Clinical significance of a patent foramen ovale in patients with pulmonary embolism

Abstract

The phenomenon of a patent foramen ovale in patients with pulmonary embolism increases the risk of ischemic stroke. The clinical significance of this phenomenon should be taken into account to determine the diagnostic algorithm, management tactics and choice of secondary prevention. The prognosis of a patient with pulmonary embolism depends not only on the likelihood of recurrent pulmonary embolism, the formation of chronic pulmonary hypertension, but is also associated with an increased risk of ischemic stroke through the mechanism of paradoxical embolism due to the presence of a patent foramen ovale. A venous thrombus migrates through the patent foramen ovale as a result of the operation of an intracardiac right-left shunt. The purpose of the scientific review is to raise awareness of the problem of ischemic stroke in patients with pulmonary embolism. The results of studies and registries are presented, which reflect that the presence of patent foramen ovale increases the risk of developing ischemic stroke in patients with pulmonary embolism. Ischemic stroke can occur within 2–22 days after the onset of a pulmonary embolism clinic, and the risk of ischemic stroke remains within a year. Non-invasive transcranial dopplerography is recommended for diagnosis at the first stage of identification of the right-to-left shunt and is highly sensitive method (95–98%). Transesophageal echocardiography should be considered for the second stage of diagnosis. Thrombolytic therapy or surgical thrombectomy improves the prognosis for this category of patients. Тhrombolytic therapy may be given for up to 14 days in patients with pulmonary embolism. The use of thrombolytic therapy in the development of ischemic stroke becomes a possible option to improve the prognosis patients. The choice strategy for secondary prevention is important because patients have an increased risk of relapse.