Paradoxical embolism in bilateral total knee arthroplasty: a case report.

Paradoxical embolism is defined as venous thrombosis causing systemic embolization through a right-to-left shunt. We, herein, report a case of bilateral total knee arthroplasty and developed paradoxical embolism caused by patent foramen ovale. A sixty-two-year-old female had a simultaneous, total knee arthroplasty for primary osteo-arthritis. A pulmonary emboli was suspected on the thirteenth post operative day. Two days later, acute arterial insufficiency at her leg was suspected. An embolectomy and intra-operative tranesophageal echocardiogram was performed. It showed patent foramen ovale (PFO) 2-3 mm. Five days after embolectomy, she developed infarction lesion at the right occipital area. The foramen ovale was closed with a closure device nineteen days later. The patient eventually could walk using a walker. She was discharged thirty-six days after the operation.