):466-71. https://doi.org/10.1016/0735-1097(95)80024-b.

9. Homma S, Sacco RL. PATENT FORAMEN OVALE AND STROKE. // Circulation. 2005; 112:1063–1072. https://doi.org/10.1161/CIRCULATIONAHA.104.524371

10. Goel SS, Tuzcu EM, Shishehbor MH, de Oliveira EI, Borek PP, Krasuski RA, Rodriguez LL, Kapadia SR. MORPHOLOGY OF THE PATENT FORAMEN OVALE IN ASYMPTOMATIC VERSUS SYMPTOMATIC (STROKE OR TRANSIENT ISCHEMIC ATTACK) PATIENTS. // Am J Cardiol. 2009; 103:124–129. https://doi.org/10.1016/j.amjcard.2008.08.036.

11. Botto N, Spadoni I, Giusti S, Ait-Ali L, Sicari R, Andreassi MG. PROTHROMBOTIC MUTATIONS AS RISK FACTORS FOR CRYPTOGENIC ISCHEMIC CEREBROVASCULAR EVENTS IN YOUNG SUBJECTS WITH PATENT FORAMEN OVALE. // Stroke. 2007; 38:2070–2073. https://doi.org/10.1161/STROKEAHA.106.480863

12. Pevzner D.V., Strazhesko I.D., Shreĭder E.V.THROMBOSIS OF THE RIGHT HEART AND THREATENING PARADOXICAL EMBOLISM. DESCRIPTION OF A CLINICAL CASE/ // Cardiological Bulletin.(InRuss.).2009;1: 80–83.

13. Myers P.O., Bounameaux H., Panos A. IMPENDING PARADOXICAL EMBOLISM: SYSTEMATIC REVIEW OF PROGNOSTIC FACTORS AND TREATMENT. // Chest. 2010;137:164–170. https://doi.org/10.1016/j.amjmed.2014.08.001