Diagnosis and management of entrapped embolus through a patent foramen ovale

The diagnosis of impending paradoxical embolus by echocardiography is exceptional and its management remains unclear. Through a personal case, we performed an exhaustive review of the medical literature of this rare finding. Since the first report, only 43 cases have ever been reported. The superiority of transesophageal echocardiography is underlined. The clinical features are complex. The classical simultaneous pulmonary and paradoxical embolism is often absent. Therapeutic options an cardiac surgery, thrombolysis or anticoagulation. The early mortality rate is high (21%). in addition, recurrent embolisms are reported when a medical treatment is chosen. The cumulative results of each possibility are described. (C) 1998 Elsevier Science B.V. All rights reserved.