ATRIAL SEPTAL ANEURYSM PLUS A PATENT FORAMEN OVALE - A PREDISPOSING FACTOR FOR PARADOXICAL EMBOLISM AND REFRACTORY HYPOXEMIA DURING PULMONARY-EMBOLISM

We report three consecutive cases of patients who had refractory hypox emia and paradoxical embolism during the course of pulmonary embolism. Transesophageal echocardiography showed an atrial septal aneurysm and a patent foramen ovale in all patients. The latter was detected by an early and massive passage of contrast from the right to the left atri um. We suggest that the presence of an atrial septal aneurysm plus a p atent foramen ovale greatly enhances both magnitude of shunting and th e risk of systemic embolism. The presence of an atrial septal aneurysm plus a patent foramen ovale should be considered and checked using tr ansesophageal echocardiography in every patient with significant pulmo nary embolism.