Pulmonary Artery Thromboembolism Research Articles

Simultaneous Type A Aortic Dissection, Pulmonary Thromboembolism, and Deep Vein Thrombosis in a COVID-19 Patient: A Case Report Study

Introduction: COVID-19 has been associated with an elevated risk of vascular complications, such as thromboembolism and arterial dissections, which can lead to adverse patient outcomes. The simultaneous occurrence of type A aortic dissection, pulmonary thromboembolism, and deep vein thrombosis in a COVID-19 patient is an unusual presentation that poses unique diagnostic and therapeutic challenges. This case aims to raise awareness of these rare complications, their clinical significance, and the challenges of managing these conditions during the COVID-19 pandemic. This report describes a COVID-19 patient presenting with type A aortic dissection, pulmonary thromboembolism, and deep vein thrombosis. Case Presentation: A 42-year-old man, a former opium user who had been abstinent for three years, was admitted to a general hospital in Qom, Iran, on January 24, 2023. While the patient had a family history of lung disease, he had no other notable risk factors or underlying conditions. Upon admission, he exhibited shortness of breath, severe chest pain, and fever. Initial examination revealed an axillary temperature of 38°C, occasional coarse crackles on lung auscultation, but no heart murmur. Blood pressure and pulse were equal in both arms and legs. A non-contrast spiral chest CT showed generalized bilateral ground-glass opacities, indicative of COVID-19. CT angiography revealed a type A aortic dissection extending from the origin of the aorta to the midpoint of the arch. Additionally, CT angiography identified bilateral segmental pulmonary artery thromboembolism. The patient also had deep vein thrombosis along with pulmonary thromboembolism. Emergency surgery was performed to replace the bentall aortic valve and repair the dissection. Unfortunately, the patient experienced cardiac arrest following the surgery, and resuscitation attempts were unsuccessful. Conclusions: This case of a COVID-19 patient with a complex presentation of concurrent type A aortic dissection, pulmonary thromboembolism, and deep vein thrombosis highlights the need for heightened clinical vigilance and prompt interdisciplinary collaboration to manage such life-threatening events. It underscores the importance of investigating the pathophysiology of severe vascular complications in COVID-19 to support the development of targeted therapies. This case emphasizes the necessity of early clinical detection and timely intervention to improve patient outcomes. Rapid diagnosis and treatment are essential to enhance outcomes in clinical situations of this nature.

Investigation of coagulation and proteomics profiles in symptomatic feline hypertrophic cardiomyopathy and healthy control cats

BackgroundHypertrophic cardiomyopathy (HCM) is a crucial heart disease in cats. The clinical manifestations of HCM comprise pulmonary edema, dyspnea, syncope, arterial thromboembolism (ATE), and sudden cardiac death. D-dimer and prothrombin time (PT) are powerful biomarkers used to assess coagulation function. Dysregulation in these two biomarkers may be associated with HCM in cats. This study aims to assess D-dimer levels, PT, and proteomic profiling in healthy cats in comparison to cats with symptomatic HCM.ResultsTwenty-nine client-owned cats with HCM were enrolled, including 15 healthy control and 14 symptomatic HCM cats. The D-dimer concentration and PT were examined. Proteomic analysis was conducted by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry and liquid chromatography-tandem mass spectrometry (LC-MS/MS). In symptomatic cats, D-dimer levels were statistically significantly higher (mean ± SEM: 372.19 ng/ml ± 58.28) than in healthy cats (mean ± SEM: 208.54 ng/ml ± 10.92) with P-value of less than 0.01, while PT was statistically significantly lower in symptomatic cats (mean ± SEM: 9.8 s ± 0.15) compared to healthy cats (mean ± SEM: 11.08 s ± 0.23) with P-value of less than 0.0001. The proteomics analysis revealed upregulation of integrin subunit alpha M (ITGAM), elongin B (ELOB), and fibrillin 2 (FBN2) and downregulation of zinc finger protein 316 (ZNF316) and ectonucleoside triphosphate diphosphohydrolase 8 (ENTPD8) in symptomatic HCM cats. In addition, protein-drug interaction analysis identified the Ras signaling pathway and PI3K-Akt signaling pathway.ConclusionsCats with symptomatic HCM have higher D-dimer and lower PT than healthy cats. Proteomic profiles may be used as potential biomarkers for the detection and management of HCM in cats. The use of D-dimer as a biomarker for HCM detection and the use of proteomic profiling for a better understanding of disease mechanisms remain to be further studied in cats.

