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. 2022 Apr 15;205(8):961-964.
doi: 10.1164/rccm.202107-1568LE.

Severe Acute Cor Pulmonale in Patients with COVID-19 Acute Respiratory Distress Syndrome: Caution with Left Turn

Bruno Evrard  1   2 , Marine Goudelin  1   2 , Julien Vaidie  1 , Anne-Laure Fedou  1 , Philippe Vignon  1   2
Affiliations

Severe Acute Cor Pulmonale in Patients with COVID-19 Acute Respiratory Distress Syndrome: Caution with Left Turn

Bruno Evrard et al. Am J Respir Crit Care Med. .
No abstract available

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Figures

Figure 1.
Figure 1.
Real-time three-dimensional (RT3D) transesophageal echocardiography was performed in a 40-year-old patient ventilated for severe acute respiratory distress syndrome related to coronavirus disease (COVID-19) with a severe acute cor pulmonale. A normal heart imaged in the supine 45° position is shown for comparison (left panels). The successive changes in body position are displayed at the bottom in the time sequence they have been performed from left to right. Images are oriented following the anatomical position of the heart within the chest when examined from the esophagus in various body positions, using the same representation as a chest computed tomographic scan. In the right lateral position, the right ventricle (RV) is in a dependent position and no significant morphological changes compared with the supine position were evidenced. In contrast, during the left lateral position, the RV is anatomically located above the left ventricle (LV). This results in a further restriction of the LV in the stiff pericardial sac due to 1) a direct compression by an increased dilatation of the RV as reflected by a higher RV/LV volume ratio, and 2) an exacerbation of end-systolic bulging of the interventricular septum toward the LV (black arrows). Hemodynamic parameters were kept steady without vasopressor support throughout the changes of body position, whereas respiratory mechanics were most impaired in the left lateral position (see Table 1). Each RT3D measurement was performed offline and independently by two experts in echocardiography on two distinct RT3D acquisitions in each body position. Reported values are the mean of these measurements. Written consents were obtained at discharge in survivors.
See this image and copyright information in PMC

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