Case report


PFO closure consideration for refractory hypoxia and secondary prevention of recurrent arterial thromboembolism

David Maksimovich BS, Christopher M Merrick MD, Cihan Cevik MD

ABSTRACT

Acute arterial and deep venous thrombosis presenting simultaneously is an uncommon medical emergency, usually secondary to an underlying cause. We report a 64-year-old woman with concurrent bilateral pulmonary emboli and acute thrombotic occlusion of the right brachial artery. Her work-up revealed a large patent foramen ovale (PFO) with a right to left intracardiac shunt and bilateral lower extremity deep venous thrombosis. The patient was unable to be weaned off mechanical ventilation due to her refractory hypoxia. However, after closure of the PFO the patient’s oxygenation improved. This case demonstrates the potential beneficial role of PFO closure in a hypoxic patient with a right to left intracardiac shunt. In addition, closure of the PFO may provide secondary prevention of paradoxical systemic thromboembolism.

Keywords: patent foramen ovale, arterial and venous thrombosis, ischemic stroke, cryptogenic stroke, refractory hypoxia, right to left intracardiac shunt.

Article citation: Maksimovich D, Merrick CM, Cevik C. PFO closure consideration for refractory hypoxia and secondary prevention of recurrent arterial thromboembolism. The Southwest Respiratory and Critical Care Chronicles 2019;7(31):49–51

From: Rocky Vista University College of Osteopathic Medicine (DM), Parker, Colorado; Memorial Hospital Central (CMM, CC), Colorado Springs, Colorado

Submitted: 8/19/2019

Accepted: 10/8/2019

Reviewer: Scott Shurmur MD

Conflicts of interest: none

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