Nakagawa Akiko, Nakamura Norihito, Torii Sho, Goto Shinya
Tokai University School of Medicine, Kanagawa, Japan.
Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Kanagawa 259-1193, Japan.
Eur Heart J Case Rep. 2023 Jul 26;7(8):ytad353. doi: 10.1093/ehjcr/ytad353. eCollection 2023 Aug.
Several side effects have been reported after mRNA COVID-19 vaccinations. Nonetheless, the risk of pulmonary hypertension (PH) is rarely reported. Most cases with acute PH following vaccination were due to macropulmonary embolism secondary to deep vein thrombosis. However, acute PH due to microthrombus formation after COVID-19 vaccination has not been reported before, although a microthrombus has been considered to lead to the dysfunction of multiple organs, particularly in patients infected with COVID-19.
A 63-year-old woman without any past medical history presented to our hospital with facial and bilateral pedal oedema and progressive dyspnoea on exertion. Her symptoms began the day after her second COVID-19 vaccination and developed gradually, which prompted her to seek consultation in our hospital 6 weeks later. An echocardiogram revealed substantially elevated right heart pressure, and cardiac catheterization revealed high pulmonary artery pressure (mean PAP, 30 mmHg). Contrast-enhanced computed tomography and venous echography revealed no apparent thrombus, and ventilation/perfusion (V/Q) scintigraphy revealed no V/Q mismatch. However, elevated D-dimer indicated the presence of a coagulation-fibrinolysis system in her body; thus, heparin therapy was initiated intravenously on Day 3 for 4 days, followed by direct oral anticoagulants ended on Day 16. Her symptoms substantially improved as her D-dimer level decreased, and a follow-up cardiac catheterization on Day 14 revealed a decline in mean PAP (15 mmHg).
Our case suggests that the presence of acute PH is likely due to microangiopathy. Further studies are required to reveal the relationship between immune responses and microthrombus formation after COVID-19 vaccination.
新冠病毒mRNA疫苗接种后已报告了几种副作用。尽管如此，肺动脉高压（PH）的风险却鲜有报道。大多数接种疫苗后发生急性PH的病例是由于深静脉血栓形成继发的大肺栓塞。然而，新冠病毒疫苗接种后因微血栓形成导致的急性PH此前尚未见报道，尽管微血栓被认为会导致多个器官功能障碍，尤其是在感染新冠病毒的患者中。
一名63岁无既往病史的女性因面部和双侧足部水肿以及进行性劳力性呼吸困难前来我院就诊。她的症状在第二次接种新冠病毒疫苗后第二天开始，并逐渐加重，这促使她在6周后到我院咨询。超声心动图显示右心压力显著升高，心导管检查显示肺动脉压力升高（平均肺动脉压，30 mmHg）。对比增强计算机断层扫描和静脉超声检查未发现明显血栓，通气/灌注（V/Q）闪烁扫描未发现V/Q不匹配。然而，D-二聚体升高表明其体内存在凝血-纤溶系统；因此，在第3天开始静脉注射肝素治疗4天，随后在第16天结束使用直接口服抗凝剂。随着D-二聚体水平下降，她的症状明显改善，第14天的随访心导管检查显示平均肺动脉压下降（15 mmHg）。
我们的病例表明，急性PH的出现可能是由于微血管病变。需要进一步研究以揭示新冠病毒疫苗接种后免疫反应与微血栓形成之间的关系。
