Diagnosis and management of entrapped embolus through a patent foramen ovale

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