Difficult Cases and Complications from the Catheterization Laboratory: PFO Device Embolization and Settling in the Distal Aorta

A 40-year-old female patient without clinical risk factors for stroke experienced a short episode of hemiparesis. CT and MR imaging revealed multiple small ischemic lesions of both cerebral hemispheres. Neurological testing showed decreased short-term memory and attention. Coagulopathy screen and cardiac rhythm monitoring were negative. A persistent foramen ovale (PFO) was evident on transesophageal echocardiography and a spontaneous right-to-left shunting was demonstrated using agitated saline contrast. The atrial septum was found to be aneurysmal with a maximum excursion of 12 mm. No other structural abnormalities were noted. Paradoxical embolism was considered a probable cause for the multiple cerebral lesions. The patient was offered device closure of the PFO, which she accepted.