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Am J Case Rep ; 21: e926915, 2020 Sep 23.
Artículo en Inglés | MEDLINE | ID: covidwho-789900


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.

Infecciones por Coronavirus/complicaciones , Ecocardiografía Transesofágica/métodos , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/terapia , Neumonía Viral/complicaciones , Síndrome Respiratorio Agudo Grave/complicaciones , Trombosis/terapia , Anciano , Terapia Combinada , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Tos/diagnóstico , Tos/etiología , Cuidados Críticos/métodos , Progresión de la Enfermedad , Servicio de Urgencia en Hospital , Fiebre/diagnóstico , Fiebre/etiología , Estudios de Seguimiento , Grecia , Atrios Cardíacos/patología , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/terapia , Índice de Severidad de la Enfermedad , Trombosis/diagnóstico por imagen , Trombosis/etiología , Resultado del Tratamiento
JACC Cardiovasc Imaging ; 13(7): 1615-1626, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-680213
J Card Surg ; 35(6): 1348-1350, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: covidwho-343637


The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being considered in order to maximise resource utilisation. We present a case of a 69-year old lady with an infected prosthetic aortic valve for consideration of urgent inpatient surgery. Despite being asymptomatic and testing negative initially for COVID-19 RT-PCR swab, further investigations with CT revealed suspicious findings. She subsequently tested positive on a repeat swab and unfortunately deteriorated rapidly with complications including gastro-intestinal and intracerebral haemorrhage.

Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Neumonía Viral/diagnóstico , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/virología , Tiempo de Tratamiento , Anciano , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Técnicas de Laboratorio Clínico , Ecocardiografía Transesofágica/métodos , Servicio de Urgencia en Hospital , Resultado Fatal , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Pandemias , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Radiografía Torácica/métodos , Reoperación/métodos , Tomografía Computarizada por Rayos X/métodos
J Am Soc Echocardiogr ; 33(8): 1040-1047, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-342809


BACKGROUND: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside. METHODS: A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic. RESULTS: Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination. CONCLUSIONS: In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.

Infecciones por Coronavirus/epidemiología , Cuidados Críticos/organización & administración , Infección Hospitalaria/prevención & control , Ecocardiografía Transesofágica/métodos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Canadá/epidemiología , Consenso , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Control de Infecciones/métodos , Masculino , América del Norte/epidemiología , Pandemias/prevención & control , Posicionamiento del Paciente , Neumonía Viral/prevención & control , Sistemas de Atención de Punto , Medición de Riesgo , Administración de la Seguridad
J Am Soc Echocardiogr ; 33(6): 658-665, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-47868