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2.
Am J Med ; 135(4): 448-452, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1520669
3.
Int J Cardiovasc Imaging ; 38(2): 351-362, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1427312

ABSTRACT

Transesophageal echocardiography (TEE) is the gold standard for assessing left atrial appendage (LAA) mechanic and thrombosis (LAAT); however, TEE is a high-risk procedure for viral transmission during coronavirus disease 2019 (COVID-19) pandemic. We investigated whether deformation indices of left atrium (LA) at transthoracic echocardiography (TTE) correlate with those of LAA assessed by TEE in nonvalvular atrial fibrillation (NVAF) patients undergoing electrical cardioversion (ECV). Consecutive patients with NVAF of ≥ 48 h or unknown duration, who underwent TEE and TTE at our Institution before ECV were retrospectively investigated. Standard echo-Doppler and LA and LAA myocardial strain and strain rate parameters were analyzed. A total of 115 NVAF patients (71.3 ± 8.1 yr/o, 59.1% men) were included: LAAT was diagnosed in 25 (21.7%) patients. Compared to patients without LAAT, those with LAAT had significantly higher CHA2DS2-VASc Risk score (4.5 ± 1.4 vs. 3.5 ± 1.1, p < 0.001), and lower ejection fraction (46.0 ± 14.8 vs. 57.6 ± 8.6%, p < 0.001). In LAAT patients, global strain of LA (8.7 ± 2.6 vs. 16.3 ± 4.5%, p < 0.001) and LAA (7.0 ± 1.7 vs. 11.7 ± 2.0%, p < 0.001) was significantly reduced compared to non-LAAT patients. A close relationship between left atrial strain reservoir (LASr) and LAA-global strain was demonstrated (r = 0.81). By univariable analysis, CHA2DS2-VASc Risk Score (OR 2.01, 95%CI 1.34-3.00), NT-proBNP (OR 1.36, 95%CI 1.19-1.54), ejection fraction (OR 0.92, 95%CI 0.88-0.96), E/e' ratio (OR 2.07, 95%CI 1.51-2.85), and LASr (OR 0.39, 95%CI 0.25-0.62) were strongly associated with LAAT presence at TEE. By multivariable analysis, only LASr (OR 0.40, 95%CI 0.24-0.70) retained statistical significance. ROC curve analysis revealed that an LASr cut-off value ≤ 9.3% had 98.9% sensibility and 100% specificity to identify LAAT by TEE (AUC = 0.98). In patients with NVAF of ≥ 48 h or unknown duration, scheduled to undergo ECV, LA deformation assessment by TTE might substitute invasive measurement of LAA function by TEE, simplifying diagnostic approach and possibly contributing to reduce COVID-19 infection diffusion.


Subject(s)
Atrial Appendage , Atrial Fibrillation , COVID-19 , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/therapy , Echocardiography, Transesophageal , Electric Countershock/adverse effects , Female , Heart Atria/diagnostic imaging , Humans , Male , Pandemics , Predictive Value of Tests , Retrospective Studies , SARS-CoV-2
5.
Rev Esp Cardiol (Engl Ed) ; 73(10): 789, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-1203257
6.
Rev Esp Cardiol (Engl Ed) ; 73(9): 699, 2020 Sep.
Article in English, Spanish | MEDLINE | ID: covidwho-1193464
8.
J Thromb Thrombolysis ; 51(4): 985-988, 2021 May.
Article in English | MEDLINE | ID: covidwho-1053058

ABSTRACT

OBJECTIVES: Infection with the SARS-COV2 virus (COVID-19) may be complicated by thrombotic diathesis. This complication often involves the pulmonary microcirculation. While macrovascular thrombotic complications of the lung may include pulmonary artery embolism, pulmonary artery thrombus in situ has also been hypothesized. Pulmonary vein thrombosis has not been described in this context. METHODS/RESULTS: Herein, we provide a case of an otherwise healthy male who developed an ischemic stroke with left internal carotid thrombus. Further imaging revealed pulmonary emboli with propagation through the pulmonary veins into the left atrium. This left atrial thrombus provides a source of atypical "paradoxic arterial embolism". CONCLUSIONS: Thrombotic outcomes in the setting of severe COVID 19 pneumonia may include macrovascular venous thromboembolism, microvascular pulmonary vascular thrombosis and arterial thromboembolism. Pulmonary vein, herein described, provides further mechanistic pathway for potential arterial embolic phenomenon.


Subject(s)
COVID-19 , Carotid Artery Thrombosis , Ischemic Stroke , Pulmonary Embolism , Pulmonary Veno-Occlusive Disease , Brain/diagnostic imaging , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , Carotid Artery Thrombosis/complications , Carotid Artery Thrombosis/diagnosis , Diagnosis, Differential , Heart Atria/diagnostic imaging , Heart Atria/pathology , Hemiplegia/diagnosis , Hemiplegia/etiology , Humans , Ischemic Stroke/diagnosis , Ischemic Stroke/etiology , Ischemic Stroke/physiopathology , Lung/diagnostic imaging , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Veno-Occlusive Disease/complications , Pulmonary Veno-Occlusive Disease/diagnosis , Pulmonary Veno-Occlusive Disease/physiopathology , SARS-CoV-2/pathogenicity , Tomography, X-Ray Computed/methods
9.
Cardiol Young ; 30(9): 1358-1359, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-851194

ABSTRACT

A 16-year-old girl with history of treated congenital mitral valve disease and signs of respiratory infection was admitted to our paediatric cardiology department. She was tested positive for severe acute respiratory syndrome coronavirus 2. Despite her severe pre-existing cardiac conditions with pulmonary hypertension, atrial arrhythmias and mitral valve stenosis, the infection did not lead to any cardiac or pulmonary deterioration. In adults, cardiac co-morbidities are known risk factors for a severe course of coronavirus disease 2019 infections. This case illustrates that in children even severe cardiac disease is not necessarily associated with a severe course of coronavirus disease 2019.


