Discontinuous-flow plasmapheresis and patent foramen ovale: a possible cause of paradoxical embolism

✍ Scribed by E. Vicenzini; M. Altieri; V. Di Piero; G. L. Lenzi

• Publisher: John Wiley and Sons
• Year: 2002
• Tongue: English
• Weight: 50 KB
• Volume: 17
• Category: Article
• ISSN: 0733-2459
• DOI: 10.1002/jca.10003

✦ Synopsis

Abstract

A 68‐year‐old woman was admitted for a subacute polyradiculoneuropathy and submitted to PE. A central right jugular venous access was placed after the third PE procedure due to a failing peripheral blood access. During the fourth PE, performed with a discontinuous‐flow system (continuous‐flow used for 3 procedures), she developed multiple embolic ischemic lesions in the left middle cerebral artery (MCA) territory. A thorough cerebrovascular screening showed only a patent foramen ovale (PFO). In our case, a possible increase of the right atrium blood pressure induced by the positive flux of the discontinuous‐flow PE could have been responsible for a paradoxical embolism through the PFO. Plasma exchange (PE) is used in several neurologic disorders. It is commonly thought to be a relatively safe procedure. However, a number of adverse events may occur: paradoxical embolism has not been reported to occur. J. Clin. Apheresis 17:47–48, 2002. © 2002 Wiley‐Liss, Inc.