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. 2014 Jul 31;8(7):1–13. doi: 10.3941/jrcr.v8i7.1679

Table 1.

Clinical presentation and management of identified recent cases (2009–2013) of impending paradoxical embolism indexed in PubMed.

Reference Demographics Hemodynamics DVT Treatment Systemic Embolism Follow up
Mintz,2013, J Emerg Med[9] 54 year old AA M BP: 144/99 mmHg, Pulse: 87/min
RR: 19/min
97% on RA		 Yes, Right LE

  • -UF Heparin

  • -IVC filter

  • -Coumadin on discharge

 Yes, renal infarct TPA was given, patient discharged on Coumadin No events
Faustino, 2012, BMJ Case Rep[10] 42 year old F BP: 100/69 mm Hg
Pulse: 110/min
95% on RA
PASP: 83 mm Hg		 Yes, Right LE

  • -Alteplase

  • -UF Heparin

  • -PFO closure

  • -Coumadin on discharge

 Cerebral embolism (multiple small strokes on MRI) Not given
Stable at discharge
Forkman,2012, Clin Res Cardiol[11] 77 year old F BP: 150/80 mm Hg
Pulse: 105/min
RR: 25/min
TTE RVSP: 50 mmHg		 Yes, Left LE

  • -UF Heparin

  • -Surgical embolectomy from right and left atria

  • - Surgical PFO closure

  • -Coumadin on discharge

 Not documented Stable at discharge
No follow up given
Turfan, 2012, Heart Lung Circ[12] 72 year old F BP: 60/40 mm Hg
80% on RA		 Yes, B/L LE

  • -streptokinase

  • -unfractionated heparin

  • -Coumadin on discharge

 Not documented Stable at discharge
No follow up given
Chow, 2012, J Clinic Ultrasound[13] 35 year old F Not given History of DVT

  • -Surgical embolectomy from right and left atria

  • - Surgical PFO closure

  • -IVC filter

  • -Coumadin on discharge

 Left middle cerebral artery stroke Stable at discharge
No events at 4 months follow up
Shah, 2011, J Card Surg[14] 78 year old M 88% on RA
Pulse: 103/min
Tachypnea		 Yes, Right LE

  • -UF Heparin

  • - Surgical embolectomy from right and left atria

  • - Surgical PFO closure

  • -IVC filter

  • -Coumadin on discharge

 Not documented Stable at discharge
No follow up given
Citro, 2010, J Cardiovasc Med[15] 69 year old F BP: 10/70 mm Hg
Pulse: 110/min
PASP: 81 mm Hg		 None

  • - Surgical embolectomy from right and left atria and from pulmonary artery

  • - Surgical PFO closure

  • -Coumadin on discharge

 Not documented Stable at discharge
No events at 1 year follow up
Fontanella, 2010, Kardiol[16] 81 year old F BP: 130/80 mm Hg
Pulse: 100/min 86% on RA
PaO2: 57 mm Hg
RVSP: 50 mm Hg		 Yes, Right LE

  • -TPA IV X 2

  • - Unfractionated Heparin

 Not documented Stable at discharge
No events at 1 year follow up
Ruiz-Bailen, 2009, Interact Cardiovasc Thorac Surg[17] 81 year old F BP: 78/42 mm Hg
Pulse: 115/min
Tachypnea
PASP: 90 mm Hg		 Yes, Right LE

  • -Alteplase

  • -Enoxaparin

 Not documented Stable at discharge
No events at 1 month follow up
Younker, 2009, Anesthesiology[18] 46 year old M BP: 110/70 to 85/50 mm Hg
Pulse: 85 - 45/min
100%-88% on RA
Followed by cardiac arrest during anesthesia induction		 Yes, Left LE

  • - RA, LA and distal PA surgical embolectomy.

  • -IVC filter

  • -Coumadin on discharge

 Not documented Stable at discharge
No follow up given
Mascarenhas, 2009, J Am Coll Cardiol[19] 66 year old F Not documented Not documented

  • -Anti coagulation

 Not documented Not documented
Dietz, 2013 J of Cardiol Cases [20] 54 years old M Not documented Yes, Left LE

  • -UF Heparin

  • - IVC filter

  • -Surgical thrombectomy

  • -Surgical PFO closure

 Yes, Left anterior descending coronary artery embolism leading to acute STEMI Stable at 3 weeks follow up.

Abbreviations: AA: African American: DVT: deep venous thrombosis, LE: Lower extremity; PFO: Patent foramen ovale; IPE: Impending paradoxical embolism; MRI: Magnetic resonance imaging; M: Male; F: Female; BP: Blood pressure; RR: respiratory rate; TTE: transthoracic echocardiogram; RVSP: right ventricular systolic pressure; IVC: Inferior vena cava; PASP: Pulmonary artery systolic pressure; RA: Room air; B/L: Bilateral; UF: unfractionated; RA: right atrium; LA: left atrium; PA: pulmonary artery; IVC: inferior vena cava filter; STEMI: ST elevation Myocardial infarction