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

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.

Fatal superior mesenteric vein thrombosis due to acute Appendicitis in an elderly patient

Superior mesenteric vein thrombosis (SMVT) is a rare complication of acute appendicitis. It has no specific clinic manifestation. Anticoagulation, antibiotics and surgery are the main treatment pillars. We report herein a case of an 86-years-old women treated for acute appendicitis complicated with SMVT and massive pulmonary embolism.

PULMONARY EMBOLISM AFTER SURGICAL RESECTION OF A MENINGIOMA

В статье представлен клинический случай успешного лечения острой массивной тромбоэмболии лёгочной артерии у пациента после удаления менингиомы. Известно, что частота тромбозов глубоких вен нижних конечностей (ТГВ) в нейрохирургической практике достаточно высока, и может достигать 25-34%. ТГВ является основной причиной более грозной тромбоэмболии легочной артерии (ТЭЛА), частота которой составляет от 1,5% до 3%. На сегодняшний день медицина располагает несколькими эффективными инструментами лечения пациентов с ТЭЛА: от антикоагулянтной терапии до хирургических методов реперфузии. Благодаря слаженной работе в современных многопрофильных клиниках интервенционных кардиохирургов, реаниматологов и нейрохирургов, обеспечивающих своевременную и высокоспециализированную помощь, становится возможным спасение жизней пациентов даже с такой тяжелой и жизнеугрожающей патологией как острая массивная тромбоэмболия легочных артерий. The article presents a clinical case of successful treatment of acute massive pulmonary embolism in a patient after resection of a meningioma. The incidence of Deep vein thrombosis (DVT) in neurosurgical practice is astonishingly high as it might reach 25-34% in some reports, and represents the first cause for pulmonary embolism (PE), which incidence is thought to be between 1,5% and 3%. Nowadays there are several options for treating patients with pulmonary embolism: from anticoagulant therapy to surgical methods of reperfusion. Effective multidisciplinary teams and coordinated team in our clinics can save the lives of people with pulmonary embolism.

232 A multidisciplinary case of multiple myeloma with cardiac and renal involvement: a look beyond amyloidosis

Aims Multiple myeloma (MM) is a malignant neoplasm with a frequent cardiac involvement characterized by restrictive cardiomyopathy. Kidney and thromboembolic complications are also described. Methods and results A 52-year-old woman with a history of kidney disease was admitted to nephrology department due to worsening of renal function and refractory hypertension. A bone marrow biopsy revealed the diagnosis of MM. A renal and fat pad biopsy with Congo red staining was performed but amyloid deposition was not observed. Increased cardiac enzymes suggested a cardiac involvement. Indeed, two intracardiac right-sided masses and massive pulmonary embolism were detected. Surgical cardiac intervention was promptly performed and a chemotherapy regimen was started. Meantime, a kidney biopsy revealed a light-chain deposition disease. Conclusions This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, in patients with not acute massive pulmonary embolism and intracardiac right masses, surgical pulmonary embolectomy should be promptly performed to preserve RV function and to avoid prevent pulmonary hypertension development.

Hormonal Contraception and Massive Pulmonary Embolism in a COVID-19 Ambulatory Patient: A Case Report

Coronavirus 19 disease (COVID-19) presents a highly variable clinical presentation and course, ranging from asymptomatic patients to rapidly progressive, fatal pneumonia. The known heterogeneous outcomes can affect both previously healthy patients and those with significant comorbidities, who develop clinical courses with possibly more multisystemic compromise. Likewise, the development of thrombotic phenomena during the acute course of the disease is associated with complications that worsen patient prognosis. We present a case report of a 45-year-old multiparous patient with a history of overweight and chronic use of oral hormonal contraception with low doses of levonorgestrel and estradiol as the only risk factors favoring the development of thrombotic events. During her outpatient COVID-19 clinical course, she developed massive pulmonary thromboembolism resulting in secondary obstructive shock, which required pharmacological thrombolysis. At discharge, hormonal contraception was considered contraindicated, and the patient was released from our institution with continued oral anticoagulant therapy. COVID-19 infection, contraceptive hormone therapy, and overweight are known risk factors for the development of thromboembolic events. The impact of their concomitance has not been studied to date. From our experience, we discuss the impact these risk factors have when present together and invite others to report similar cases.