Transjugular patent foramen ovale closure in a young patient with stroke caused by inferior vena cava thrombus: a different method with balloon anchor support to pulmonary vein

Abstract

AbstractPatent foramen ovale closure is recommended for patients who are at risk for recurrent paradoxical embolism and cryptogenic stroke. The standard technique of patent foramen ovale closure is established from the femoral vein. However, alternative methods may be necessary for patent foramen ovale closure as in every interventional procedure. A 45-year-old female patient with an intramural giant uterine myoma had a history of recurrent deep vein thrombosis and stroke. A diffuse thrombus was detected in both iliac veins associated with inferior vena cava compression of the myoma. Also, a patent foramen ovale was revealed on echocardiography as a cause of embolic events. Hysterectomy was initially planned by gynaecology, but due to the possible risk of embolisation of inferior vena cava thrombus and stroke after removal of the compressive mass during hysterectomy, initial patent foramen ovale closure and then hysterectomy was scheduled in the Gynecology-Cardiology-Cardivascular Surgery council. Patent foramen ovale closure was performed via the right jugular vein approach. But because of the tight left atrial ostium of the patent foramen ovale, the catheter could not pass to the left atrium from the right atrium. With an anchor of a 5.0 × 15 mm coronary balloon over a 0.014-inch guidewire to the pulmonary vein, we were able to reach the left atrium. The patent foramen ovale was closed successfully, and the patient underwent a hysterectomy after closure without any embolic event. The patient was asymptomatic at 6 months of control.