Surgical Treatment of Pulmonary Embolism Associated with COVID-19: First-Hand Experience

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Abstract

INTRODUCTION: Venous thromboembolic complications occupy one of the central positions in the structure of complications associated with CoronaVirus Disease 2019 (COVID-19). Characterized by high epidemiological threshold values, as well as an atypical clinical picture, they determine the need for new approaches to early diagnosis and active treatment. Surgical treatment of pulmonary embolism in itself is an extremely controversial method of reperfusion of the pulmonary arterial bed. Concerning pulmonary embolism associated with a new coronavirus infection, we did not find a single clinical case reported in the available literature. The article considers a clinical case of surgical treatment of pulmonary embolism against the background COVID-19 infection, demonstrates a comprehensive approach to treatment and describes peculiarities of the clinical picture.

CONCLUSION: Based on the presented case, one should note the importance of the anticoagulant therapy in a group of people with a virus-specific intervention to prevent recurrence of thromboembolic complications. Complex surgical treatment in combination with the proposed methods of anesthesiological support are the methods of choice in a group of people at intermediate-high and high risk of early cardiac death.

About the authors

Sergey A. Fedorov

Research Institute Specialized Cardiosurgical Clinical Hospital named after academician B. A. Korolev

Author for correspondence.
Email: sergfedorov1991@yandex.ru
ORCID iD: 0000-0002-5930-3941
SPIN-code: 3574-8749

MD, Cand. Sci. (Med.)

Russian Federation, Nizhnу Novgorod

Sergey A. Zhurko

Research Institute Specialized Cardiosurgical Clinical Hospital named after academician B. A. Korolev

Email: zhurkoser@mail.ru
ORCID iD: 0000-0002-5222-1329
SPIN-code: 9201-1438

MD, Cand. Sci. (Med.)

Russian Federation, Nizhnу Novgorod

Vladimir V. Pichugin

Research Institute Specialized Cardiosurgical Clinical Hospital named after academician B. A. Korolev; Privolzhsky Research Medical University

Email: pichugin.vldmr@mail.ru
ORCID iD: 0000-0001-7724-0123
SPIN-code: 6986-2331

MD, Dr. Sci. (Med.), Professor

Russian Federation, Nizhnу Novgorod; Nizhnу Novgorod

Vladimir A. Chiginev

Research Institute Specialized Cardiosurgical Clinical Hospital named after academician B. A. Korolev; Privolzhsky Research Medical University

Email: chiginevvladimir@yandex.ru
ORCID iD: 0000-0001-8977-1968
SPIN-code: 2459-4291

MD, Dr. Sci. (Med.)

Russian Federation, Nizhnу Novgorod; Nizhnу Novgorod

Anton L. Maximov

Research Institute Specialized Cardiosurgical Clinical Hospital named after academician B. A. Korolev

Email: maximoval@mail.ru
ORCID iD: 0000-0002-7241-7070
SPIN-code: 3748-4358

MD, Cand. Sci. (Med.)

Russian Federation, Nizhnу Novgorod

Sanika V. Kulkarni

Privolzhsky Research Medical University

Email: ksanika59@yahoo.in
ORCID iD: 0000-0003-4910-3820
Russian Federation, Nizhnу Novgorod

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Supplementary files

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2. Fig. 1. Fragments of multispiral СT-angiopulmonography in coronal (A, D), axial (B) and sagittal (C, D) projections: оcclusive thrombotic masses are determined at the level of the right branch of the PA (A, B, C); stenosing thrombotic defects of the left main branch and the left lower lobe branch of the PA (E). Notes: CT — computed tomography, PA — pulmonary artery.

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3. Fig. 2. Fragments of multispiral computed tomography — angiopulmonography angiopulmonography in axial planes. Signs of a sharp overload of the right chambers of the heart: — balloon-like dilatation of the trunk and main branches of the pulmonary artery (2A); a sharp increase in the size of the right chambers of the heart, the ratio of the transverse size of the right ventricle in relation to the left as 1.8:1.0; dilatation of the right atrium (2B).

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4. Fig. 3. Parameters of transthoracic echocardiography: Paradoxical movement of the interventricular septum (3А); Sharp expansion of the right chambers of the heart (3В); High rates of peak and moderate pulmonary hypertension (3С).

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5. Fig. 4. Angiography results: no hemodynamically significant stenoses were found.

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6. Fig. 5. Angiography results: а branch of the left coronary artery that forms 2 bronchial arteries of the right lung.

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7. Fig. 6. Angiography results: а branch of the left coronary artery that forms 2 bronchial arteries of the right lung.

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Copyright (c) 2023 Fedorov S.A., Zhurko S.A., Pichugin V.V., Chiginev V.A., Maximov A.L., Kulkarni S.V.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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