{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T23:32:35Z","timestamp":1778542355952,"version":"3.51.4"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Pulmonary embolism (PE) is the leading cause of in-hospital death and the third most frequent cause of cardiovascular death. The clinical presentation of PE is variable, and choosing the appropriate treatment for individual patients can be challenging.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 64-year-old man presented to hospital with acute chest pain, shortness of breath, and pulmonary oedema. Electrocardiogram revealed ST-elevation myocardial infarction. D-dimer was 18.8\u2005mg\/L fibrinogen equivalent units (FEU) (normal &amp;lt;0.64), and troponin was 25 (normal 5\u201314\u2005ng\/L). After systemic thrombolysis, respiratory failure persisted, and the arterial blood gas showed PaO2 of 6.0\u2005kPa (normal 10.5\u201313.5\u2005kPa), with 100% oxygen delivery via high-flow nasal cannula. A computed tomography diagnosed bilateral lobar PE, and coronary angiogram showed multiple thrombus in the right coronary artery. A bubble study with thoracic echocardiogram revealed a large right\u2013left inter-atrial shunt. The patient denied treatment with extracorporeal membrane oxygenation and surgical thrombectomy. With no access to percutaneous catheter-directed thrombectomy, the patient received three separate thrombolysis treatments followed by a continued infusion for 22\u2005h. After 6 weeks in hospital, the patient was discharged to rehab.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>For a long time, PE has been largely seen as a medical disease. Intra-cardiac shunts such as patent foramen ovale can complicate thrombo-venous disease and introduce paradoxical shunts leading to arterial emboli and persistent hypoxaemia. Over recent years, modern percutaneous catheter-directed thrombectomy has been developed for both high-risk and intermediate to high-risk PEs. Thrombectomy might improve right ventricular function and haemodynamics, but there is lacking evidence from randomized trials on efficacy, safety, and long-term outcome.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae133","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T16:29:29Z","timestamp":1710433769000},"source":"Crossref","is-referenced-by-count":3,"title":["Pulmonary embolism with paradoxical embolization to right coronary artery in the presence of a large patent foramen ovale: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0738-5321","authenticated-orcid":false,"given":"Erik","family":"Boberg","sequence":"first","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute , Entrev\u00e4gen 2, 182 88 Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0044-1485","authenticated-orcid":false,"given":"Anders","family":"Hedman","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute , Entrev\u00e4gen 2, 182 88 Stockholm , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3100-9716","authenticated-orcid":false,"given":"Jacob","family":"Hollenberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Center for Resuscitation Science, Karolinska Institute , Entrev\u00e4gen 2, 182 88 Stockholm , 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development of novel evidence: a scientific statement from the American Heart Association","volume":"140","author":"Giri","year":"2019","journal-title":"Circulation"},{"key":"2024043014111552000_ytae133-B10","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.jcin.2018.12.022","article-title":"A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study","volume":"12","author":"Tu","year":"2019","journal-title":"JACC Cardiovasc Interv"}],"container-title":["European Heart Journal - Case 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