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(Circulation. 2001;103:1928.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Migrating Thrombus Trapped in a Patent Foramen Ovale

Arnheid Kessel-Schaefer, MD; Michael Lefkovits, MD; Michael J. Zellweger, MD; Wolfgang Brett, MD; Florian Rüter, MD; Matthias E. Pfisterer, MD; Peter Buser, MD

From the Department of Cardiology and Cardiovascular Surgery, University Hospital Basel, Switzerland.

Correspondence to Matthias E. Pfisterer, Head, Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.

A 36-year-old woman with a 3-week history of shortness of breath was admitted to the hospital after having suffered syncope. She also complained of left-sided leg pain. Duplex ultrasound revealed a right-sided proximal deep venous thrombosis and an occluded left popliteal artery. Echocardiography demonstrated a dilated right ventricle and tricuspid regurgitation with an estimated pulmonary systolic pressure of 80 mm Hg. Spiral CT demonstrated multiple central pulmonary emboli; cranial MRI showed multiple small infarcted zones; and transesophageal echocardiography (TEE) revealed a patent foramen ovale. After embolectomy of the left popliteal artery and a 10-day course of anticoagulation, follow-up echocardiography showed a possible thrombus in the right atrium. Therefore, TEE was performed, which revealed a thrombus 10 cm long caught in the foramen ovale on its way to the left atrium (Figure 1). At emergent cardiac surgery, the thrombus was extracted (Figure 2), the persistent foramen ovale closed, and a vena cava filter inserted.

View larger version (103K): [in this window] [in a new window]   Figure 1. Multiplane TEE (60°). Thrombus (arrowheads) makes its way through patent foramen ovale. Ao indicates ascending aorta; IAS, interatrial septum; LA, left atrium; and RA, right atrium.

View larger version (113K): [in this window] [in a new window]   Figure 2. Perioperative view: extracted thrombus.

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