Management of Paradoxical Coronary Embolism

To the Editor:I read with interest the dramatic case report by Egred et al.1 However, I was somewhat puzzled by the indication of a left internal mammary artery graft insertion into the left anterior descending coronary artery at the time of the emergency thromboembolectomy.Although the patient had suffered an anterolateral non–Q-wave myocardial infarction 2 months previously, coronary arteriography revealed essentially normal vasculature apart from mild (40%) plaque disease in the proximal left anterior descending coronary artery. The most likely cause of his myocardial infarction was paradoxical coronary embolism,2 because he had experienced paradoxical embolism to …