In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
Abstract:
Case Presentation: A 42-year-old female in her 24 th week of pregnancy was admitted to an outside hospital with respiratory failure due to COVID-19 pneumonia and was managed with Remdesivir, Dexamethasone, and pharmacological DVT prophylaxis. Her chest CT showed a massive PE. Due to instability, a cesarean section was necessitated, which resulted in delivering a stillborn baby. Two days later, she developed a severe circulatory shock with acute renal failure, not responding to conventional vasopressors/inotropic therapy. VA-ECMO was inserted for hemodynamic stabilization and the patient was transferred to our advanced ICU for further management. Upon arrival, the clinical picture was suggestive of COVID-19- induced thrombotic storm. Furthermore, the patient underwent several imaging studies which showed additional de-novo thromboembolic events in the brain (stroke), pulmonary circuit (PE), and portal circuit (hepatic thrombosis), which were managed medically. A transesophageal echocardiogram was done and revealed a large highly mobile echogenic structure, measuring up to 40 mm, crossing a patent foramen ovale (PFO) highly suggestive of thrombus in transit, in addition to the findings of significantly dilated RA and RV cavities (Figure 1 A, B). The team decided to perform an urgent surgical excision of that highly mobile thrombus accompanied by PFO closure to prevent catastrophic strokes. The thrombus in transit was extracted and was consistent with prior obtained imaging (Figure 1 C, D). Her postoperative course was uncomplicated. With advanced ICU and multidisciplinary care, she was finally discharged home hemodynamically stable on anticoagulation with Apixaban. Discussion: COVID-19 induced thrombus in-transit crossing a PFO is a rare finding and carries a high risk of paradoxical embolism. Multidisciplinary approach in integrating clinical and imaging findings can further help in a timely-manner decision making which improves patient's outcome.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_2.16935
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
detail.hit.zdb_id:
80099-5
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