Paradoxical embolism is often a presumptive diagnosis as definitive evidence of venous thrombi, arterial embolism and a clot traversing a cardiac defect is extremely uncommon. We present a rare case report of a patient diagnosed with paradoxical embolism, in whom a thrombus-in-transit through a patent foramen ovale was identified.

Infective endocarditis still has significant morbimortality, despite diagnostic and therapeutic improvements. We describe a case of a 67-year-old man with recurrent prosthetic aortic valve infective endocarditis complicated by massive local tissue damage, making valve replacement unfeasible. Although rarely performed in this setting, heart transplantation was a needed salvage strategy, highlighting the need to make bold decisions for complex clinical scenarios.