Paradoxical embolism via an atrial septal defect: in flagrante delicto

Lindsay E M Reid, Dana K Dawson

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


A 76-year-old woman presented with acute lower limb ischemia. Transthoracic echocardiography showed highly mobile structures present in both atria. Transesophageal echocardiography (TEE) demonstrated a single fusiform mass straddling the interatrial septum (A) and extending through both the mitral (B) and the tricuspid valve (C, white arrows). Repeat TEE following 6 months of anticoagulation revealed a 3-mm secundum atrial septal defect (D, Online Videos 1A, 1B, 1C, and 1D). Paradoxical embolism is well described in the presence of patent foramen ovale. A possible association with atrial septal defects was recently raised in a retrospective study (1 A. Bannan, R. Shen, F.E. Silvestry and H.C. Herrmann, Characteristics of adult patients with atrial septal defects presenting with paradoxical embolism. Catheter Cardiovasc Interv, 74 (2009), pp. 1066–1069. | View Record in Scopus | | Full Text via CrossRef | Cited By in Scopus (3)1). This report brings confirmatory evidence to support this association. This could have management implications in a subgroup of patients with atrial septal defect. In this case, we prescribed lifelong oral anticoagulation.
Original languageEnglish
Pages (from-to)e43
Number of pages1
JournalJournal of the American College of Cardiology
Issue number22
Early online date16 Nov 2010
Publication statusPublished - 23 Nov 2010


  • aged
  • embolism, paradoxical
  • female
  • heart septal defects, atrial
  • humans


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