Effects of Ranolazine and Ivabradine on Pulmonary Microhemodynamics in Experimental Model of Pulmonary Thromboembolism.

We studied changes of pulmonary microhemodynamics when modeling pulmonary artery thromboembolism on perfused isolated rabbit lungs after pretreatment with ranolazine and ivabradine. The increase in pulmonary artery pressure, pulmonary vascular resistance, and pre- and postcapillary resistance was less pronounced than in control animals, but was close to that in case of pulmonary thromboembolism after pretreatment with voltage-gated Na+ channel blockers lidocaine and ropivacaine. The increase of capillary filtration coefficient inversely correlated with values of capillary hydrostatic pressure. Thus, ranolazine and ivabradine exhibit the properties of voltage-gated Na+ channel blockers mainly in smooth muscles of pulmonary arterial vessels and promote the decrease in endothelial permeability.

E012 Burden and risk factors for cardiovascular involvement in connective tissue disease

Abstract Background/Aims Connective tissue diseases (CTD) are associated with several cardiovascular manifestations. Cardiovascular diseases (CVD) are significant cause of morbidity and premature death. The pathogenesis of CVD in CTD patients is incompletely understood and likely multifactorial. Traditional risk factors for atherosclerosis are common among patients with CTD as well as metabolic syndrome. Furthermore, diabetes, dyslipidaemia, hypertension, and obesity may all be exacerbated by connective tissue disease itself or treatment with glucocorticoids. The aim of this study was to assess the burden of CVD and the risk factors for the development of cardiovascular disease in patients with CTD. Methods This was a retrospective study from a single centre. We reviewed clinical records of CTD patients as determined by treating rheumatologist. This CTD cohort included patients with systemic lupus erythematosus (SLE), myositis, systemic sclerosis, Sjogren’s syndrome, mixed and undifferentiated connective tissue diseases. Data on demographic, clinical, laboratory parameters, cardiac investigations, treatment and outcome were collected from electronic patient records. CVD and traditional risk factors were defined using standard criteria. Results A total of 298 patients with CTD were included in the analysis. Mean age of the cohort was 61±17.7 years and majority were females (n = 240, 80.5%). Of the 298 patients, 64 had CVD (21.5%). Most common CVD was ischaemic heart disease (17 patients) followed by hypertension (12), arrhythmia (9), pulmonary arterial hypertension (7), valvular diseases (5), pericardial disease (3), cardiomyopathy (3), myocarditis (2), thromboembolism (3), aortic dissection (2) and coronary spasm (1). Patient with CTD who had CVD were older (72.5±12.2 years) compared to CTD patients who did not develop CVD (non-CVD group, 57.7±17.6 years). The duration of CTD was shorter in patients with CVD (88.9±41.7 months), compared to 106±84.3 months in non-CVD group. The risk factors such as smoking, diabetes and dyslipidaemia was higher in the CVD group. Comparing CVD vs non-CVD patients respectively, systolic BP (147.1±23.0 vs 133.6±18.3mmHg), diastolic BP (83.2 ± 16.3 vs 78.2 ± 11.2mmHg) and serum uric acid (321.8±97.4 vs 292±83.9mg/dL) values were higher and statistically significant (p < 0.05) in CVD group. Patients with CVD had longer exposure to steroids (50%) compared to non-CVD patients (31.6%). They required high dose steroids (9.4% vs 5.6% in non-CVD patients). Current and previous DMARD use was also higher in patients who had CVD (51.6% vs 44.9%). Conclusion This study has demonstrated high burden of cardiovascular disease in CTD patients. Traditional risk factors were more prevalent in the CVD group. DMARD’s and steroid use was also higher in the CVD group. Screening for cardiovascular diseases and disease control in CTD patients is paramount for better outcomes. Further analysis will be carried out for risk factors and relevant outcomes. Disclosure K.K. Garg: None. S. Sampath: None. A. Erinjogunola: None. B. Ting: None. H. Noori: None. G.M. Koduri: None.

