The university medical center in New Orleans constructed after the hurricane Katrina has the section hall which conforms to modern standards according to the recommendations of the Centers for control and prevention of diseases of the USA and is intended for carrying out pathoanatomical opening of patients with the confirmed diagnosis of COVID-19. Researchers of this center prepared the report about morphological changes in bodies of patients at a new koronavirusny infection. In the report they report the results concerning cardiopulmonary complications; these results were received during the early four autopsiyny studies.
Four dead — male and female patients of 44-76 years. All four Afro-Americans with obesity 2–3 degrees and medicamentally controlled hypertensia in the anamnesis. Three patients had achrestic diabetes 2 types, at two — the confirmed chronic disease of kidneys (a stage 2 and 3), and one of patients accepted a methotrexate. At all patients in process of a clinical picture of a disease within about three days weak cough and temperature increase to 38.3-38.9 ℃ with the subsequent sudden development of a decompensation of bodies of a respiratory system just before receipt in office of acute management were observed.
The roentgenogram of a thorax showed existence of bilateral blackouts as "opaque glass", the corresponding acute respiratory distress syndrome (ARDS) which degree worsened during hospitalization. Patients were intubated and transferred to ORIT. Medicamentous therapy included Vancomycinum, azithromycin in ORIT and tsefepy for all patients, and to one of patients therapy was carried out by dexamethasone. At all patients the diagnosis of infection with the SARS-CoV-2 virus was confirmed (as a result of diagnostics of PTsR in real time). During the laboratory research the following characteristic results were received: the raised ferritin, fibrinogen, the prothrombin time (PT) and — within 24 hours from the moment of approach of death — increase in number of neutrophils with a relative lymphopenia are revealed. All patients have indicators of glucose and nuclear heating plant norms were a little higher, and creatinine was above initial level. At two patients significant increase in the D-dimera level which value was received closer by the time of death (1200–2900 ng/ml) is noted. After the death of patients they were directed to pathoanatomical opening.
The macroscopic research of lungs at the time of opening showed that tracheas were the normal size and with moderately expressed by erythematic changes. The weight of all lungs was increased: the weight of the left lung varied from 680 to 1030 g (normal weight of 583±216 g); the weight of the right lung varied from 800 to 1050 g, (the normal weight of 663±239 g). All lungs consisted of usual shares and interlobar cracks, except for one dead at whom the partial lobectomy on the right side was executed earlier. Pulmonary arteries in gate of all lungs were without symptoms of a thrombembolia. Survey of bronchial tubes showed availability of dense white slime in lungs of one of patients and pink foam in respiratory tracts at other three patients. Also existence of a pericardiac and pleural sanious exudate from soft to moderate degree was noted. The parenchyma of each lung was diffusion and edematous and firm, and corresponded to the clinical diagnosis of ORDS. It is remarkable that at all dead, except one, on all parenchyma located on the periphery the centers of hemorrhage of dark color with focal demarcation were visualized. On sections of fragments in those areas which were determined by an outer surface as the hemorrhage centers obviously expressed hemorrhage was visualized. After fixing on the dissect surfaces of pulmonary fabric the sites of consolidation of brown-gray color alternating with non-uniform sites of hemorrhage which size varied within 3–6 cm in the maximum diameter were found. Some patients at cuts of a peripheral parenchyma had small dense blood clots. Only at one patient who took the immunosuppressive drugs focal consolidation was observed — on the rest of lungs signs of lobar infiltrate, abscess or obviously expressed general inflammatory process were not noted.
The research of heart was executed concerning three patients, the weight of heart varied from 430 to 550 g (normal weight of 365±71 g). As the most significant results of a macroscopic research the cardiomegaly and dilatation of a right ventricle were revealed. At one of patients massive dilatation at which the size of a cavity of a right ventricle was 3.6 cm in the diameter while the size of a left ventricle was 3.4 cm in the maximum diameter was visualized. All patients had a firm surface of a cut of a myocardium, red-brown, without considerable damages, and on coronary arteries there were no significant stenosing education or acute thrombosis.