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. 2023 Sep;21(3):122-130.
doi: 10.1007/s12574-023-00603-1. Epub 2023 May 23.

Changes in blood flow vortices inside the left ventricle in COVID-19 patients with intraventricular clot despite a normal coronary and myocardial motion

Mersedeh Karvandi  1 , Arash Mohammadi Tofigh  2 , Saeed Ranjbar  1 , Luigi P Badano  3
Affiliations

Changes in blood flow vortices inside the left ventricle in COVID-19 patients with intraventricular clot despite a normal coronary and myocardial motion

Mersedeh Karvandi et al. J Echocardiogr. 2023 Sep.

Abstract

Purpose: Our clinical observations showed clot formations in different regions of the left ventricle of the heart in some COVID-19 patients with normal myocardial motion and coronary artery. The aim of this study was to examine the changes caused by COVID-19 disease on blood flow inside the heart as a possible etiology of intracardiac clot formation.

Methods: In a synergic convergence of mathematics, computer science, and cardio-vascular medicine, we evaluated patients hospitalized due to COVID-19 without cardiac symptoms who underwent two-dimensional echocardiography. Patients with normal myocardial motions on echocardiography, normal coronary findings on noninvasive cardio-vascular diagnostic tests, and normal cardiac biochemical examinations but who presented with a clot in their left ventricle were included. To display the velocity vectors of the blood in the left ventricle, motion and deformation echocardiographic data were imported into MATLAB software.

Results: Analysis and output of the MATLAB program indicted anomalous blood flow vortices inside the left ventricular cavity, indicating irregular flow and turbulence of the blood inside the left ventricle in COVID-19 patients.

Conclusion: Our results suggest that in some COVID-19 patients, cardiac wall motion is not satisfactorily able to circulate the blood fluid in normal directions and that, despite normal myocardium, changes in the directions of blood flow inside the left ventricle might lead to clots in different zones. This phenomenon may be related to changes in blood properties, such as viscosity.

Keywords: Apical clot; COVID-19; Echocardiography; Interventricular septum clot; MATLAB; Vorticity.

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Conflict of interest statement

The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Blood circulation in a normal heart left ventricle: A the rapid filling phase has an irrational flow shown by green velocity vectors. B Blood as a fluid moves rotationally in a clockwise direction at the diastasis phase. C In the late filling phase, blood has an irrational flow (a non-rotational bunch velocity vectors) obscuring the vortex. D In the early iso-volumic contraction (IVC) period, the blood flow has a counterclockwise rotation. During the late IVC phase and ejection time, the vortex remains in the LVOT region, and the blood flows directly toward aortic valves
Fig. 2
Fig. 2
Blood flow circulation inside the left ventricular cavity of a COVID-19 patient with an apical clot (patient number 8): A green velocity vectors show the blood flow during the rapid filling phase and are rotational. B Blood fluid moves in a straight direction at the diastasis phase. C In the late filling phase, the blood flow has a rotational flow again. D In the early iso-volumic contraction (IVC) period, the blood flow has a clockwise rotation toward the LV-free wall
Fig. 3
Fig. 3
Blood flow direction inside the left ventricular cavity of the same COVID-19 patient (patient number 8) after the clot resolves with anticoagulation therapy is the same as when the clot is present, with the difference that the delay in the direction of the blood flow is reduced. A Green velocity vectors show the blood flow during the rapid filling phase and are rotational. B Blood fluid moves in a straight direction at the diastasis phase. C In the late filling phase, the blood flow has a rotational flow again. D In the early iso-volumic contraction (IVC) period, the blood flow has a clockwise rotation toward the LV-free wall
Fig. 4
Fig. 4
Blood flow circulation inside the left ventricular cavity of a COVID-19 patient with a clot in the base of the interventricular septum (patient number 10): A in these transesophageal echocardiography views, green velocity vectors located under the mitral valve during the rapid filling phase have a rotational flow. B A bundle of green velocity vectors moves non-rotationally at the diastasis phase. C In the late atrial contraction time, the blood fluid had a rotational flow again and inclined toward the left ventricle's free wall. D In the early iso-volumic contraction (IVC) period, the blood flow has a clockwise rotation toward the LV-free wall
See this image and copyright information in PMC

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