Mama mia! PFO is still hot in 2009, some 450 papers added to pubmed this year, including this case.

J Forensic Leg Med. 2009 Nov;16(8):482-5. Epub 2009 Aug 7.
Paradoxical air embolism through patent foramen ovale during consensual intercourse in a non-pregnant young female.
Moreschi C, Da Broi U.

Department of Medical Morphological Research, Section of Forensic Medicine, University of Udine, Italy.

Sudden vaginal bleeding and a cardiac arrest occurred in a 18-year-old female during consensual intercourse. Resuscitation procedures, applied at the arrival of a medical emergency team, restored the cardiac function allowing admission to hospital, where two vaginal mucosal lacerations were diagnosed and sutured. Cardiological investigations diagnosed a left ventricle myocardial infarction and a patent foramen ovale while a brain CT scan showed ischemic signs and intravascular air images. Death occurred after 48 h, due to heart failure, cerebral anoxia and multiorgan failure. Autopsy confirmed a patent foramen ovale considered as responsible for a paradoxical air embolism. Judicial Authority evaluated the fatal paradoxical air embolism as a consequence of an unpredictable accident occurred during consensual intercourse without sexual violence.