Fatal disseminated paradoxical embolism in inferior sinus venosus atrial septal defect

Authors

  • Zul Khairul Azwadi Ismail
  • Khairil Amir Sayuti
  • Mohd Shafie Abdullah

DOI:

https://doi.org/10.32896/cvns.v3n4.1-6

Keywords:

arteriovenous shunting, pulmonary embolism, limbs ischaemia, arteriovenous, shunting, pulmonary, embolism, ischaemia, limb, cardiac, CT, Computed, Tomography

Abstract

Inferior sinus venosus arterial septal defect (ASD) is a rare congenital cardiac anomaly. As with other types of ASDs and patent foramen ovale (PFO), this defect results in arteri-venous shunting with the risk of developing paradoxical embolism (PDE) to the systemic circulation from venous emboli. We report  a case of a 67-year-old lady presented to emergency department (ED) with massive pulmonary embolism (PE) and recurrent acute limb ischaemia. On CT pulmonary angiography (CTPA), an incidental finding of inferior sinus venosus ASD was discovered that has caused the PDE. Thrombolysis was administered followed by open mechanical thrombectomy. The patient developed massive lower gastrointestinal bleed post thrombolysis then passed away despite embolization. This case report describes the catastrophic effect of  PDE to cause disseminated multisystem thromboembolism. It also emphasizes the importance of early detection of a possible right-to-left shunt in patients presented with recurrent acute limb ischaemia. Transthoracic echocardiography has reduced sensitivity for inferior sinus venosus ASD requiring further assessment with transoesophageal echocardiography in selected cases.

Author Biographies

Zul Khairul Azwadi Ismail

Department of Radiology, Universiti Sains Malaysia, School of Medical Sciences, Kota Bharu, Kelantan, Malaysia.
Hospital Universiti Sains Malaysia, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia.

Khairil Amir Sayuti

Department of Radiology, Universiti Sains Malaysia, School of Medical Sciences, Kota Bharu, Kelantan, Malaysia.
Hospital Universiti Sains Malaysia, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia.

Mohd Shafie Abdullah

Department of Radiology, Universiti Sains Malaysia, School of Medical Sciences, Kota Bharu, Kelantan, Malaysia.
Hospital Universiti Sains Malaysia, Universiti Sains Malaysia Health Campus, Kota Bharu, Kelantan, Malaysia.

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Published

01-12-2021

How to Cite

Ismail, Z. K. A., Sayuti, K. A. ., & Abdullah, M. S. . (2021). Fatal disseminated paradoxical embolism in inferior sinus venosus atrial septal defect . Journal Of Cardiovascular, Neurovascular & Stroke, 3(4), 1–6. https://doi.org/10.32896/cvns.v3n4.1-6