Cardona Buitrago Carolina, Builes Gutierrez Aida Maired, Jiménez Marín David, Aristizábal García Camilo
Internal Medicine, Hospital San Vicente Fundación, Rionegro, COL.
Epidemiology, Hospital San Vicente Fundación, Rionegro, COL.
Cureus. 2022 Mar 21;14(3):e23358. doi: 10.7759/cureus.23358. eCollection 2022 Mar.
Although the association of coronavirus disease 2019 (COVID-19) and thromboembolic disease is well known, cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mechanical valve thrombosis have not been described enough. Mechanical valve thrombosis is a medical emergency that is associated with a great impact on patients' morbidity and mortality. Here, we report a case of a patient with mechanical valve thrombosis secondary to SARS-CoV-2 infections that required valve replacement with satisfactory postoperative recovery. A 52-year old female patient was presented with a previously implanted mechanical prosthesis (type - St. Jude Medical 29 mm; St. Paul, MN: St. Jude Medical, Inc.) eight years ago due to rheumatic fever, under anticoagulation with warfarin and valvular atrial fibrillation (permanent), congenital single kidney (glomerular filtration rate {GFR}: 89.9 mL/min), and hypothyroidism. She was admitted to the hospital with a high level of complexity due to respiratory difficulty and generalized edematous syndrome, and a reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 infection (20 days before admission); the patient was anticoagulated with warfarin (international normalized ratio {INR} at admission was 2.63 seconds). As per protocol, a CT-chest scan tomography was performed and showed organized pneumonia in the right apical lobe. We performed a transesophageal echocardiogram, which showed a thrombus (20 x 15 x 20 mm) in the lateral disc of the mechanical prosthesis, restricting its mobility. The patient presented signs of hypoperfusion (lactate levels: 4 mmol/L; urine per hour: 1 cc/kg) with associated low cardiac output syndrome, requiring double vasopressor support at the maximum dose (achieving a mean arterial pressure of 72 mmHg) due to the clinical condition and the large size of the thrombus, the cardiovascular surgeon, in agreement with the family, decides to carry out emergency valve replacement surgery with replacement of a mechanical prosthesis replacement (St. Jude No. 29; St. Paul, MN: St. Jude Medical, Inc.). The patient presented a satisfactory postoperative recovery, achieving INR goals, with subsequent discharge and follow-up at two months with transthoracic ultrasound, where normofunctional mitral prosthesis was demonstrated, without evidence of thrombi or intracavitary masses. Mechanical mitral valve thrombosis, secondary to SARS-CoV-2 infection is a serious complication with poor prognosis that requires a high rate of suspicion, and timely diagnostic aids are essential to confirm the diagnosis. Managing this issue should be interdisciplinary and individualized considering the clinical condition of the patient and the associated comorbidities.
尽管2019冠状病毒病（COVID-19）与血栓栓塞性疾病之间的关联已广为人知，但严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染与机械瓣膜血栓形成的病例尚未得到充分描述。机械瓣膜血栓形成是一种医疗急症，对患者的发病率和死亡率有重大影响。在此，我们报告一例继发于SARS-CoV-2感染的机械瓣膜血栓形成患者，该患者需要进行瓣膜置换，术后恢复良好。一名52岁女性患者八年前因风湿热植入了一枚机械瓣膜假体（型号 - 圣犹达医疗29毫米；明尼苏达州圣保罗：圣犹达医疗公司），接受华法林抗凝治疗，患有瓣膜性心房颤动（永久性）、先天性单肾（肾小球滤过率{GFR}：89.9毫升/分钟）和甲状腺功能减退。她因呼吸困难和全身水肿综合征入院，病情复杂，逆转录聚合酶链反应（RT-PCR）确诊为COVID-19感染（入院前20天）；患者接受华法林抗凝治疗（入院时国际标准化比值{INR}为2.63秒）。按照方案进行了胸部CT扫描，显示右肺尖叶有组织性肺炎。我们进行了经食管超声心动图检查，显示机械瓣膜假体侧盘有血栓（20×15×20毫米），限制了其活动。患者出现低灌注体征（乳酸水平：4毫摩尔/升；每小时尿量：1毫升/千克），伴有低心输出量综合征，由于临床状况和血栓体积较大，需要最大剂量的双重血管升压药支持（平均动脉压达到72毫米汞柱），心血管外科医生与家属协商后，决定进行紧急瓣膜置换手术，更换一枚机械瓣膜假体（圣犹达29号；明尼苏达州圣保罗：圣犹达医疗公司）。患者术后恢复良好，达到了INR目标，随后出院，并在两个月后进行经胸超声检查随访，结果显示二尖瓣假体功能正常，未发现血栓或心腔内肿块。继发于SARS-CoV-2感染的机械性二尖瓣血栓形成是一种预后不良的严重并发症，需要高度怀疑，及时的诊断辅助对于确诊至关重要。考虑到患者的临床状况和相关合并症，处理这个问题应该是跨学科的且个体化的。
