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- Received November 12, 2010
- Revision received January 6, 2011
- Accepted January 11, 2011
- Published online October 25, 2011.
A 69-year-old woman presented with acute inferior ST-segment elevation myocardial infarction (A). Coronary angiography revealed an occlusion of the dominant left circumflex coronary artery (B), with otherwise healthy vessels. A 35-mm embolus was retrieved via aspiration through the guide catheter, with an excellent result in the left circumflex (C, Online Video 1). Because dyspnea had preceded chest pain, pulmonary angiography was performed, showing a floating embolus in the left pulmonary artery (LPA) and occlusion of various segmental branches (D, Online Videos 2 and 3). Under the assumption of a paradoxical embolism to the left circumflex, a patent foramen ovale was sought under fluoroscopic guidance, found, and closed ad hoc with a 25-mm Amplatzer (AGA Medical Corporation, Plymouth, Minnesota) closure device (E).
As this case demonstrates, with elevated right ventricular filling pressures, a patent foramen ovale may act as a detrimental pathway for paradoxical embolism not only to the brain but also to the coronary arteries, so ad hoc percutaneous closure should be considered. LA = left atrium; RA = right atrium.
- Received November 12, 2010.
- Revision received January 6, 2011.
- Accepted January 11, 2011.
- American College of Cardiology Foundation