Thrombus straddling a patent foramen ovale and pulmonary embolism:A case report

BACKGROUND Venous thromboembolism is a common vascular syndrome presenting as deep vein thrombosis and/or pulmonary embolism.Thrombus has the possibility of migrating into the left circulation via patent foramen ovale in certain extreme circumstances.Thrombus straddling a patent foramen ovale is a direct evidence of this scenario.However,the confirmed cases of thrombus in transit are still rare.CASE SUMMARY A 32-year-old man suffered from recurrent syncope and intermittent dyspnea for 1 wk.Transthoracic echocardiography confirmed a thrombus straddling the patent foramen ovale,and thrombi were also found in the bilateral pulmonary artery by computed tomography.The man underwent inferior vena cava filter placement and thrombolysis with alteplase.Echocardiography showed the absence of thrombi in both the right atrium and left atrium 2 d after hospitalization.The man was discharged to home on warfarin without any complications 2 wk later.CONCLUSION Scrutinizing intracardiac thrombi provides measurable value in pulmonary embolism as closure of patent foramen ovale may be considered in certain patients.Early intervention plays a critical role in thrombus straddling a patent foramen ovale.A sedentary lifestyle may predispose young adults to thromboembolism,even if there are no other risk factors.

Long-term outcomes of high-risk percutaneous coronary interventions under extracorporeal membrane oxygenation support:An observational study

BACKGROUND Venoarterial extracorporeal membrane oxygenation(VA-ECMO)offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions(PCIs).However,long-term outcomes associated with VA-ECMO have not previously been studied.AIM To explore long-term outcomes in high-risk cases undergoing PCI supported by VA-ECMO.METHODS In the present observational cohort study,61 patients who received VA-ECMOsupported high-risk PCI between April 2012 and January 2020 at the Sixth Medical Center of Chinese People’s Liberation Army General Hospital were enrolled.The endpoint characteristics such as all-cause mortality,repeated cardiovascular diseases,and cardiac death were examined.RESULTS Among 61 patients,three failed stent implantation due to chronic total occlusions with severely calcified lesions.One patient showed VA-ECMO intolerance because of high left ventricular afterload.PCI was successfully performed in 57 patients(93.4%).The in-hospital mortality was 23.0%,and the overall survival was 45.9%,with a median follow-up period of 38.6(8.6-62.1)mo.CONCLUSION VA-ECMO can be used as a support in patients undergoing high-risk PCI as it is associated with favorable long-term patient survival.