Medical treatment for paradoxical and saddle pulmonary embolism in a young man with patent foramen ovale and coronavirus disease 2019
1Department of Internal Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5Department of Cardiology, School of Medicine, Imam Hossein Hospital, Shahid Behehsti University of Medical Sciences, Tehran, Iran
Keywords: Case report, coronavirus disease 2019, fibrinolytic therapy, impending paradoxical embolism, massive pulmonary emboli
Here, we reported a 32-year-old male presenting to the emergency department with respiratory symptoms and coronavirus disease 2019 (COVID-19) diagnosis. Multiple thrombi were detected in his heart and inferior vena cava, probably due to former deep-vein thrombosis. The presence of patent foramen ovale and high pressure of the right heart caused the clots to enter the heart's left side. He received fibrinolytics, and his condition improved with no need for surgery. Hence, patients with impending paradoxical embolism may take advantage of medical treatment, such as fibrinolytics. Moreover, COVID-19 appears to be associated with a strong thrombotic tendency, and anticoagulants might be helpful.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
F.O: conceived of the presented idea; AK, H.H and F.Sh.: wrote the manuscript in consultation with all authors; AK, S.M, and H.H: conceived the study and were in charge of overall direction and planning; AK, S.M, H.H, and F.O: were directly involved in the treatment plan of the patients; F.O has conducted the TTE and reported PCTA; All authors discussed the results and commented on the manuscript.
We would like to thank Dr. Masoomeh Raoufi for obtaining the images and pictures presented in this case report.