Vasculary Surgery

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Paradoxical Embolism:

Passage of a clot (thrombus) from a vein to an artery. When clots in veins break off (embolize) , they travel first to the right side of the heart and, normally, then to the lungs where they lodge. The lungs act as a filter to prevent the clots from entering the arterial circulation. However, when there is a hole in the wall between the two upper chambers of the heart (an atrial septal defect), a clot can cross from the right to the left side of the heart, then pass into the arteries as a paradoxical embolism. Once in the arterial circulation, a clot can travel to the brain, block a vessel there, and cause a stroke (cerebrovascular accident). Because of the risk of stroke from paradoxical embolism, it is usually recommended that even small atrial septal defects be repaired. Also called crossed embolism.

Symptoms include the following:

  • Dyspnea
  • Chest pain
  • Hemoptysis
  • Syncope
  • Unilateral weakness
  • Speech abnormality
  • Visual abnormality
  • Swallowing abnormality
  • Seizures


Intracardiac communication of the venous and arterial circulations can lead to paradoxical embolism (PDE), and this communication can occur via the following:

  • PFO
  • ASD
  • Pulmonary arteriovenous malformation
  • Ventricular septal defect
  • Ebstein anomaly
  • Patent ductus arteriosus

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