ABSTRACT
A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to 'think horses and not zebras', and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.
Subject(s)
COVID-19/diagnosis , Chest Pain/physiopathology , Dyspnea/physiopathology , Heart Septal Defects, Atrial/diagnostic imaging , Hypertension, Pulmonary/diagnostic imaging , Hypertrophy, Right Ventricular/diagnostic imaging , Persistent Left Superior Vena Cava/diagnostic imaging , Scimitar Syndrome/diagnostic imaging , Adult , Cardiac Catheterization , Chest Pain/etiology , Computed Tomography Angiography , Coronary Angiography , Diagnosis, Differential , Dilatation, Pathologic/complications , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/physiopathology , Dyspnea/etiology , Echocardiography , Electrocardiography , Female , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Atrial/physiopathology , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/physiopathology , Hypertrophy, Right Ventricular/complications , Hypertrophy, Right Ventricular/physiopathology , Magnetic Resonance Imaging , Persistent Left Superior Vena Cava/complications , Persistent Left Superior Vena Cava/physiopathology , SARS-CoV-2 , Scimitar Syndrome/complications , Scimitar Syndrome/physiopathology , Tomography, X-Ray Computed , Ventricular PressureABSTRACT
Bell's palsy is an acute facial paralysis with known association to viral infections. We describe a medically complex 6-year-old male with hyper IgM syndrome who presented with unilateral facial droop and positive SARS-CoV-2 RT-PCR. This is the first reported pediatric case of Bell's palsy in the setting of SARS-CoV-2 infection.
Subject(s)
Abnormalities, Multiple , Bell Palsy/complications , COVID-19/complications , Hyper-IgM Immunodeficiency Syndrome/complications , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Asthma/complications , Bell Palsy/diagnosis , Bell Palsy/drug therapy , COVID-19/diagnosis , Child , Cleft Palate/complications , Gastrostomy , Glucocorticoids/therapeutic use , Heart Septal Defects, Atrial/complications , Heart Septal Defects, Ventricular/complications , Humans , Hyper-IgM Immunodeficiency Syndrome/drug therapy , Hypospadias/complications , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Male , Prednisolone/therapeutic use , SARS-CoV-2 , Sleep Apnea, Obstructive/complicationsABSTRACT
OBJECTIVE: To explore the effect of atrial septal defect (ASD) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the treatment of ARDS combined with left ventricular dysfunction (LVD) to find a new effective method for treating severe COVID-19 patients. MATERIALS AND METHODS: Five large animal ARDS models of sheep were established by intravenous injection of Lipopolysaccharide. ASD was made under general anesthesia and VA-ECMO was simulated by extracorporeal circulation machine. The oxygenation of peripheral blood, systemic circulation, and cardiac function were observed under conditions of closed and opened ASD, and the significance of ASD shunt in improving cardiopulmonary function was evaluated. RESULTS: With ASD closed, the atrial shunts disappeared, the peripheral artery pressure of oxygen(PaO2): 141.2±21.4mmHg, the oxygenation index (PaO2/FiO2): 353.0±53.5, the mean blood pressure (MAP): 49.3±13.5 mmHg, the heart was full; with ASD opened, the left-to-right shunt was observed, PaO2: 169.3±18.9mmHg, PaO2/FiO2: 423.3±47.3, MAP: 68.2±16.1 mmHg, the range of cardiac motion significantly increased, heart beat was powerful, and systemic circulation significantly improved. Statistical analysis showed that there were significant differences between opened and closed ASD (P < .01). CONCLUSION: ASD plus VA-ECMO is an effective method for the treatment of ARDS combined with LVD, which is the main cause of death in severe COVID-19 patients. However, further clinical validation is needed.