Surgical treatment of a massive bilateral pulmonary embolus due to an entrapped thrombus in a patent foramen ovale: a case report

INTRODUCTION: Entrapped thrombus in a patent foramen ovale is a rare form of right heart thromboembolism. Various treatments have been used, such as anti-coagulation and thrombolytic therapy, vena cava filter, percutaneous thrombectomy and surgical embolectomy. CASE PRESENTATION: A 60-year-old Kosovan woman was admitted to our hospital with a massive bilateral pulmonary thromboembolism, entrapped thrombus in the patent foramen ovale and severe right ventricular dysfunction. The patient underwent on-pump beating-heart removal of the intracardiac thrombus and bilateral pulmonary embolectomy with the use of a Fogarty catheter. The patient’s post-operative course was uneventful. In this report, we describe for the first time in this pathology, to the best of our knowledge, a surgical strategy that seems to offer an excellent outcome in patients with severe right ventricular dysfunction. CONCLUSIONS: The chosen surgical technique, consisting of on-pump open beating-heart surgery, is a unique procedure in the treatment of an acute pulmonary thromboembolism and entrapped thrombus in a patent foramen ovale.