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Case Reports
. 2020 Jul 15;2(9):1383-1387.
doi: 10.1016/j.jaccas.2020.05.017. Epub 2020 May 19.

Difficulties of Managing Submassive and Massive Pulmonary Embolism in the Era of COVID-19

Alexandru Marginean  1 , Dalila Masic  2 , Yevgeniy Brailovsky  3 , Jawed Fareed  4 , Amir Darki  1
Affiliations
Case Reports

Difficulties of Managing Submassive and Massive Pulmonary Embolism in the Era of COVID-19

Alexandru Marginean et al. JACC Case Rep. .

Abstract

Acute pulmonary embolism (PE) is a potentially life-threatening manifestation of venous thromboembolic disease. Severe acute respiratory syndrome-coronavirus-2, a novel coronavirus that causes coronavirus disease-2019 (COVID-19), has been associated with an increased risk of thrombosis. We describe the therapeutic challenges of 3 patients presenting with PE and suspected or confirmed COVID-19. (Level of Difficulty: Beginner.).

Keywords: ARDS, acute respiratory distress syndrome; CDT, catheter-directed thrombolysis; PE, pulmonary embolism; PUI, patient under investigation; RV, right ventricular; RV/LV, right ventricular to left ventricular diameter ratio; TTE, transthoracic echocardiography; UFH, unfractionated heparin; anticoagulation; computed tomography; pulmonary circulation; right ventricle; thrombus.

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Figures

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Graphical abstract
Figure 1
Figure 1
Mechanical Thrombectomy of Massive Pulmonary Embolism (A) Left pulmonary artery (PA) angiogram showing thrombus burden (red arrows). (B) Angiogram following mechanical thrombectomy with restoration of blood flow (black arrows). (C) Clots aspirated from bilateral PA.
Figure 2
Figure 2
Chest CT Demonstrating Pulmonary Artery Thrombi and Lung Infiltrates (A) Axial plane demonstrating pulmonary embolism in the bilateral main pulmonary artery (red arrows). (B) Axial plane lung window demonstrating ground glass opacities (black arrows).
Figure 3
Figure 3
PERT Protocol for Management of PE in the COVID-19 Era Algorithm detailing clinical decision tree for PE management in suspected or confirmed COVID-19 patients. BNP = B-type natriuretic peptide; CDT = catheter-directed thrombolysis; COVID-19 = coronavirus disease-2019; ICU = intensive care unit; IV = intravenous; LVOT = left ventricular outflow tract; MCS = mechanical circulatory support; PE = pulmonary embolism; Perc = percutaneous; PERT = pulmonary embolism response team; RV = right ventricular; RVOT = right ventricular outflow tract; VTI = velocity time integral.
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