Background Coronavirus disease has spread widely all over the world since the beginning of 2020, and this required rapid adequate management. High-resolution computed tomography (HRCT) has become an initial valuable tool for screening, diagnosis, and assessment of disease severity. This study aimed to assess the clinical, radiographic, and laboratory findings of COVID-19 with HRCT follow-up in discharged patients to predict lung fibrosis after COVID-19 infection in survived patients. Results This study included two-hundred and ten patients who were tested positive for the novel coronavirus by nasopharyngeal swap, admitted to the hospital, and discharged after recovery. Patients with at least a one-time chest CT scan after discharge were enrolled. According to the presence of fibrosis on follow-up CT after discharge, patients were classified into two groups and assigned as the “non-fibrotic group” (without evident fibrosis) and “fibrotic group” (with evident fibrosis). We compared between these two groups based on the recorded clinical data, patient demographic information (i.e., sex and age), length of stay (LOS) in the hospital, admission to the ICU, laboratory results (peak C-reactive protein [CRP] level, lowest lymphocyte level, serum ferritin, high-sensitivity troponin, d-dimer, administration of steroid), and CT features (CT severity score and CT consolidation/crazy-paving score). CT score includes the CT during the hospital stay with peak opacification and follow-up CT after discharge. The average CT follow-up time after discharge is 41.5 days (range, 20 to 65 days). There was a statistically significant difference between both groups (p ˂0.001). Further, a multivariate analysis was performed and found that the age of the patients, initial CT severity score, consolidation/crazy-paving score, and ICU admission were independent risk factors associated with the presence of post-COVID-19 fibrosis (p<0.05). Chest CT severity score shows a sensitivity of 86.1%, a specificity of 78%, and an accuracy of 81.9% at a cutoff point of 10.5. Conclusion The residual pulmonary fibrosis in COVID-19 survivors after discharge depends on many factors with the patient’s age, CT severity, consolidation/crazy-paving scores, and ICU admission as independent risk factors associated with the presence of post-COVID-19 fibrosis.
Background: Early survivors of acute type A aortic dissection (AAAD) remain at risk for late death and late aortic events. However, the frequency and long-term effects of warfarin anticoagulation on long-term outcome in post-surgical AAAD survivors have not been elucidated. Methods:Two tertiary care centers performed a retrospective observational cohort study of warfarin anticoagulation in AAAD in 243 persons with early survival of surgical repair (WATAS). Serial postoperative tomographic imaging was available in 106 persons.Results: A total of 88 postoperative AAAD survivors (36%) were on long-term warfarin anticoagulation.The indication for anticoagulation was a mechanical aortic prosthesis in 46 (52%), atrial fibrillation in 33 (38%), stroke in 7 (8%), and pulmonary embolism in 1 (1%). The indication for anticoagulation remained unclear in 1 person (1%). Survival and aortic event free survival were 98.3±0.01 and 98.7±0.01 at 1 year, and 76.4±0.03 and 91.8±0.02 at 5 years, respectively, with no differences irrespective of warfarin anticoagulation. Multivariate Cox regression analysis established higher age (P<0.001), and operation extending into the descending aorta (P=0.030) as independent predictors of late death. Follow-up without tomographic imaging independently predicted increased long-term mortality (P<0.001) and lower rates of documented aortic events (P=0.003). Kaplan-Meyer analysis showed a relationship of aortic diameter growth ≥0.5 cm per year with late death (P=0.041) and with late aortic events (P<0.001). However, rapid aortic growth did not relate to warfarin anticoagulation.Conclusions: Warfarin anticoagulation is frequent in postsurgical AAAD and it is administered for vital indications. Warfarin anticoagulation does not relate to late mortality or to late aortic events. Rapid aortic growth predicts late mortality and late aortic events, but warfarin anticoagulation is not associated with aortic growth. Follow-up tomographic imaging is mandatory for long-term survival after surgical repair of AAAD. von Kodolitsch et al. Warfarin in aortic dissection
In Stanford type A aortic dissection, adopting an aggressive surgical strategy does not improve the quality of life in midterm follow-up compared to a defensive strategy. Unless the clinical setting dictates an aggressive management strategy, a defensive strategy can be safely adopted.
An open operation on the aortic arch is a complex procedure that requires not only surgical expertise but also meticulous management to ensure excellent outcomes. In recent years, the procedure has often been performed with the patient under circulatory arrest, with antegrade cerebral perfusion. With such a strategy, efficient monitoring to ensure adequate cerebral perfusion is essential. Here we describe a case of Stanford type A aortic dissection repair in which transcranial Doppler sonography was used as an excellent monitoring tool to allow visualization of cerebral flow and the online status of perfusion, providing instant feedback to allow changes in strategy to optimize inadequate cerebral perfusion.
Postinfarction ventricular septal defect (pVSD) due to acute myocardial infarction complicated by cardiogenic shock (CS) is associated with high mortality. The aim of this study was to determine the outcome of primary surgical repair of pVSD in patients with CS and examine whether it is influenced by the use of mechanical circulatory support (MCS) devices. Between October 1994 and April 2016, primary surgical repair of pVSD complicated by CS was performed in 53 patients. Thirty‐six (68%) were implanted pre‐operatively with an intra‐aortic balloon pump (IABP), 4 (8%) with extracorporeal life support (ECLS), and 13 (24%) received no MCS device. Prospectively collected demographic and perioperative data were analyzed retrospectively. All‐cause, 30‐day mortality rates were analyzed and multivariate analysis was performed to differentiate independent risk factors. No pre‐operatively implanted MCS device was able to improve 30‐day survival, whereas pre‐operatively implanted ECLS tended to have a positive effect (P = .106). The post‐operative need for a MCS device or escalation of MCS invasiveness (IABP upgrade to ECLS) was associated with a higher 30‐day mortality (P = .001) compared with patients without any MCS device or those with pre‐operatively implanted MCS devices. An independent risk factor for 30‐day mortality was the interval between acute myocardial infarction and surgery <7 days (OR 5.895, CI 1.615‐21.515; P = .007). Pre‐operative implantation of ECLS for CS tends to improve the outcome of early primary surgical pVSD repair. The need for a post‐operative MCS device is associated with a worse 30‐day survival after early primary surgical pVSD repair.
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