Case Report

Major Pulmonary Embolism and Hemodynamic Stability from Shunting Through a Patent Foramen Ovale

Authors: Teng Moua, MD, Kenneth E. Wood, DO, Brett D. Atwater, MD, James R. Runo, MD

Abstract

While the combination of a patent foramen ovale (PFO) and thromboembolic disease is thought to portend increased morbidity and mortality, PFO presence in the setting of major pulmonary embolism (PE) may serve as a means to rescue patients from immediate hemodynamic collapse and death. We present two patients with major pulmonary embolism and right-to-left shunting consistent with PFO as seen on transthoracic echocardiography. In the setting of major PE, PFO may prevent acute right ventricular failure by acting as a ‘pop-off’ valve, alleviating increased ventricular pressures; but concomitantly portend deleterious effects in the form of paradoxical embolism and intractable hypoxemia.


Key Points


* Major pulmonary embolism presents with hemodynamic instability and morbidity as a result of acute right ventricular failure, requiring intensive care triage and management with aggressive thrombolytic therapy.


* The coincidental finding of patent foramen ovale has been reported in the literature with PE, usually portending increased morbidity and mortality through intractable hypoxemia and paradoxical embolism.


* We propose the presence of PFO as a means of rescue from acute hemodynamic collapse in two patients with major PE.

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