Complete surgical correction for impending paradoxical embolism with pulmonary embolism, tricuspid regurgitation, and atrial flutter.

Impending paradoxical embolism through a patent foramen ovale with concomitant pulmonary embolism is a rare entity that requires urgent treatment. We present the case of a 74-year-old woman with acute pulmonary embolism and atrial flutter and with echocardiographic features of impending paradoxical embolism through the patent foramen ovale and tricuspid regurgitation. We performed an open pulmonary embolectomy with removal of thrombus from both atria, closure of the patent foramen ovale, a right-sided modified Maze procedure, and De Vega's tricuspid annuloplasty. The patient made a satisfactory recovery. Surgical management is preferable in this setting because it provides the opportunity to correct any associated cardiac abnormalities.