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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 65-year-old woman was admitted to the hospital with fever and decompensated heart failure&#46; She had long-lasting peripheral venous insufficiency and had been experiencing heart failure symptoms for six months&#46; She had no history of hypertension&#44; diabetes mellitus&#44; coronary heart disease&#44; atrial fibrillation&#44; stroke or transient ischemic attack&#46; Six days after admission&#44; she developed acute pulmonary edema&#46; A transesophageal echocardiography &#40;TEE&#41; revealed severe left ventricular dysfunction and an intracardiac thrombus measuring 5-6 cm&#44; traversing a small patent foramen ovale &#40;PFO&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Unfractionated heparin was promptly initiated&#46; Nevertheless&#44; one week later&#44; she woke up aphasic with right-sided hemiparesis&#46; A brain computed tomography scan showed a left hemispheric stroke&#44; while the patient&#39;s blood work&#44; a cervical duplex scan and cardiac catheterization revealed no significant findings&#46; The TEE was repeated and a smaller thrombus found &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; Two months after discharge&#44; the thrombus was undetectable &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">PFO is not considered to be a major cause of cardioembolic stroke&#44; especially in the elderly&#44; since other potential causes exist&#46; Our case&#44; however&#44; shows that a causative thrombus resulting from a paradoxical PFO embolism could be detected before giving rise to a stroke&#46; This case is important as it allowed direct thrombus imaging within the PFO before it led to a stroke&#44; which is not always possible&#44; as well as revealing a smaller thrombus trapped inside the PFO after the stroke&#46; The first thrombus visualized probably arose from the venous system of the lower limbs and passed through a small ostium&#44; giving us the exceptional opportunity to prove the stroke&#39;s cardioembolic etiology through a PFO in an elderly patient&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Image in Cardiology
Patent foramen ovale may not always be benign in the elderly
Foramen oval patente pode não ser sempre benigno no idoso
Ana Airesa,b,
Autor para correspondência
ana.aires.mail@gmail.com

Corresponding author.
, Nuno Oliveirac, Filipe Macedob,c, Elsa Azevedoa,b
a Department of Neurology, São João Hospital Center, Porto, Portugal
b Faculty of Medicine, University of Porto, Porto, Portugal
c Department of Cardiology, São João Hospital Center, Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 65-year-old woman was admitted to the hospital with fever and decompensated heart failure&#46; She had long-lasting peripheral venous insufficiency and had been experiencing heart failure symptoms for six months&#46; She had no history of hypertension&#44; diabetes mellitus&#44; coronary heart disease&#44; atrial fibrillation&#44; stroke or transient ischemic attack&#46; Six days after admission&#44; she developed acute pulmonary edema&#46; A transesophageal echocardiography &#40;TEE&#41; revealed severe left ventricular dysfunction and an intracardiac thrombus measuring 5-6 cm&#44; traversing a small patent foramen ovale &#40;PFO&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Unfractionated heparin was promptly initiated&#46; Nevertheless&#44; one week later&#44; she woke up aphasic with right-sided hemiparesis&#46; A brain computed tomography scan showed a left hemispheric stroke&#44; while the patient&#39;s blood work&#44; a cervical duplex scan and cardiac catheterization revealed no significant findings&#46; The TEE was repeated and a smaller thrombus found &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; Two months after discharge&#44; the thrombus was undetectable &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">PFO is not considered to be a major cause of cardioembolic stroke&#44; especially in the elderly&#44; since other potential causes exist&#46; Our case&#44; however&#44; shows that a causative thrombus resulting from a paradoxical PFO embolism could be detected before giving rise to a stroke&#46; This case is important as it allowed direct thrombus imaging within the PFO before it led to a stroke&#44; which is not always possible&#44; as well as revealing a smaller thrombus trapped inside the PFO after the stroke&#46; The first thrombus visualized probably arose from the venous system of the lower limbs and passed through a small ostium&#44; giving us the exceptional opportunity to prove the stroke&#39;s cardioembolic etiology through a PFO in an elderly patient&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2018.05.012
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