January 9, 1995

Systemic Embolization Complicating Right Ventricular Myocardial Infarction

Author Affiliations

From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Arch Intern Med. 1995;155(1):111-113. doi:10.1001/archinte.1995.00430010119016

We describe a patient in whom multiple episodes of pulmonary and systemic embolization occurred in the setting of right ventricular infarction. The mechanism of paradoxical embolization was determined based on transesophageal echocardiographic findings that included right atrial spontaneous contrast, appendage thrombosis, patent foramen ovale with right-to-left atrial shunting, and absence of left ventricular thrombosis. Recurrent thromboembolization was prevented by percutaneous placement of a "clamshell" occluder across the patent foramen. This clinical scenario may be more common than previously believed and is best detected with transesophageal echocardiography. Early identification of this condition can lead to prompt treatment and prevention of subsequent thromboembolic morbidity.

(Arch Intern Med. 1995;155:111-113)