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Editor's Correspondence
August 10/24, 1998

Impending Paradoxical Embolism

Arch Intern Med. 1998;158(15):1720. doi:

I read with interest the case report and literature review of impending paradoxical embolism by Meacham et al.1 I wish to comment on additional published cases that were not included in their review.

Elliott and Beamish2 reported 2 cases in 1953 with instructive demonstrations at autopsy of the intracardiac embolus "caught in the act" of traversing the patent foramen ovale. Based on their review of the literature on embolic occlusion of the patent foramen ovale, Elliott and Beamish2 found that 29 cases, including 2 of their own, were reported after 1926. They further noted that 48 cases of a clot caught in a patent foramen ovale had been described since 1859, and that many had been described as paradoxical emboli. The term paradoxical emboli was originally coined by Zahn in 1885 to describe a condition in which emboli derived from the systemic venous system reach the systemic arterial system by passing through an abnormal communication between the chambers of the heart.3