{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T11:10:40Z","timestamp":1778238640761,"version":"3.51.4"},"reference-count":7,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>Paradoxical coronary embolism (PCE) is an uncommon cause of acute myocardial infarction (AMI), typically occurring when venous thromboemboli cross a right-to-left shunt in the setting of elevated right-sided pressures. We report a case of mixed obstructive and cardiogenic shock caused by simultaneous pulmonary embolism (PE) and PCE. A previously healthy 43-year-old woman developed profound hypoxemia and inferior ST-segment elevation 3\u00a0days after knee surgery. Coronary angiography revealed distal right coronary artery occlusion, successfully treated with aspiration thrombectomy and percutaneous coronary intervention. Persistent hypoxemia, right ventricular injury, and hemodynamic collapse prompted initiation of venoarterial extracorporeal membrane oxygenation (VA ECMO). Subsequent imaging identified extensive bilateral PE and a patent foramen ovale with significant right-to-left shunting. Catheter-based pulmonary embolectomy improved cardiopulmonary function, followed by percutaneous PFO closure. She recovered fully and was discharged home neurologically intact. This case highlights the importance of early recognition, appropriate ECMO configuration, and comprehensive management of PCE with concurrent PE.<\/jats:p>","DOI":"10.1177\/02676591261424686","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T06:30:36Z","timestamp":1778049036000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal support for cardiorespiratory failure from paradoxical coronary and pulmonary embolism: A case report of mechanical support, revascularization, embolectomy, and shunt closure"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6015-4998","authenticated-orcid":false,"given":"Casey","family":"Carr","sequence":"first","affiliation":[{"name":"INTEGRIS Health Baptist Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Chrysant","sequence":"additional","affiliation":[{"name":"INTEGRIS Heart Hospital, INTEGRIS Health Baptist Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Phillips","sequence":"additional","affiliation":[{"name":"INTEGRIS Health Baptist Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S.","family":"Schoaps","sequence":"additional","affiliation":[{"name":"INTEGRIS Health Baptist Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Obaid","family":"Ashraf","sequence":"additional","affiliation":[{"name":"INTEGRIS Health Baptist Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura V.","family":"Swant","sequence":"additional","affiliation":[{"name":"INTEGRIS Health Baptist Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9323-0547","authenticated-orcid":false,"given":"Joseph M.","family":"Brewer","sequence":"additional","affiliation":[{"name":"INTEGRIS Health Baptist Medical Center"},{"name":"Queens University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60336-X"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.063"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.015134"},{"issue":"14","key":"e_1_3_6_5_2","first-page":"1097","article-title":"Management of patent foramen ovale in paradoxical embolism","volume":"96","author":"Rana BS","year":"2010","unstructured":"Rana BS, Thomas MR, Calvert PA, et al. Management of patent foramen ovale in paradoxical embolism. Heart 2010; 96(14): 1097\u20131104.","journal-title":"Heart"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705915"},{"issue":"3","key":"e_1_3_6_7_2","first-page":"889","article-title":"Mechanical circulatory support in massive pulmonary embolism","volume":"156","author":"Walmrath D","year":"1997","unstructured":"Walmrath D, Schmidt H, Winterhalter M, et al. Mechanical circulatory support in massive pulmonary embolism. Am J Respir Crit Care Med 1997; 156(3 Pt 1): 889\u2013894.","journal-title":"Am J Respir Crit Care Med"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/02676591231167713"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261424686","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591261424686","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261424686","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T10:46:19Z","timestamp":1778237179000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591261424686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":7,"journal-issue":{"issue":"1_suppl","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/02676591261424686"],"URL":"https:\/\/doi.org\/10.1177\/02676591261424686","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}