Real-world incidence and risk factors of bortezomib-related cardiovascular adverse events in patients with multiple myeloma

BackgroundAlthough most studies on the cardiovascular toxicity of proteasome inhibitors have focused on carfilzomib, the risk of cardiotoxicity associated with bortezomib remains controversial. This study aimed to evaluate the incidence and risk factors of cardiovascular adverse events (CVAEs) associated with bortezomib in patients with multiple myeloma in a real-world setting.MethodsThis cross-sectional study included patients who were treated with bortezomib at a tertiary hospital in South Korea. CVAEs, defined as hypertension, arrhythmia, heart failure, myocardial infarction, pulmonary arterial hypertension, angina, and venous thromboembolism, were detected using cardiac markers, ECG, echocardiography, medications, or documentation by clinicians. The patients were observed for at least 6 months and up to 2 years after starting bortezomib administration.ResultsAmong the 395 patients, 20.8% experienced CVAEs of any grade, and 14.7% experienced severe adverse events. The median onset time for any CVAE was 101.5 days (IQR, 42–182 days), and new-onset/worsened hypertension was the most prevalent CVAE. The risk of CVAEs increased in patients with a body mass index lower than 18.5 (adjusted HR (aHR) 3.50, 95% confidence interval (CI) 1.05-11.72), light chain (1.80, 1.04-3.13), and IgD (4.63, 1.06-20.20) as the multiple myeloma subtype, baseline stroke (4.52, 1.59-12.80), and hypertension (1.99, 1.23-3.23). However, CVAEs did not significantly affect the 2-year overall survival and progression-free survival.ConclusionApproximately 15% of the Korean patients treated with bortezomib experienced severe CVAEs. Thus, patients, especially those with identified risk factors, should be closely monitored for CVAE symptoms during bortezomib treatment.

Venous Thrombosis and Thromboembolism of Pulmonary Artery in Plastic Surgery: Risk Factors, Course Options and Therapeutic Strategies

A detailed analysis of the literature was carried out and an analysis of our own clinical case of managing a patient with thrombosis of the veins of the lower extremities and thromboembolism of the pulmonary arteries, which developed after the procedure of abdominoplasty and liposuction, is presented. There are limited descriptions of thromboembolic events and their treatment after abdominoplasty and/or liposuction in the literature. The article summarizes modern mechanisms of development and variants of the course of venous thrombosis, pulmonary embolism and pulmonary fat embolism in plastic surgery, as well as approaches to the management of such patients, with special attention paid to the interdisciplinary approach.

Antiphospholipid Antibodies and Vascular Thrombosis in Patients with Severe Forms of COVID-19.

Antiphospholipid antibodies (aPLA) are a laboratory criterion for the classification of antiphospholipid syndrome (APS) and are known to cause clinical symptoms such as vascular thrombosis or obstetric complications. It is suggested that aPLA may be associated with thromboembolism in severe COVID-19 cases. Therefore, we aimed to combine clinical data with laboratory findings of aPLA at four time points (admission, worsening, discharge, and 3-month follow-up) in patients hospitalized with COVID-19 pneumonia. In 111 patients with COVID-19 pneumonia, current and past history of thrombosis and pregnancy complications were recorded. Nine types of aPLA were determined at four time points: anticardiolipin (aCL), anti-β2-glycoprotein I (anti- β2GPI), and antiphosphatidylserine/prothrombin (aPS/PT) of the IgM, IgG, or IgA isotypes. During hospitalization, seven patients died, three of them due to pulmonary artery thromboembolism (none were aPLA positive). Only one of the five who developed pulmonary artery thrombosis was aPLA positive. Out of 9/101 patients with a history of thrombosis, five had arterial thrombosis and none were aPLA positive at admission and follow-up; four had venous thrombosis, and one was aPLA positive at all time points (newly diagnosed APS). Of these 9/101 patients, 55.6% were transiently aPLA positive at discharge only, compared to 26.1% without a history of thrombosis (p = 0.041). Patients with severe forms of COVID-19 and positive aPLA should receive the same dose and anticoagulant medication regimen as those with negative aPLA because those antibodies are mostly transiently positive and not linked to thrombosis and fatal outcomes.

Spectrum of Thrombotic Complications in Fatal Cases of COVID-19: Focus on Pulmonary Artery Thrombosis In Situ.

COVID-19-related thrombosis affects the venous and arterial systems. Data from 156 autopsies of COVID-19 patients were retrospectively analyzed to investigate the pattern of thrombotic complications and factors associated with pulmonary artery thrombosis and thromboembolism. Thrombotic complications were observed in a significant proportion (n = 68, 44%), with pulmonary artery thrombosis the most frequently identified thrombotic event (42, 27%). Multivariate analysis revealed that the length of hospital stay (OR 1.1, p = 0.004), neutrophil infiltration in the alveolar spaces (OR 3.6, p = 0.002), and the absence of hyaline membranes (OR 0.1, p = 0.01) were associated with thrombotic complications. Neutrophil infiltration in the alveolar spaces (OR 8, p < 0.001) and the absence of hyaline membranes (OR 0.1, p = 0.003) were also independent predictors of pulmonary artery thrombosis. The association of pulmonary artery thrombosis with an absence of hyaline membranes suggests it occurs later in the course of COVID-19 infection. As neutrophil infiltration in the alveolar spaces may indicate bacterial infection, our studies suggest the consideration of bacterial infections in these critically ill patients.

The role of endosonography in cardiology: case series and literature review.

Endosonography (EUS) is the diagnostic tool with the highest resolution for the local staging of gastrointestinal tumours and, due to the detailed visualization of the wall layers, is recommended in current guidelines for cancer management. In addition, an endoscope has an ultrasound tip design and balloon insufflation control design, and a 120° bending mechanism to deflect the endoscope tip. These advantages could be beneficial and valuable while investigating the cardiovascular structures during routine gastrointestinal procedures using this diagnostic tool. We present six cases of incidentally diagnosed cardiac pathologies (pulmonary thromboembolism of the main pulmonary artery, patent foramen oval with right to left shunt under Valsalva, left atrial appendage thrombus, aortic dissection, moderate aortic valve stenosis, mitral and aortic valve endocarditis) during routine gastrointestinal endosonographic procedures. These diagnoses influenced changes in management strategies in four cases. The introduction of EUS in cardiovascular medicine allows for a real-time high-resolution assessment of cardiovascular structures and allows early detection of silent cardiac pathologies during routine gastrointestinal procedures. It is the diagnostic tool with the highest resolution for accurate definition of variable gastrointestinal anatomy. Thus, help for accurate definitions of cardiovascular anatomy and pathology, which could influence optimal management strategies with improved safety, efficacy, and economic outcomes.

The clinical and prognostic role of changes in parameters of the hemostasis system and C-reactive protein in the development of thrombotic complications in oxygen-dependent patients with coronavirus disease (COVID-19)

Aim. The purpose of our work was to find out the clinical and prognostic role of changes in hemostasis parameters and C-reactive protein (CRP) in the development of thrombotic complications in oxygen-dependent patients with coronavirus disease (COVID-19). Materials and methods. 211 oxygen-dependent patients with COVID-19 were examined. To assess the prognostic role of changes in hemostasis parameters and CRP, patients were divided into groups: I group – 94 patients who recovered, II group – 117 patients who died. Subgroups: II-A subgroup – 35 patients with thrombotic complications and II-B subgroup – 82 patients without these complications. All patients were examined and received treatment according to the normative documents in force at the relevant time. Results. The frequency of thrombotic complications in oxygen-dependent patients with COVID-19 was 16.6 %, among which the most common were pulmonary embolism (6.6 %), myocardial infarction (6.2 %), and ischemic stroke (3.2 %). Lifetime diagnosis of thrombotic complications took place on the 18th [16.0; 24.0] day of illness in 45.9 % of cases. Deathtime diagnosis of thrombotic complications took place on the 24th [20.0; 28.0] day of illness in 54.1 % of cases. Lifetime pulmonary artery thromboembolism was diagnosed less frequently than ischemic stroke (p = 0.002) and myocardial infarction (p = 0.02). With the development of oxygen dependence and admission to the intensive care unit on the 9th [8.0; 11.0] day of illness, changes in the hemostasis system were characterized as prothrombotic with an increase above the reference values of fibrinogen and D-dimer in patients of all groups. CRP in patients with fatal outcomes of the disease, regardless of the development of thrombotic complications, was higher (p &lt; 0.05) than in patients who subsequently recovered, and was accordingly in patients of the I group – 67.65 [41.20; 139.95] mg/l, in the II-A group – 122.2 [61.2; 178.0] mg/l, and in patients of the II-B group – 109.8 [56.3; 180.0] mg/l. In the dynamics of complex treatment after 5–7 days, the level of fibrinogen, D-dimer and CRP had a diagnostic value in predicting the further development of thrombotic complications. With an increase in the level of fibrinogen &gt;4.6 g/l (AUC = 0.600, p = 0.042), D-dimer &gt;2.1 μg/ml (AUC = 0.704, p = 0.001) and CRP &gt;89.3 mg/l (AUC = 0.720, p &lt; 0.001) the probability of developing thrombotic complications was significant. Conclusions. In dynamics of complex treatment of oxygen-dependent patients after 5–7 days, the levels of fibrinogen, D-dimer and C-reactive protein had consistent diagnostic value in predicting further development of thrombotic complications. Increased fibrinogen &gt;4.6 g/l, D-dimer &gt;2.1 μg/ml, and CRP &gt;89.3 mg/l were important for predicting the risk of developing thrombotic complications.

ROLE OF CT PULMONARY ANGIOGRAPHY IN EVALUATION OF PULMONARY THROMBOEMBOLISM IN COVID-19 POSITIVE PATIENTS

Introduction- COVID-19 disease has been strongly associated with a pro thrombotic state and vascular endothelial damage resulting into wide range of thromboembolic phenomena including deep venous thrombosis involving extremeties, pulmonary artery thrombo-embolism and eventually pulmonary infarctions. Computed tomography pulmonary angiography (CTPA) was used at our hospital for assessment of patients with risk of pulmonary embolism. It plays a vital role in its establishing its diagnosis, defining its extent, stage and thereby guiding towards further management. Materials and Methods- A Retrospective study was performed in Sri Aurobindo Medical College and Post graduate Institute, Indore, Madhya Pradesh, India and was approved by the ethical committee. It was performed on 250 COVID-19 patients with clinically suspected pulmonary thromboembolism who underwent CTPA between the months of December 2021 and May 2021. The scans were analysed by skilled radiologists, having good experience in the field of CT reporting. Results- Our study demonstrated that approx. 14% of the patients had pulmonary thromboembolism and these cases were observed in patients with moderate to severe lung involvement. ConclusionIn this study, we have thoroughly tried to assess the presence of pulmonary thromboembolism using CTPA and establish its relationship with severity of lung involvement on HRCT

Local application of heparin ointment as a trigger factor for the heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia (GIT) is a paradoxical reaction of platelets to heparin (their aggregation and destruction), potentially dangerous by the development of venous and arterial thrombosis, less often bleeding. There are serious problems of timely diagnosis of this complication. They are due to both insufficient awareness of specialists and the presence of a negative psychological attitude. The article presents a clinical case of treatment of a 57-year-old patient who was prescribed local application of heparin ointment for catheter thrombosis of the superficial veins of the left upper limb. After 8 days, the patient developed a clinical and instrumental picture of occlusive thrombosis of the right brachial vein. The patient was prescribed enoxaparin 0.6 x 2 times a day subcutaneously. After 4 days since the appointment of enoxaparin, a sharp deterioration in the patient’s condition: lower paraplegia with impaired pelvic organ function developed. There was a decrease in platelet levels by more than 2 times to 49x109/l. The probability of developing GIT on the «4T» scale is 8 points (high probability of GIT). Despite the treatment, the patient’s condition progressively worsened with the development of thrombosis of the infrarenal aorta, both common iliac arteries, massive trunk thromboembolism, segmental and subsegmental branches of the left pulmonary artery, intracerebral hemorrhage with a breakthrough into the ventricular system. Conclusion: heparin-induced thrombocytopenia, a rare but extremely dangerous complication observed in patients receiving heparin. The key to preventing the catastrophic consequences of GIT is awareness, alertness of clinicians and the use of modern algorithms for the diagnosis and treatment of GIT.

Hemostasiological aspects after the planned and urgent laparoscopic operations on the appendages of uterus

Postoperative period was complicated in three supervisions (6,0%) by development of thrombophlebitis of muscular veins of right shin, in one (2,0%) – thromboembolism of pulmonary artery, unconnected with development of sharp thrombophlebitis. In all supervisions after the leadthrough of conservative treatment postoperative complications were with sleeping compartments. Before an operation the indexes of coagulative hemostasis of women, gettings traditional treatment, for certain did not differ from the indexes of healthy women of genital age. At the analysis of platelet link of hemostasis it is set by us, that in preoperative period an amount of thrombocytes was on 47,8% higher as compared to healthy women. In addition, for certain the indexes of number of small aggregation appeared more high – in 2,2 time, number of large aggregation – in 2,9 time, number of aggregation – in 2,3 time higher. Other indexes of platelet hemostasis for certain did not differ from a control group. The results of the conducted researches testify to the high risk of thromohemorrhagic complications for patients after laparoscopic operations on the appendages of uterus. It dictates the necessity of improvement of algorithm of diagnostic and treatment-and-prophylactic measures.

Management of a patient with cardiac arrest: a clinical case of massive pulmonary embolism in an obese young man

Pulmonary artery thromboembolism is one of the few life-threatening conditions. Today, with less mobility due to their professional activities (prolonged sitting at a computer) and social behavior, the number of cases of venous thromboembolism has increased. The recommendations of the European Society of Cardiology for pulmonary embolism (2008, 2014, 2019) have become a powerful tool for diagnosing, treating and stratifying the risk of death. Prevention of recurrence of thromboembolic complications and its duration depends on the fact of provocation of pulmonary embolism. Recommendations for the development of thromboembolic complications take into account the presence of heart failure, coronary heart disease, atrial fibrillation (AF), which to some extent blurs the distinction between arterial and venous thrombosis. The fact that the incidence of pulmonary embolism increases with age is indisputable, but in contrast to atherothrombosis, venous thrombosis occurs much earlier, in the younger population. Thus, venous thrombosis is somewhat “younger” than arterial. Regarding gender differences, it is more common in men with age, and women tend to “rejuvenate”. Contraceptives play an important role in this, the risks of venous thromboembolism are pregnancy and childbirth. Although less influential in the development of venous thromboembolism and pulmonary embolism are bed rest (more than three days), immobilization in a sitting position (long flight, car trip), old age, in real clinical practice should not be neglected laparoscopic surgery and concomitant conditions— obesity, diabetes mellitus, hypertension and varicose veins. At the slightest suspicion of pulmonary embolism, it is important for the physician to consider the above factors. A clear algorithm for diagnosis and timely treatment will ensure the effectiveness of such patients and the process of their recovery. In recent years, obesity at the angle of low-intensity inflammation began to be considered involved in the processes of increased thrombosis. Although certain mechanisms of thrombosis in obesity have been elucidated, the frequent fatal thrombotic consequences of severe COVID-19 remain unclear, mainly in the category of patients with obesity, carbohydrate metabolism disorders, and diabetes. In this clinical case, the authors demonstrate the total stratification of risk factors, even at first glance insignificant effects of obesity of the first degree, but in combination with varicose veins of the lower extremities, which caused massive pulmonary embolism in young men.

Pulmonary artery thromboembolism and beyond

Pulmonary artery thromboembolism and beyond

Diagnostic imaging in obstetrics (Lecture)

Summarizing the variety of diagnostic imaging methods in obstetrics, there are next main offensive positions. Urgent indications for CT during pregnancy. Appendicitis – during pregnancy of the first and second trimesters. Ultrasound and/or MRI should be performed before CT. Pulmonary artery thromboembolism – in this case low-dose CT angiography of the lungs (with X-ray protection of the fetus). If suspected – CT should be the primary method of examination. In renal colic, ultrasound is the method of choice. In case of injury, ultrasound may be sufficient for the initial assessment in pregnant women, but CT should be performed if more severe or polytrauma is suspected. All patients who undergo CT of the abdomen or pelvis during pregnancy must sign a written personal consent form. In a study that presents a minimal risk (including CT pelviometry, CT of other areas of the body and MRI), it is advisable to explain to the pregnant woman about the minimal risk. Intravenous gadolinium is contraindicated in pregnancy and should be used only when absolutely necessary. Pelviometry can be performed either by low-dose CT or by MRI. Key words: pregnant women, fetuses, ultrasound (ultrasound diagnostics), MRI (magnetic resonance imaging), CT (X-ray computed tomography).

Clinical case of pulmonary artery thromboembolism diagnosed in the subacute period

Clinical case of pulmonary artery thromboembolism diagnosed in the subacute period

Congenital Anomalous Azygos Vein Drainage Causing Pulmonary Embolus in a 91-Year-Old Patient.

BackgroundRetroaortic course and azygos continuation of aberrant left brachiocephalic vein is a rare venous anomaly, which is usually associated with congenital heart disease and pulmonary artery anomalies. Venous stasis is a cause of pulmonary arterial thromboembolism, which can result from venous anomalies.Case presentationWe describe the case of a 91-year-old female admitted to our hospital with shortness of breath diagnosed with pulmonary embolism and infarctions by a CT pulmonary angiogram. CT also showed aberrant left brachiocephalic vein with vascular webs at its retroaortic course and azygos continuation, suggesting chronic venous thrombosis, which was considered to be the suspected source of emboli.ConclusionTo our knowledge, this is the first report presenting this vascular anomaly manifesting with chronic venous thrombosis and pulmonary embolism. Although rare, awareness and identification of this entity is important, especially in the absence of obvious embolic sources or in patients with recurrent embolus/consolidation.LEARNING POINTSAwareness of congenital anomalous drainage anatomy is important even if there has been a relatively benign clinical course.Alterations in morphology due to age and degenerative change may result in altered flow predisposing to chronic embolic phenomena.Recurrent consolidation may not necessarily be due to infection in the elderly, a recurrent embolic phenomenon may also be a cause, in this case without a common cause such as deep vein thrombosis.

Right ventricular myocardial work characterisation in patients with pulmonary hypertension: association with invasive haemodynamic parameters

Abstract Background Non-invasive evaluation of indices of right ventricular (RV) myocardial work derived from RV pressure-strain loops may provide novel insights into RV function in pre-capillary pulmonary hypertension. Purpose This study was designed to evaluate the association between the indices of RV myocardial work and invasive haemodynamic parameters in a patient cohort with pulmonary arterial hypertension (Group I) or chronic thromboembolism pulmonary hypertension (Group IV). Methods The non-invasive analysis of echocardiography-derived RV myocardial work (Figure 1, upper panel) was completed in 51 patients (mean age 58.1±12.7 years, 31% male) with Group I (78%) or Group IV (22%) pulmonary hypertension. Conventional echocardiographic measurements of RV systolic function, RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW) and RV global work efficiency (RV GWE) were compared with parameters derived invasively during right heart catheterisation (RHC). Results The median RV GWI, RV GCW, RV GWW and RV GWE were 620 (443 to 857) mmHg%, 830 (650 to 1206) mmHg%, 105 (54 to 169) mmHg% and 87 (82 to 93)%, respectively. Compared to pulmonary artery systolic pressure and conventional echocardiographic parameters of RV systolic function (RV global longitudinal strain [GLS], tricuspid annular plane systolic excursion and RV fractional area change), RV GCW and RV GWI correlated more closely with invasively-derived RV stroke work index (R=0.63, P&amp;lt;0.001 and R=0.60, P&amp;lt;0.001, respectively) (Figure 1, lower panels). Invasively-derived pulmonary vascular resistance (PVR) correlated with RV GWW (R=0.63, P&amp;lt;0.001), RV GWE (R=0.48, P&amp;lt;0.001) and RV GLS (R=0.58, P&amp;lt;0.001). RV GLS correlated more closely with invasively-derived stroke volume index (R=−0.57, P&amp;lt;0.001) than RV GCW, RV GWI and RV GWE (R=0.34, P=0.016, R=0.48, P&amp;lt;0.001 and R=0.47, P&amp;lt;0.001, respectively). Conclusions In a patient cohort with Group I and Group IV pulmonary hypertension, indices of RV myocardial work were more closely correlated with invasively-derived RV stroke work index and PVR than conventional echocardiographic parameters of RV systolic function. Funding Acknowledgement Type of funding sources: None. Figure 1. Method and correlations

Overview of the Covid-19 Coagulopathy Complications, Pathogenesis and Treatment Recommendations

Kristina Bubulytė1, Pijus Ruokis1 1Lithuanian University of Health Sciences, Medicine academy, faculty of Medicine Abstract. Covid-19 disease is a respiratory disease caused by the SARS-CoV-2 virus. In severe cases the disease presents itself with coagulation disorders, the most common complications of which are pulmonary artery thromboembolism (PATE), venous and arterial thrombosis, and disseminated intravascular coagulation […]