In-transit thrombi in right heart chambers treated with percutaneous intervention after COVID-19

Zuilma Y. Vásquez-Ortiz, Departamento de Ecocardiografía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Beatriz A. Fernández-Campos, Departamento de Ecocardiografía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
José I. Tartón-Sisimit, Departamento de Ecocardiografía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Sergio M. Alday-Ramírez, Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Alejandro Gabutti, Departamento de Radiología e Imagen, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Francisco Baltazar-Jiménez, Departamento de Ecocardiografía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Itamar Arango-Flores, Departamento de Ecocardiografía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Solange G. Koretzky, Departamento de Publicaciones, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
María E. Soto, Departamento de Investigación, Instituto Nacional de Cardiología Ignacio Chávez; Departamento de Investigación Cardiovascular, Centro Médico ABC, Campus Observatorio. Ciudad de México, México

Acute and chronic complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are related to an acquired thromboinflammatory state. The incidence of deep vein thrombosis and acute pulmonary embolism in patients with COVID-19 is up to 85%, which is why thromboprophylaxis was recommended for hospitalized patients. In-transit thrombi increase mortality, so multiple management strategies have been developed. A 63-year-old man hospitalized for severe COVID-19 pneumonia was discharged after improvement. One month later, he presented to the emergency department with hemoptysis, dyspnea, and chest pain. A bulla was detected in the right lung as a complication of SARS-CoV-2 infection. It was treated with segmentectomy, and postoperatively, antithrombotic prophylaxis was administered. However, 24 hours later, the patient presented with ventilatory and hemodynamic deterioration, requiring invasive mechanical ventilation and vasopressor administration. Pulmonary embolism was found, so thrombectomy and in situ thrombolysis were performed, which significantly improved hemodynamic parameters. Percutaneous intervention in patients with COVID-19 who have a thrombus in transit is a therapeutic strategy that can improve outcomes and survival.

Keywords: Echocardiography. Percutaneous interventionism. SARS-Cov2 pneumoniae. Thrombus in transit.