Hans K. Meier-Ewert, MD, Sherif B. Labib, MD, Edgar C

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Paradoxical Embolism in the Left Main Coronary Artery: Diagnosis by Transesophageal Echocardiography Hans K. Meier-Ewert, MD, Sherif B. Labib, MD, Edgar C. Schick, MD, David E. Gossman, MD, Michael S. Stix, MD, Christina A. Williamson, MD Mayo Clinic Proceedings Volume 78, Issue 1, Pages 103-106 (January 2003) DOI: 10.4065/78.1.103 Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Angiogram of the left coronary artery showing obstruction of the left main segment by a radiolucency with occlusion of the left anterior descending coronary artery and obstruction of circumflex branches. C = catheter; Cx = circumflex coronary artery; Lm = left main coronary artery. Mayo Clinic Proceedings 2003 78, 103-106DOI: (10.4065/78.1.103) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Transesophageal echocardiogram. A, Thrombus traversing patent foramen ovale (small arrows) from right atrium into left atrium. B, Long-axis view of the ascending aorta, showing mobile echodensity in the ascending aorta with attachment to the left main coronary ostium (large arrow). Ao = ascending aorta; LA = left atrium; RA = right atrium; RPA = right pulmonary artery; Th = thrombus. Mayo Clinic Proceedings 2003 78, 103-106DOI: (10.4065/78.1.103) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 A, Thrombus removed from the left main coronary ostium showing molding of the embolus by the coronary artery anatomy, allowing clear distinction of left main coronary artery segment and bifurcation into left anterior descending and circumflex coronary branches (arrowhead). B, Thrombus removed from the right atrium. The region where the thrombus had lodged in the patent foramen ovale can be distinguished (arrow), as can the leading edge from which the emboli that traveled to the brain and coronary artery were presumably detached. Mayo Clinic Proceedings 2003 78, 103-106DOI: (10.4065/78.1.103) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions