Right Ventricular Clot in Transit in COVID-19

Sethi, Sanjum S.; Zilinyi, Robert; Eisenberger, Andrew; Brodie, Daniel; Agerstrand, Cara; Takeda, Koji; Kirtane, Ajay J.; Parikh, Sahil A.; Rosenzweig, Erika B.

doi:10.1016/j.jaccas.2020.05.034

Cited by 22 publications

(12 citation statements)

References 13 publications

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“… 6 14 Arterial thromboembolism including aortic thrombi are less frequently described. 14 15 Rarely do both co-occur, 16 as did in our patient. The mechanisms involved in the formation of thrombosis in COVID-19 are not yet fully elucidated but appear multifactorial.…”

Section: Discussionsupporting

confidence: 75%

Case of right ventricular and aortic thrombi in a patient with severe COVID-19

2021

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Emerging evidence suggests that novel COVID-19 is associated with increased prothrombotic state and risk of thromboembolic complications, particularly in severe disease. COVID-19 is known to predispose to both venous and arterial thrombotic disease. We describe a case of a 61-year-old woman with history of type II diabetes, hypertension and hyperlipidaemia who presented with dry cough and acute abdominal pain. She was found to have a significantly elevated D-dimer, prompting imaging that showed thrombi in her right ventricle and aorta. She had rapid clinical deterioration and eventually required tissue plasminogen activator with subsequent durable clinical improvement. This case highlights a rare co-occurrence of venous and arterial thrombi in a patient with severe COVID-19. Further studies are needed to clarify the molecular mechanism of COVID-19 coagulopathy, the utility of D-dimer to predict and stratify risk of thrombosis in COVID-19, and the use of fibrinolytic therapy in patients with COVID-19.

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Section: Discussionsupporting

confidence: 75%

Case of right ventricular and aortic thrombi in a patient with severe COVID-19

2021

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“…The presence of right-heart echodensity on transoesophageal and transthoracic echocardiography has been reported in COVID-19 patients (117)(118)(119). Interestingly, intracardiac thrombus coexisted with persistent tachycardia, global hypokinesis, left ventricular dysfunction, and right ventricular dilatation and reduced systolic function (117)(118)(119). Taken together, this indicates that thromboembolism in COVID-19 might be mediated via cardiacspecific pathologies.…”

Section: Coagulation Cascades and The Mechanisms Of Thrombosis In Covmentioning

confidence: 76%

“…Cardiomyopathy, consisting of mechanical dysfunction, structural remodeling, and electrophysiological changes, is a common cause of both intracardiac thrombus and cardiac arrhythmogenic substrate formation (116). The presence of right-heart echodensity on transoesophageal and transthoracic echocardiography has been reported in COVID-19 patients (117)(118)(119). Interestingly, intracardiac thrombus coexisted with persistent tachycardia, global hypokinesis, left ventricular dysfunction, and right ventricular dilatation and reduced systolic function (117)(118)(119).…”

Section: Coagulation Cascades and The Mechanisms Of Thrombosis In Covmentioning

confidence: 99%

Vascular Manifestations of COVID-19 – Thromboembolism and Microvascular Dysfunction

Roberts

Colley

Agbaedeng

et al. 2020

Front. Cardiovasc. Med.

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The coronavirus pandemic has reportedly infected over 31.5 million individuals and caused over 970,000 deaths worldwide (as of 22nd Sept 2020). This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g., lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19.

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“…A modified PERT algorithm to address some of the unique challenges posed by VTE in the setting of COVID-19 was recently described. 15 Hence, we utilized our multidisciplinary PERT to improve our clinical decision-making and come to a rapid consensus on the best management approach for this patient.…”

Section: Discussionmentioning

confidence: 99%

Saddle pulmonary embolism and clot in transit in COVID-19 infection: a case report of catastrophic venous thromboembolism

Aoi

Kakkar

Golowa

et al. 2020

European Heart Journal - Case Reports

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Background Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized. Case summary During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure. Discussion This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.

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Right Ventricular Clot in Transit in COVID-19

Cited by 22 publications

References 13 publications

Case of right ventricular and aortic thrombi in a patient with severe COVID-19

Case of right ventricular and aortic thrombi in a patient with severe COVID-19

Vascular Manifestations of COVID-19 – Thromboembolism and Microvascular Dysfunction

Saddle pulmonary embolism and clot in transit in COVID-19 infection: a case report of catastrophic venous thromboembolism

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