Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 343 Peri-operative echocardiography for lung transplantation in a critical patient with COVID-19 Yan Chen, Hongxia Wang, Yun Mou, Zhelan Zheng Abstract Critical patients with coronavirus disease 2019 (COVID-19) suffer from severe illness and have a high mortality rate. Lung transplantation may be the final option for a subset of these patients. Herein we report the important role of peri-opera- tive echocardiography in a COVID-19 patient who underwent bilateral lung transplantation because of severe respiratory failure. The precise evaluation provided by echocardiography enabled the prevention of anastomotic complications and the successful management of haemodynamic instability. Echocardiographers should be familiar with the complica- tions of lung transplantation and the haemodynamics under extracorporeal membrane oxygenation support to achieve a more accurate interpretation of cardiac parameters. Keywords: echocardiography, lung transplantation, extracorpor- eal membrane oxygenation Submitted 29/5/20, accepted 23/12/20 Published online 19/1/21 Cardiovasc J Afr 2021; 32 : 343–345 www.cvja.co.za DOI: 10.5830/CVJA-2020-064 Since late December 2019, coronavirus disease 2019 (COVID- 19) has spread across China and throughout the world. The mortality rate of COVID-19 among critical cases is as high as 49%, according to a report by the Chinese Center for Disease Control and Prevention. 1 Theoretically, lung transplantation may be the only choice for a subset of critical patients who have had a long-term dependence on ventilator and extracorporeal membrane oxygenation (ECMO) support. 2 This is a case report in which we describe the role of peri- operative echocardiography to assist in the clinical strategy and management of haemodynamic instability in a patient who underwent bilateral lung transplantation because of severe respiratory failure caused by COVID-19, after complicated therapy without any signs of respiratory improvement. Case report A 66-year-old woman with COVID-19 was transferred to our hospital owing to deterioration from pneumonia, with progressive shortness of breath, diarrhoea, fever and cough after two days of treatment in a local hospital. The patient had a body mass index of 31 kg/m 2 , with no clinical history except appendectomy, which had taken place 34 years earlier. After admission, she received an oral tracheal cannula when the blood gas analysis showed a PO 2 value of 56.5 mmHg, with oxyhaemoglobin saturation decreased to 74% under light activity, even with high nasal flow oxygen (FiO 2 100%). An X-ray demonstrated continuous aggravation of pneumonia after treatment involving lopinavir–ritonavir and umifenovir antiviral therapy, interferon α -2b, immunoglobulin, methylprednisolone, piperacillin–tazobactam and nutritional support. Veno-venous ECMO was performed to reduce the pulmonary burden. A tracheostomy tube was used after hospitalisation for three weeks. The patient had respiratory failurewith lung consolidation seen on the X-ray but showed no clinical improvement after aggressive treatment, even after the COVID-19 test was continuously negative for one week (Fig. 1). Transthoracic echocardiography (TTE) showed a gradual increase of pulmonary artery systolic pressure (PASP) up to 80 mmHg and a slight decline in the right heart function, with the tricuspid annular plane systolic excursion (TAPSE) decreasing to 17 mm. No abnormality was found in the left heart, with a left ventricular ejection fraction of 60–68%. The brain natriuretic peptide level gradually increased up to 1 012 pg/ml, and the serum cardiac troponin I level was up to 0.322 ng/ml. The other organ functions were well maintained. Blood count revealed a white blood cell count of 9.8 × 10 9 cells/l, haemoglobin level was 87 g/l and platelet count was 72 × 10 9 cells/l. Serum creatinine level was 49 µmol/l and blood glucose was mainly between 9 and 10.5 mmol/l. She had no history of hypertension, hyperlipidaemia or diabetes. Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China Yan Chen, MD Hongxia Wang, MD Yun Mou, PhD Zhelan Zheng, MD, 1186034@zju.edu.cn Fig. 1. Chest X-ray showing consolidation of the lung.