Spontaneous closure of a patent foramen ovale and disappearance of impending paradoxical embolism after fibrinolytic therapy in the course of massive pulmonary embolism

Our case suggests that a negative transesophageal contrast echocardiographic study during stable hemodynamic conditions does not definitively rule out the possibility of a functional PFO with transient right-to-left shunting in situations of increased right heart pressures. In addition, we confirm that thrombolysis can be considered as an alternative to surgery in high risk patients with impending paradoxical embolism. The risk to benefit ratio of this choice, however, should be individually evaluated.