Embolismo paradójico secundario a trombosis del septo interauricular en paciente con asistencia ventricular mecánica: una entidad raramente diagnosticada

A 59-year-old woman admitted to the ICU due to STEACS. Coronary angiography was performed that revealed total stenosis of the proximal anterior descending artery, and primary angioplasty was performed. During the procedure, hemodynamic instability warranting placement of an Impella device and later a VA ECMO device. Progressive improvement until both devices were decannulated on the tenth day of admission. Twenty-four hours after decannulation, motor focus was observed in the left upper limb. A transthoracic echocardiography was performed, appreciating a dense image with anarchic movement occupying the thickness of the interatrial septum. The transesophageal study confirmed the presence of a thrombus in a patent foramen ovale and an aneurysmal area of the interatrial septum which, in a situation of cardiogenic shock and atrial ectasia, entails an increased risk of paradoxical embolisms.