DOI: 10.12890/2020_002160
Pulmonary Hypertension in COVID-19 Pneumoniae: It Is Not Always as It Seems
Authors
mariacri.pasqualetto@aulss3.veneto.it
Keywords
COVID-19, pulmonary hypertension, right ventricular involvement, partial anomalous pulmonary venous drainageAbstract
A patient affected by COVID-19 pneumonia may develop pulmonary hypertension (PH) and secondary right ventricular (RV) involvement, due to lung parenchymal and interstitial damage and altered pulmonary haemodynamics, even in non-advanced phases of the disease. This is a consequence of hypoxic vasoconstriction of the pulmonary circulation, the use of positive end-expiratory pressure (PEEP) in mechanical ventilation, pulmonary endothelial injury, and local inflammatory thrombotic and/or thromboembolic processes.
We report the case of a young man admitted with a diagnosis of COVID-19 pneumoniae with PH unrelated to viral infection and in whom partial anomalous pulmonary venous drainage (PAPVD) was eventually diagnosed.
References
- Hiten R. Patel, Suchit Bhutani1 , Fayez Shamoon, Hartaj Virk. Deciphering a case of pulmonary hypertension in a young female: Partial anomalous pulmonary venous drainage the culprit. Ann Thorac Med 2018;13(1): 55-58.
- Pagnesi M, Baldetti L, Beneduce A, Calvo F, Gramegna M, Pazzanese V, et al. Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19. Heart 2020;106(17):1324–1331.
- Sylvester JT, Shimoda LA, Aaronson PI, Ward JPT. Hypoxic pulmonary vasoconstriction. Physiol Rev 2012;92:367–520.
- Jardin F, Delorme G, Hardy A, Ward JPT. Reevaluation of hemodynamic consequences of positive pressure ventilation: emphasis on cyclic right ventricular afterloading by mechanical lung inflation. Anesthesiology 1990;72:966.
- uan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–1720.
- Tian S, Hu W, Niu L, Liu H, Xu H, Xiao S-Y. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J ThoracOncol 2020;15:700–704.
- Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020;395:1417–1418.
- Ciceri F, Beretta L, Scandroglio AM, Colombo S, Landoni G, Ruggeri A, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc 2020;31:685–690.
- Grosse C, Grosse A, Salzer HJF, MW Dünser, Motz R, Langer R. Analysis of cardiopulmonary ?ndings in COVID-19 fatalities: high incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia. Cardiovasc Pathol 2020;49:107263.
