Clinical observations of COVID-19 infection in patients with chronic thromboembolic pulmonary hypertension

Aim    To present clinical observations of the novel coronavirus infection (COVID-19) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after a surgical intervention in the form of thromobendarterectomy from pulmonary artery branches.
Material and methods    The Acad. E.N. Meshalkin National Medical Research Center performed 127 open surgical interventions for CTEPH in the form of thromobendarterectomy from 2016 through 2020. The present study enrolled 113 patients included into the follow-up care group and into the Center Registry who were followed up for more than 6 months after the surgery. Clinical and functional features of COVID-19 were evaluated in the studied group.
Results    In the follow-up care group, 5 (4.4%) postoperative CTEPH patients had COVID-19. One patient had asymptomatic disease, and others had typical clinical symptoms and bilateral polysegmental pneumonia. There were no cases requiring artificial ventilation and no lethal outcomes. All patients with COVID-19 received anticoagulants as a basis therapy for CTEPH, and two patients who had residual pulmonary arterial hypertension (PAH) additionally received a PAH-specific therapy. During the treatment of COVID-19, no adjustment of the anticoagulant or PAH-specific therapy was required.
Conclusion    The group of patients with CTEPH is a unique pathophysiological model for studying the effect of COVID-19 under the conditions of compromised pulmonary circulation. In the studied follow-up care group, the COVID-19 morbidity was 4.4 % without fatal outcomes. Evaluation of the role of chronic anticoagulant and PAH-specific therapy in COVID-19 postoperative patients as well as evaluation of the role of COVID-19 in CTEPH progression merit further investigation.

1. World Health Organisation. Coronavirus Disease (COVID-19). Situation Report – 189. Av. at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200727-covid-19-sitrep-189.pdf?sfvrsn=b93a6913_2.

2. Ministry of Health of Russian Federation. Temporary methodical recommendations. Prevention, diagnosis and treatment of new coronavirus infection (COVID-2019). Version 8.1 (01.10.2020). Av. at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/052/219/original/Временные_МР_COVID-19_(v.8.1).pdf?1601561462. 2020.

3. Nuche J, Segura de la Cal T, Jiménez López Guarch C, López-Medrano F, Delgado CP-O, Ynsaurriaga FA et al. Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension. Diagnostics. 2020;10(8):548. DOI: 10.3390/diagnostics10080548

4. Avdeev S.N., Tsareva N.N., Merzhoeva Z.M., Trushenko N.V., Yaroshetskiy A.I. Practical guidance for oxygen treatment and respiratory support of patients with COVID-19 infection before admission to intensive care unit. Pulmonology. 2020;30(2):151–63. DOI: 10.18093/0869-0189-2020-30-2-151-163

5. Potus F, Mai V, Lebret M, Malenfant S, Breton-Gagnon E, Lajoie AC et al. Novel insights on the pulmonary vascular consequences of COVID-19. American Journal of Physiology-Lung Cellular and Molecular Physiology. 2020;319(2): L277–88. DOI: 10.1152/ajplung.00195.2020

6. Exercise and Sports Pulmonology: Pathophysiological Adaptations and Rehabilitation. Cogo A, Bonini M, Onorati P, editors – Cham: Springer International Publishing;2019. - 216 p. ISBN 978-3-030-05257-7

7. Horn EM, Chakinala M, Oudiz R, Joseloff E, Rosenzweig EB. Could pulmonary arterial hypertension patients be at a lower risk from severe COVID-19? Pulmonary Circulation. 2020;10(2):204589402092279. DOI: 10.1177/2045894020922799

8. Segura de la Cal T, Nuche J, Jiménez López-Guarch C, Pérez-Olivares C, Velázquez M, López-Medrano F et al. Unexpected Favourable Course of Coronavirus Disease 2019 in Chronic Thromboembolic Pulmonary Hypertension Patients. Archivos de Bronconeumología. 2020;56(11):749–52. DOI: 10.1016/j.arbres.2020.06.004

9. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T et al. Cardiovascular Implications of Fatal Outcomes of Patients with Coronavirus Disease 2019 (COVID-19). JAMA Cardiology. 2020;5(7):811–8. DOI: 10.1001/jamacardio.2020.1017

10. Magrone T, Magrone M, Jirillo E. Focus on Receptors for Coronaviruses with Special Reference to Angiotensin- Converting Enzyme 2 as a Potential Drug Target - A Perspective. Endocrine, Metabolic & Immune Disorders - Drug Targets. 2020;20(6):807–11. DOI: 10.2174/1871530320666200427112902

11. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. New England Journal of Medicine. 2020;383(2):120–8. DOI: 10.1056/NEJMoa2015432

12. Becker RC. COVID-19 update: Covid-19-associated coagulopathy. Journal of Thrombosis and Thrombolysis. 2020;50(1):54–67. DOI: 10.1007/s11239-020-02134-3