Subject(s)
Coronavirus Infections , Heart Atria , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Mitral Valve Stenosis , Pandemics , Pneumonia, Viral , Prosthesis Failure/adverse effects , Adolescent , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Echocardiography/methods , Female , Heart Atria/diagnostic imaging , Heart Atria/pathology , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/methods , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Mitral Valve/pathology , Mitral Valve/physiopathology , Mitral Valve/surgery , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/congenital , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/congenital , Mitral Valve Stenosis/surgery , Organ Size , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Treatment Outcome
10.
Am J Case Rep ; 21: e926915, 2020 Sep 23.
Article in English | MEDLINE | ID: covidwho-789900

ABSTRACT

BACKGROUND Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. CASE REPORT A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient's successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echocardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. CONCLUSIONS The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU.


Subject(s)
Coronavirus Infections/complications , Echocardiography, Transesophageal/methods , Heart Atria/diagnostic imaging , Heart Diseases/therapy , Pneumonia, Viral/complications , Severe Acute Respiratory Syndrome/complications , Thrombosis/therapy , Aged , COVID-19 , Combined Modality Therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Cough/diagnosis , Cough/etiology , Critical Care/methods , Disease Progression , Emergency Service, Hospital , Fever/diagnosis , Fever/etiology , Follow-Up Studies , Greece , Heart Atria/pathology , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Humans , Intensive Care Units , Length of Stay , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Severity of Illness Index , Thrombosis/diagnostic imaging , Thrombosis/etiology , Treatment Outcome
11.
Rev Neurol ; 71(5): 186-190, 2020 09 01.
Article in Spanish | MEDLINE | ID: covidwho-704453

ABSTRACT

INTRODUCTION: Severe infection by SARS-CoV-2 has shown to entail an increased risk of thrombotic, especially venous, events. Central venous catheters have also been associated with an increased risk of thrombotic complications. Paradoxical embolism as an aetiological mechanism of ischaemic stroke should be considered in a highly prothrombotic context, where it may be more frequent. CASE REPORT: A 40-year-old woman with a central venous catheter, with a large vessel ischaemic stroke, treated with mechanical thrombectomy for an atypical paradoxical embolism while in intensive care for bilateral COVID-19 pneumonia. In the aetiological study, analysis highlighted an elevation of the D-dimer and right-left shunt with massive passage of contrast directly from the central peripheral access pathway in the left upper extremity to the left atrium in the transoesophageal echocardiogram. Thoracic tomographic angiography showed an anomalous venous structure with its origin in the subclavian vein and drainage to the segmental vein of the left upper lobe with direct emptying into the left atrium. Treatment consisted in anticoagulation until removal of the central venous catheter and simple anti-aggregating medication on discharge. CONCLUSIONS: Paradoxical embolism due to intra- or extra-cardiac shunt should be considered in patients with COVID-19, given the high associated risk of venous thromboembolism. Further studies are needed to be able to define optimal prophylactic and therapeutic management.


TITLE: Complicación trombótica de neumonía grave por COVID-19: ictus por embolismo paradójico atípico.Introducción. La infección grave por el SARS-CoV-2 ha demostrado un incremento del riesgo de fenómenos trombóticos, especialmente venosos. Los catéteres venosos centrales también se han asociado a un mayor riesgo de complicaciones trombóticas. El embolismo paradójico como mecanismo etiológico del ictus isquémico debe tenerse en cuenta en un contexto protrombótico elevado, en el que puede ser más frecuente. Caso clínico. Mujer de 40 años, portadora de un catéter venoso central, con ictus isquémico de gran vaso, tratada con trombectomía mecánica por embolismo paradójico atípico durante el ingreso en cuidados intensivos por neumonía bilateral por COVID-19. Dentro del estudio etiológico, destacaba analíticamente una elevación del dímero D y shunt derecha-izquierda con paso masivo de contraste directamente desde la vía central de acceso periférico en la extremidad superior izquierda a la aurícula izquierda en el ecocardiograma transesofágico. Una angiotomografía torácica mostró una estructura venosa anómala con origen en la vena subclavia y drenaje a la vena segmentaria del lóbulo superior izquierdo con vaciado directo a la aurícula izquierda. Se decidió anticoagulación hasta la retirada del catéter venoso central y antiagregación simple al alta. Conclusiones. El embolismo paradójico por shunt intra o extracardíaco debe considerarse en pacientes con COVID-19, dado el elevado riesgo tromboembólico venoso asociado. Para definir el manejo profiláctico y terapéutico óptimo son necesarios más estudios.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Embolism, Paradoxical/etiology , Heart Atria/abnormalities , Pneumonia, Viral/complications , Subclavian Vein/abnormalities , Adult , Anticoagulants/therapeutic use , COVID-19 , Catheterization, Central Venous/adverse effects , Combined Modality Therapy , Computed Tomography Angiography , Contrast Media/pharmacokinetics , Coronavirus Infections/blood , Echocardiography, Transesophageal , Embolism, Paradoxical/diagnostic imaging , Embolism, Paradoxical/drug therapy , Embolism, Paradoxical/therapy , Female , Fibrin Fibrinogen Degradation Products/analysis , Heart Atria/diagnostic imaging , Humans , Mechanical Thrombolysis , Pandemics , Platelet Aggregation Inhibitors/therapeutic use , Pneumonia, Viral/blood , SARS-CoV-2 , Subclavian Vein/diagnostic imaging
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