# Transesophageal echocardiography as the final defense in impending paradoxical embolism: a case report

## TL;DR

A case report shows how transesophageal echocardiography (TEE) helped diagnose and guide surgery for a life-threatening heart condition.

## Contribution

The paper highlights TEE as a critical diagnostic and decision-making tool for impending paradoxical embolism during surgery.

## Key findings

- Intraoperative TEE diagnosed impending paradoxical embolism and acute pulmonary embolism in a patient.
- Real-time TEE findings led to a change in surgical approach, including pulmonary artery thrombectomy.
- Routine use of TEE is recommended to improve outcomes in similar cases.

## Abstract

Impending paradoxical embolism (IPDE) involves venous thrombi crossing a patent foramen ovale, posing high risks of systemic embolization.

A 64-year-old male was admitted to the operation theater due to heart failure symptoms, with the original plan of undergoing atrial mass resection and mitral valve replacement. Intra—operative transesophageal echocardiography (TEE) diagnosed the patient with IPDE and acute pulmonary embolism. And this critical diagnosis immediately altered the surgical decision-making process, which included pulmonary artery thrombectomy. The successful treatment of this case was significantly attributed to the intraoperative TEE examination, which provided essential real—time diagnostic information guiding the surgical approach. This case highlighted the importance of intra-operative TEE in management of IPDE for surgical planning.

TEE is the final defense in IPDE. To optimize surgical outcomes and avert misdiagnosis, routine utilization of intraoperative TEE is highly recommended for similar cases.

The online version contains supplementary material available at 10.1186/s13019-025-03386-x.