scholarly journals Percutaneous thrombectomy and right ventricular mechanical circulatory support for pulmonary embolism in a COVID-19 patient: Case report, one-year update, and echocardiographic findings

2022 ◽  
Author(s):  
Gerald I Cohen ◽  
Theodore Schreiber ◽  
Hemindermeet Singh ◽  
Amir Kaki
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism ◽  
Circulatory Support ◽  
Medical Systems ◽  
One Year ◽  
Percutaneous Thrombectomy

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.

scholarly journals Predictive value of plasma copeptin level for diagnosis and mortality of pulmonary embolism

2020 ◽  
Vol 66 (12) ◽  
pp. 1645-1650
Author(s):  
Caglar Ozmen ◽  
Onur Sinan Deveci ◽  
Muhammet Bugra Karaaslan ◽  
Oya Baydar ◽  
Anil Akray ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Right Ventricular ◽  
Sensitivity And Specificity ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Copeptin Level ◽  
One Year ◽  
The One

SUMMARY OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.

Right Ventricular Dysfunction and Pulmonary Obstruction Index at Helical CT: Prediction of Clinical Outcome during 3-month Follow-up in Patients with Acute Pulmonary Embolism

Radiology ◽  
2005 ◽  
Vol 235 (3) ◽  
pp. 798-803 ◽  
Author(s):  
Rutger W. van der Meer ◽  
Peter M. T. Pattynama ◽  
Marco J. L. van Strijen ◽  
Annette A. van den Berg-Huijsmans ◽  
Ieneke J. C. Hartmann ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Outcome ◽  
Right Ventricular ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Helical Ct

Biomarker-based strategy for screening right ventricular dysfunction in patients with non-massive pulmonary embolism

2006 ◽  
Vol 33 (2) ◽  
pp. 286-292 ◽  
Author(s):  
Damien Logeart ◽  
Lucien Lecuyer ◽  
Gabriel Thabut ◽  
Jean-Yves Tabet ◽  
Jean-Michel Tartière ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism

Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism

2009 ◽  
Vol 5 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Domenico Rendina ◽  
Silvana De Bonis ◽  
Giovanni Gallotta ◽  
Vincenzo Piedimonte ◽  
Giuseppe Mossetti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism

scholarly journals Case of a floating right atrial thrombus successfully treated with fibrinolysis

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Chloé Bernard ◽  
Olivier Bouchot ◽  
Marjolaine Georges ◽  
Marie Catherine Morgant
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Anticoagulation Therapy ◽  
Right Ventricular Dysfunction ◽  
Blood Gases ◽  
Good Alternative ◽  
Massive Pulmonary Embolism ◽  
Medical Emergency ◽  
Right Atrial

Mobile right atrial thrombi are at high risk of causing massive pulmonary embolism and are a medical emergency. This type of thrombus is identified in about 4-18% of pulmonary embolism cases. The presence of a free-floating embolic mass in right atrial or ventricle is often mortal: the death rate can reach 27%. Although surgery is commonly indicated, fibrinolysis is a therapeutic alternative. Here, a 58-year-old man presented to the emergency department for acute dyspnea associated with a painful right leg. Initial exams showed a shunt effect on blood gases with increased brain natriuretic peptide. Transthoracic echography (TTE) found a free-floating thrombus in the right atrium with signs of pulmonary hypertension and right ventricular dysfunction. Bilateral pulmonary embolism was confirmed by computed tomography angiography. Because there were signs of acute cor pulmonale and no contraindications, treatment with systemic fibrinolysis was decided. The treatment was delivered in intensive care unit and a cardiac surgical team was available. Subsequent clinical improvement was observed. TTE follow up at 12 hours revealed complete thrombus dissolution. There were no complications, in particular no hemorrhage. The patient was discharged after eleven days. At 6 months of follow-up, outcomes with oral anticoagulation therapy were satisfactory. Scintigraphy found good symmetrical perfusion of both lungs with stackable ventilation. TTE at 1 year showed preserved left and right ventricular function with no sign of pulmonary arterial hypertension and no thrombus recurrence. Systemic fibrinolysis appears to be a good alternative to surgery in this case.

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