Fatal Paradoxical Embolus Due to a Central Venous Pressure

A case of paradoxical embolus that caused initial ischemic changes on the electrocardiogram monitor and later a massive myocardial infarction and cardiac arrest with death is presented. This occurred during a pulmonary wedge biopsy to determine the operability in a twenty-eight-year-old patient with ventricular septal defect and high pulmonary artery pressure diagnosed by catheterization. Autopsy revealed a long blood clot measuring 6 cm in length and 0.5 cm in width sitting and completely blocking the orifice of the left coronary artery. This caused the coronary insufficiency. A similar clot was found on the tip of the central venous pressure catheter when the right atrium was opened. The causes of and means of preventing this fatal complication in patients with left and right-heart communications are discussed in detail