A paradoxical emboli occurs when a thrombus from venous circulation crosses an intracardiac defect into systemic circulation.
The underlying etiology is when the right heart pressure exceeds the left heart pressure in a pt with ASD, VSD, or PFO. Ultimately, a shunt reversal that results in Eisenmenger Syndrome.
ASD, VSD, and PFO should all be correct answers for this card.
Please resubmit with an acceptable source. Please review suggestion guidelines, specifically rule #1: https://community.ankihub.net/t/anking-step-deck-submission-guidelines/166504
I'm also not sure your suggestion is correct based on my understanding of Eisenmenger syndrome and paradoxical embolism. At the very least, PFO is the common cause of embolic stroke in the context of DVT and thus the card is still correct. https://next.amboss.com/us/article/iJ0JFS#Zb35dc0d441c16d3b6d78d6aa995c96fe
But definitely resubmit if you find one of the accepted sources saying otherwise!