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Paradoxical embolism

MedGen UID:
116043
•Concept ID:
C0238096
•
Disease or Syndrome
Synonyms: Crossed Embolism; Crossed Embolisms; Embolism, Crossed; Embolism, Paradoxical; Embolisms, Crossed; Embolisms, Paradoxical; Paradoxical Embolism; Paradoxical Embolisms
SNOMED CT: Paradoxical embolism (134296002); Paradoxical embolus (134296002)
 
HPO: HP:0033520

Definition

Paradoxical embolism describes the passage of a venous or right-sided cardiac thrombus into the arterial or systemic circulation. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVParadoxical embolism

Professional guidelines

PubMed

Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE
JAMA 2021 Dec 14;326(22):2277-2286. doi: 10.1001/jama.2021.20956. PMID: 34905030Free PMC Article
Paradoxical embolism: role of imaging in diagnosis and treatment planning.
Saremi F, Emmanuel N, Wu PF, Ihde L, Shavelle D, Go JL, Sánchez-Quintana D
Radiographics 2014 Oct;34(6):1571-92. doi: 10.1148/rg.346135008. PMID: 25310418
Diagnosis and management of patent foramen ovale.
Buchholz S, Shakil A, Figtree GA, Hansen PS, Bhindi R
Postgrad Med J 2012 Apr;88(1038):217-25. Epub 2012 Jan 25 doi: 10.1136/postgradmedj-2011-130368. PMID: 22282739

Recent clinical studies

Etiology

Patent foramen ovale and stroke.
Miranda B, Fonseca AC, Ferro JM
J Neurol 2018 Aug;265(8):1943-1949. Epub 2018 Apr 21 doi: 10.1007/s00415-018-8865-0. PMID: 29680895
Cryptogenic Stroke and Patent Foramen Ovale.
Mojadidi MK, Zaman MO, Elgendy IY, Mahmoud AN, Patel NK, Agarwal N, Tobis JM, Meier B
J Am Coll Cardiol 2018 Mar 6;71(9):1035-1043. doi: 10.1016/j.jacc.2017.12.059. PMID: 29495983
Cryptogenic stroke.
Fonseca AC, Ferro JM
Eur J Neurol 2015 Apr;22(4):618-23. Epub 2015 Jan 18 doi: 10.1111/ene.12673. PMID: 25597418
Paradoxical embolism.
Windecker S, Stortecky S, Meier B
J Am Coll Cardiol 2014 Jul 29;64(4):403-15. doi: 10.1016/j.jacc.2014.04.063. PMID: 25060377
Embolic strokes of undetermined source: the case for a new clinical construct.
Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, Sacco RL, Connolly SJ; Cryptogenic Stroke/ESUS International Working Group
Lancet Neurol 2014 Apr;13(4):429-38. doi: 10.1016/S1474-4422(13)70310-7. PMID: 24646875

Diagnosis

Patent foramen ovale: diagnostic evaluation and the role of device closure.
Gonnah AR, Bharadwaj MS, Nassar H, Abdelaziz HK, Roberts DH
Clin Med (Lond) 2022 Sep;22(5):441-448. doi: 10.7861/clinmed.2022-0040. PMID: 36507808Free PMC Article
Impending Paradoxical Embolism.
Ma X, Song L, Yang H, Xia J, Wu C, He Y
Ann Thorac Surg 2019 Aug;108(2):e73-e75. Epub 2019 Feb 11 doi: 10.1016/j.athoracsur.2019.01.011. PMID: 30763556
Patent foramen ovale.
Homma S, Messé SR, Rundek T, Sun YP, Franke J, Davidson K, Sievert H, Sacco RL, Di Tullio MR
Nat Rev Dis Primers 2016 Jan 21;2:15086. doi: 10.1038/nrdp.2015.86. PMID: 27188965
Cryptogenic stroke.
Fonseca AC, Ferro JM
Eur J Neurol 2015 Apr;22(4):618-23. Epub 2015 Jan 18 doi: 10.1111/ene.12673. PMID: 25597418
Paradoxical embolism.
Windecker S, Stortecky S, Meier B
J Am Coll Cardiol 2014 Jul 29;64(4):403-15. doi: 10.1016/j.jacc.2014.04.063. PMID: 25060377

Therapy

Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE
JAMA 2021 Dec 14;326(22):2277-2286. doi: 10.1001/jama.2021.20956. PMID: 34905030Free PMC Article
Eustachian valve, interatrial shunt, and paradoxical embolism.
Cai Q, Ahmad M
Echocardiography 2020 Jun;37(6):939-944. Epub 2020 May 19 doi: 10.1111/echo.14682. PMID: 32426851
Cryptogenic Stroke and Patent Foramen Ovale.
Mojadidi MK, Zaman MO, Elgendy IY, Mahmoud AN, Patel NK, Agarwal N, Tobis JM, Meier B
J Am Coll Cardiol 2018 Mar 6;71(9):1035-1043. doi: 10.1016/j.jacc.2017.12.059. PMID: 29495983
Cryptogenic stroke.
Fonseca AC, Ferro JM
Eur J Neurol 2015 Apr;22(4):618-23. Epub 2015 Jan 18 doi: 10.1111/ene.12673. PMID: 25597418
Embolic strokes of undetermined source: the case for a new clinical construct.
Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, Sacco RL, Connolly SJ; Cryptogenic Stroke/ESUS International Working Group
Lancet Neurol 2014 Apr;13(4):429-38. doi: 10.1016/S1474-4422(13)70310-7. PMID: 24646875

