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Es erscheint pathophysiologisch plausibel, dass dieses Risiko durch Auftreten einer Knochenzementreaktion (\u201ebone cement implantation syndrome\u201c, BCIS) bei endoprothetischen Gelenkoperationen weiter zunimmt. Aber trotz einer PFO- bzw. BCIS-Inzidenz im jeweils zweistelligen Prozentbereich gibt es bisher keine Berichte \u00fcber die m\u00f6gliche Koinzidenz beider Komplikationen.<\/jats:p>\n                  <jats:p>Am Beispiel einer 81-j\u00e4hrigen PFO-Tr\u00e4gerin, die w\u00e4hrend einer H\u00fcfttotalendoprothese (H\u00fcft-TEP) ein BCIS erlitt und sich in der Folge eine paradoxe Embolie mit zerebralem Insult entwickelte, werden die pathophysiologischen Interaktionen beider Krankheitsbilder aufgezeigt. Anhand der aktuellen Literatur werden die daraus folgenden an\u00e4sthesiologischen Implikationen diskutiert und Empfehlungen abgeleitet.<\/jats:p>\n                  <jats:p>Die Wahrscheinlichkeit einer paradoxen Embolie bei endoprothetischem Gelenkersatz wird im Schrifttum mit gro\u00dfer Inkoh\u00e4renz angegeben, von 0\u202f% bis zu einem um den Faktor\u00a029 gesteigerten Risiko. Diese schwer vereinbarenden Befunde lassen sich dadurch erkl\u00e4ren, dass nicht alle stattfindenden Embolien auch klinisch sichtbar werden.<\/jats:p>\n                  <jats:p>F\u00fcr eine paradoxe Embolie sind zwei Voraussetzungen notwendig: Im ven\u00f6sen Gef\u00e4\u00dfsystem m\u00fcssen gasf\u00f6rmige oder korpuskul\u00e4re Emboli vorhanden sein, und es muss es zu einer Umkehr des physiologischen transforaminalen Links(L)\/Rechts(R)-Shunts zu einem pathologischen R\/L-Shunt kommen. Beide Mechanismen werden durch ein BCIS induziert, im Operationsgebiet werden Emboli freigesetzt und durch einen Anstieg des pulmonalvaskul\u00e4ren Widerstands (PVR) entsteht ein R\/L-Shunt. Die Gefahr einer paradoxen Embolie nimmt zu. Die an\u00e4sthesiologischen prophylaktischen und therapeutischen M\u00f6glichkeiten zur Intervention sind begrenzt. Bei postoperativen neurologischen oder h\u00e4modynamischen Auff\u00e4lligkeiten ist deshalb eine sofortige umfassende Diagnostik zur Abkl\u00e4rung unverzichtbar.<\/jats:p>","DOI":"10.1007\/s00101-026-01706-x","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T11:32:16Z","timestamp":1781868736000},"page":"771-779","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patent foramen ovale, bone cement implantation syndrome and paradoxical embolism","Offenes Foramen ovale, Knochenzementreaktion und paradoxe Embolie"],"prefix":"10.1007","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8685-0927","authenticated-orcid":false,"given":"Ludwig","family":"Brandt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Artmeier-Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klara Luisa","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"issue":"S","key":"1706_CR1","doi-asserted-by":"publisher","first-page":"3119","DOI":"10.1161\/STROKEAHA.120029350","volume":"51","author":"DM Kent","year":"2020","unstructured":"Kent\u00a0DM, Saver\u00a0JL, Ruthazer\u00a0R et\u00a0al (2020) Risk of paradoxical embolism (RoPE) - estimated attributable fraction correlates with the benefit of patent foramen ovale closure: An analysis of 3 trials. 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