Recurrent paradoxical embolism complicating severe thromboembolic pulmonary hypertension

A patient with a three-year history of recurrent pulmonary embolismis presented. Thromboembolic pulmonary hypertension was provenin the final stage of disease in the presence of repeated episodesof systemic embolic events. Paradoxical embolism was assumedto be present on the basis of blood-gas analysis and contrastechocardiography that demonstrated a right-to-left shunt atatrial level. Autopsy revealed a patent foramen ovale and providedstrong evidence for the accuracy of the clinical diagnosis.