PARADOXICAL EMBOLISM - AN UNDERRECOGNIZED PROBLEM

Despite reports of the clinical presentations and devastating conseque nces of paradoxical embolus (PDE) for more than a century, this diagno sis continues to be frequently missed. Because the prevalence of paten t foramen ovale (PFO) is 27 to 35% in the normal population and the pr esence of deep vein thrombosis or pulmonary embolus may not be clinica lly obvious, a high suspicion for PDE is needed in the event of unexpl ained arterial occlusion, While contrast echocardiography and transcra nial Doppler ultrasound have facilitated clinical recognition of PDE, the optimum approach to diagnosis requires clarification. Primary ther apy for patients with PDE is anticoagulation, with thrombolytics consi dered in carefully selected individuals, but there is little published information regarding long-term treatment and outcomes. Prevention re mains essential whenever possible. It is not yet defined whether proph ylactic treatment of persons with recognized predispositions to PDE (e g, PFO and pulmonary hypertension) is beneficial.