Abstract
BACKGROUND: Impending paradoxical embolism (IPDE) involves venous thrombi crossing a patent foramen ovale, posing high risks of systemic embolization. CASE PRESENTATION: 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. CONCLUSIONS: 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.