Unusually Rapid Development of Pulmonary Hypertension and Right Ventricular Failure after COVID-19 Pneumonia

Authors

• Christel van Dongen Department of Rheumatology, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands
• Marlou Janssen Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands
• Robrecht van der Horst Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands; Department of Intensive Care Medicine, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands
• Dave van Kraaij Department of Cardiology, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands
• Ralph Peeters Department of Rheumatology, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands
• Leon van den Toorn Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
• Remy Mostard Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands

ch.vandongen@zuyderland.nl

Keywords

Abstract

COVID-19 is a novel viral disease caused by SARS-CoV-2. The mid- and long-term outcomes have not yet been determined. COVID-19 infection is increasingly being associated with systemic and multi-organ involvement, encompassing cytokine release syndrome and thromboembolic, vascular and cardiac events. The patient described experienced unusually rapid development of pulmonary hypertension (PH) and right ventricular failure after recent severe COVID-19 pneumonia with cytokine release syndrome, which initially was successfully treated with methylprednisolone and tocilizumab. The development of pulmonary hypertension and right ventricular failure – in the absence of emboli on multiple CT angiograms – was most likely caused by progressive pulmonary parenchymal abnormalities combined with microvascular damage of the pulmonary arteries (group III and IV pulmonary hypertension, respectively). To the best of our knowledge, these complications have not previously been described and therefore awareness of PH as a complication of COVID-19 is warranted.