Conclusions

Catheter-directed interventions have transformed the management of massive and submassive PE. However, we presented a case where surgical embolectomy was preferred over catheter-directed interventions with an excellent outcome. In our opinion, surgical embolectomy can potentially prove to be a critical life-saving intervention in this subgroup of patients with acute PE and clot-in-transit/PFO. This not only prevented systemic embolization from clot-breaking but also avoided further paradoxical embolism by surgically closing the PFO, as other clots in the venous system can easily migrate from the right side of the heart through the PFO into the systemic circulation.