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首页> 外文期刊>European Heart Journal - Case Reports >Left ventricular mural thrombi with multisystem thrombosis in patients with COVID-19 and myocardial injury: a case series
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Left ventricular mural thrombi with multisystem thrombosis in patients with COVID-19 and myocardial injury: a case series

机译：左心室壁血栓与多系统血栓形成患者Covid-19和心肌损伤：案例系列

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Background Cardiovascular and thromboembolic complications have been reported in patients with Coronavirus disease-2019 (COVID-19)-related severe respiratory distress syndrome. Although myocarditis associated with COVID-19 pneumonia has been described, evidence of left ventricular (LV) mural thrombi with other multisystem events has not been reported. Case summary We report two cases with severe COVID-19 pneumonia and myocardial injury with large LV thrombi and other multisystem thrombotic events. The first patient represents an unusual case of large LV apical thrombus without concordant regional wall motion abnormality and mildly reduced LV function. A subsequent inferior ST-elevation myocardial infarction (STEMI) was likely related to either an embolic event or in situ coronary thrombosis. We could not ascertain whether the acute right ventricular dysfunction was due to in situ pulmonary thrombosis or inferior STEMI. The catastrophic cerebrovascular accident was likely an embolic phenomenon. Similarly, the second patient demonstrated multiple large pedunculated thrombi occupying one-third of the LV cavity with moderately reduced LV function. A segmental pulmonary embolism was diagnosed on computed tomography chest, confirming multiple territories of in situ thrombosis. Discussion COVID-19-related inflammatory cytokine release has been linked to activation of coagulation pathways. Marked elevation of ferritin and C-reactive protein levels in both patients were consistent with evidence of a hyperinflammatory state with ‘cytokine storm’. Furthermore, the finding of elevated D-dimer levels lends support to the altered coagulation cascade that plausibly explains the multisystem thrombosis observed in our patients. The direct viral endothelial involvement and subsequent endothelial dysfunction may play an important role in the development of thrombosis in different vascular beds, as seen in our patients.
机译：冠心病病毒疾病 - 2019年（Covid-19）相关的严重呼吸窘迫综合征患者报道了心血管和血栓栓塞并发症。虽然已经描述了与Covid-19肺炎有关的心肌炎，但尚未报告左心室（LV）壁血栓的证据尚未报告其他多系统事件。案例概要我们报告了两种患有严重Covid-19肺炎和心肌损伤的两种病例，具有大型LV血栓和其他多系统血栓形成事件。第一患者代表大型LV顶端血栓的不寻常情况，而没有协调的区域壁运动异常和轻度降低的LV功能。随后的劣质ST升高心肌梗死（Stemi）可能与栓塞事件或原位冠状动脉血栓形成有关。我们无法确定急性右心室功能障碍是否是由于原位肺血栓形成或劣质梗死。灾难性的脑血管事故可能是栓塞现象。类似地，第二患者展示了多个大的血栓血栓，其具有适度降低的LV函数占据LV腔中的三分之一。诊断出节段性的肺栓塞在计算机断层扫描胸上，确认了原位血栓形成的多个领土。讨论Covid-19相关的炎症细胞因子释放与凝血途径的活化有关。两种患者的铁蛋白和C反应蛋白水平的标记升高与具有“细胞因子风暴”的患有高炎症状态的证据一致。此外，升高的D-二聚体水平的发现为改变的凝固级联提供了良好的凝固级联，可言论解释我们患者在患者中观察到的多系统血栓形成。如患者所见，直接病毒内皮受累和随后的内皮功能障碍可能在不同血管床的血栓形成发育中发挥重要作用。

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