A patent foramen ovale provides a portal through which a thrombus might pass from the right side of the circulation to the left. A 65-year-old man underwent high tibial osteotomy after the diagnosis of the right knee osteoarthritis. On postoperative day 12, he developed bilateral arm paresthesia. Enhanced CT revealed emboli in the bilateral pulmonary and subclavian arteries and deep vein thrombosis in the left lower limb. Transesophageal echocardiography after treatment revealed a patent foramen ovale during the Valsalva maneuver. It was thought that bilateral arm paresthesias were caused by the arterial emboli in the bilateral subclavian arteries.
From the Advanced Critical Care Center, Gifu University Hospital, Gifu-shi, Gifu, Japan (Dr. Miyake, Dr. Okada, and Dr. Ogura); the Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Izunokuni, Shizuoka, Japan (Dr. Miyake, Dr. Obayashi, and Dr. Kanda); and the Department of Orthopaedic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan (Dr. Kaneko).
Correspondence to Dr. Miyake: firstname.lastname@example.org
None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Miyake, Dr. Obayashi, Dr. Kanda, Dr. Okada, Dr. Ogura, and Dr. Kaneko.
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