Thrombus through a patent foramen ovale: a direct cause of cardioembolic stroke and pulmonary embolism.

d t R c e We report the case of a 79-year-old man hospitalized for stroke. The patient had hypertension and dyslipidemia and the ECG revealed previously unknown atrial fibrillation. A transthoracic echocardiogram (TTE) was performed two days after admission to exclude an embolic source. This showed marked dilatation of the right cavities, systolic--diastolic flattening of the interventricular septum (IVS) (Figure 1, panel A) and depressed right ventricular systolic function (S′: 8 cm/s; 3D ejection fraction: 18%) (Figure 1, panel D; Video 1). The left ventricle was small and compressed by the bulging IVS; no other wall motion abnormalities were observed. There was a large thrombus 35 mm × 19 mm in size on the right atrium (RA) lateral wall (Figure 1, panel B), and another thrombus 40 mm in length through the patent foramen ovale (PFO) (Figure 1, panel C; Video 2). The patient underwent thoracic CT angiography that confirmed signs of chronic pulmonary embolism and assessed