Prognosis

Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update.
Sacco S, Harriott AM, Ayata C, Ornello R, Bagur R, Jimenez-Ruiz A, Sposato LA
Neurology 2023 Apr 11;100(15):716-726. Epub 2022 Dec 15 doi: 10.1212/WNL.0000000000201699. PMID: 36522158Free PMC Article
Eustachian valve, interatrial shunt, and paradoxical embolism.
Cai Q, Ahmad M
Echocardiography 2020 Jun;37(6):939-944. Epub 2020 May 19 doi: 10.1111/echo.14682. PMID: 32426851
Echocardiographic features of PFOs and paradoxical embolism: a complicated puzzle.
Aggeli C, Verveniotis A, Andrikopoulou E, Vavuranakis E, Toutouzas K, Tousoulis D
Int J Cardiovasc Imaging 2018 Dec;34(12):1849-1861. Epub 2018 Jun 28 doi: 10.1007/s10554-018-1406-1. PMID: 29956022
An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke.
Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, Di Tullio MR, Lutz JS, Elkind MS, Griffith J, Jaigobin C, Mattle HP, Michel P, Mono ML, Nedeltchev K, Papetti F, Thaler DE
Neurology 2013 Aug 13;81(7):619-25. Epub 2013 Jul 17 doi: 10.1212/WNL.0b013e3182a08d59. PMID: 23864310Free PMC Article
Brain embolism, revisited.
Caplan LR
Neurology 1993 Jul;43(7):1281-7. doi: 10.1212/wnl.43.7.1281. PMID: 8327124

Clinical prediction guides

Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Soendergaard L, Song JK, Mas JL, Thaler DE
JAMA 2021 Dec 14;326(22):2277-2286. doi: 10.1001/jama.2021.20956. PMID: 34905030Free PMC Article
Eustachian valve, interatrial shunt, and paradoxical embolism.
Cai Q, Ahmad M
Echocardiography 2020 Jun;37(6):939-944. Epub 2020 May 19 doi: 10.1111/echo.14682. PMID: 32426851
Echocardiographic features of PFOs and paradoxical embolism: a complicated puzzle.
Aggeli C, Verveniotis A, Andrikopoulou E, Vavuranakis E, Toutouzas K, Tousoulis D
Int J Cardiovasc Imaging 2018 Dec;34(12):1849-1861. Epub 2018 Jun 28 doi: 10.1007/s10554-018-1406-1. PMID: 29956022
Patent foramen ovale and stroke.
Miranda B, Fonseca AC, Ferro JM
J Neurol 2018 Aug;265(8):1943-1949. Epub 2018 Apr 21 doi: 10.1007/s00415-018-8865-0. PMID: 29680895
An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke.
Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, Di Tullio MR, Lutz JS, Elkind MS, Griffith J, Jaigobin C, Mattle HP, Michel P, Mono ML, Nedeltchev K, Papetti F, Thaler DE
Neurology 2013 Aug 13;81(7):619-25. Epub 2013 Jul 17 doi: 10.1212/WNL.0b013e3182a08d59. PMID: 23864310Free PMC Article

Recent systematic reviews

Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis.
Rais G, Vassallo P, Schorer R, Bollen Pinto B, Putzu A
Br J Anaesth 2022 Dec;129(6):898-908. Epub 2022 Aug 18 doi: 10.1016/j.bja.2022.06.036. PMID: 35987705
The association between pulmonary hypertension and stroke: A systematic review and meta-analysis.
Shah TG, Sutaria JM, Vyas MV
Int J Cardiol 2019 Nov 15;295:21-24. Epub 2019 Jul 31 doi: 10.1016/j.ijcard.2019.07.085. PMID: 31402157
A Systematic Review of the Semi-Sitting Position in Neurosurgical Patients with Patent Foramen Ovale: How Frequent Is Paradoxical Embolism?
Klein J, Juratli TA, Weise M, Schackert G
World Neurosurg 2018 Jul;115:196-200. Epub 2018 Apr 26 doi: 10.1016/j.wneu.2018.04.114. PMID: 29704690
Patent foramen ovale and stroke in childhood: A systematic review of the literature.
Khan R, Chan AK, Mondal TK, Paes BA; Thrombosis and Hemostasis in Newborns (THIN) Group
Eur J Paediatr Neurol 2016 Jul;20(4):500-11. Epub 2016 Apr 28 doi: 10.1016/j.ejpn.2016.04.012. PMID: 27169856
Impending paradoxical embolism: systematic review of prognostic factors and treatment.
Myers PO, Bounameaux H, Panos A, Lerch R, Kalangos A
Chest 2010 Jan;137(1):164-70. Epub 2009 Jul 10 doi: 10.1378/chest.09-0961. PMID: 19592472

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