PMC9650637_01
Representative images from echocardiograms obtained during the patient's course. (A) Immediately after cardiac arrest while on ECMO. Left panel: Apical 4-chamber view demonstrates right ventricular dilation (double headed arrows) and hypertrophy (single headed arrows). Right panel: Increased peak velocity of the tricuspid valve regurgitation jet indicates elevated right ventricular pressure. (B) Four weeks after cardiac arrest - on sildenafil. Left Panel: Parasternal short axis image demonstrates normal end-systolic septal position (indicated by circle), normal right ventricular size, and mild right ventricular hypertrophy. Right Panel: Normal peak velocity of the tricuspid valve regurgitation jet indicates normal right ventricular pressure. (C) Nine months after cardiac arrest - off sildenafil. Left Panel: Parasternal short axis image demonstrates normal end-systolic septal position (indicated by circle), normal right ventricular size, and no right ventricular hypertrophy. Right Panel: Normal peak velocity of the tricuspid valve regurgitation jet indicates normal right ventricular pressure.
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F1
Echocardiogram shortly post-arrest showed signs of pulmonary arterial hypertension (PAH) including not only elevated tricuspid regurgitation peak velocity and severely diminished right ventricular function, but also significant right ventricular hypertrophy, suggesting that PAH predated the cardiac arrest (Figure 1A). A repeat echocardiogram prior to discharge showed only persistent right ventricular hypertrophy (Figure 1B), and repeat selenium and thiamine levels were normal. Sildenafil was discontinued six months after the cardiac arrest and a follow up echocardiogram three months off sildenafil remained stable (Figure 1C).
Timeline of case.
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F2
A timeline of the case is outlined in Figure 2.