ABSTRACT
BACKGROUND: COVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both. CASE PRESENTATION: A 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated. CONCLUSIONS: This report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.
Subject(s)
COVID-19 , Fontan Procedure , Gangrene , Mechanical Thrombolysis , Postoperative Complications , Thrombophlebitis , Tricuspid Atresia , Warfarin/therapeutic use , Amputation, Surgical/methods , Atrial Flutter/drug therapy , Atrial Flutter/etiology , COVID-19/blood , COVID-19/complications , COVID-19/therapy , Fontan Procedure/adverse effects , Fontan Procedure/methods , Gangrene/etiology , Gangrene/surgery , Heart Defects, Congenital/surgery , Humans , Image Processing, Computer-Assisted/methods , Lower Extremity/blood supply , Lower Extremity/pathology , Lower Extremity/surgery , Male , Mechanical Thrombolysis/adverse effects , Mechanical Thrombolysis/methods , Middle Aged , Phlebography/methods , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/etiology , Thrombophlebitis/diagnosis , Thrombophlebitis/etiology , Thrombophlebitis/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Tricuspid Atresia/etiology , Tricuspid Atresia/surgeryABSTRACT
Coronavirus disease 2019 (COVID-19) has been widely reported to be associated with increased risk of Venous Thromboembolism, both deep vein thrombosis (DVT) and pulmonary embolism. A rare and extreme manifestation of DVT is Phlegmasia cerulea dolens, characterized by poor tissue perfusion due to marked limb swelling which can progress to limb and life-threatening venous gangrene. We report the case of a 53-year-old man with severe SARS-CoV2 pneumonia who developed acute iliofemoral DVT leading to acute limb ischemia due to Phlegmasia cerulea dolens. The patient underwent successful emergent fasciotomy and mechanical thrombectomy with removal of extensive thrombus burden and restoration of normal venous circulation. Our case highlights the importance of clinical vigilance and early implementation of therapeutic interventions to avoid adverse outcomes in patients who develop SARS-CoV2 induced Venous Thromboembolism complications.