Abstract
Background
We previously described percutaneous thrombectomy and right ventricular mechanical support of a COVID-19 patient with a massive pulmonary embolism. Here we present a detailed echocardiographic and clinical timeline with 1 year follow-up.
Case Summary
A 57-year-old female with COVID-19 went into shock from a massive pulmonary embolism. After percutaneous removal of a large thrombus burden (AngioVac system; AngioDynamics Inc, Latham, NY, USA), she became severely hypotensive, requiring CPR, and was resuscitated with an Impella RP device (Abiomed, Danvers, MA, USA). A pediatric TEE probe monitored the procedure because an adult probe would not pass (S7-3t—Philips Medical Systems, Andover, MA, USA). Post thrombectomy, surface imaging documented gradual resolution of right ventricular dysfunction, tricuspid regurgitation, and elevated pulmonary artery pressure. Her course was complicated by renal failure requiring temporary dialysis. She was discharged home on apixaban. Hypercoagulability work-up was negative. Two months later, vocal cord surgery was performed for persistent stridor. Esophagoscopy at that time was prevented by osteophyte obstruction. At 10 months, she received the Pfizer-BioNTech vaccine. At one year, the patient remains healthy on apixaban, and her echocardiogram is normal.
Discussion
This case illustrates the pivotal role of echocardiography in the diagnosis, percutaneous treatment, and near- and long-term follow-up and management of a patient with massive pulmonary embolism due to COVID-19 with documentation of complete recovery from severe right ventricular dysfunction and hemodynamic collapse. A pediatric TEE probe was a crucial alternative to the adult probe because of possible osteophyte obstruction.
Functional limitation and right ventricular dysfunction at 6-month follow-up in patients with non-massive pulmonary embolism: useful outcomes for testing therapy of acute submassive pulmonary embolism?
