Acute Type a Aortic Dissection in a Patient With COVID-19

Tabaghi, Shiva; Akbarzadeh, Mohammad Ali

doi:10.2217/fca-2020-0103

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…Our study did not capture COVID-19 positive patients who required cardiac surgery but failed to survive in the operating room. 63 During the COVID-19 pandemic, cardiac surgery has faced many challenges. Many cardiac surgeons have had to change their daily practice, with some offering their services in critical care units to meet the demand caused by the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Further studies investigating the outcomes of COVID‐19 positive patients who undergo cardiac surgery may yield different results compared with our review, in particular more recent studies conducted after the date of our search. Our study did not capture COVID‐19 positive patients who required cardiac surgery but failed to survive in the operating room 63 …”

Section: Discussionmentioning

confidence: 99%

“…Our study did not capture COVID‐19 positive patients who required cardiac surgery but failed to survive in the operating room. 63 …”

Section: Discussionmentioning

confidence: 99%

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Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

Gupta

Leslie

Hewitt

et al. 2022

ANZ Journal of Surgery

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Introduction:The COVID-19 pandemic has had a significant impact on global surgery. In particular, deleterious effects of SARS-CoV-2 infection on the heart and cardiovascular system have been described. To inform surgical patients, we performed a systematic review and meta-analysis aiming to characterize outcomes of COVID-19 positive patients undergoing cardiac surgery. Methods: The study protocol was registered with PROSPERO (CRD42021228533) and conformed with PRISMA 2020 and MOOSE guidelines. PubMed, Ovid MEDLINE and Web of Science were searched between 1 January 2019 to 24 February 2022 for studies reporting outcomes on COVID-19 positive patients undergoing cardiac surgery. Study screening, data extraction and risk of bias assessment were conducted in duplicate. Meta-analysis was conducted using a random-effects model where at least two studies had sufficient data for that variable. Results: Searches identified 4223 articles of which 18 studies were included with a total 44 patients undergoing cardiac surgery. Within these studies, 12 (66.7%) reported populations undergoing coronary artery bypass graft (CABG) surgery, three (16.7%) aortic valve replacements (AVR) and three (16.7%) aortic dissection repairs. Overall mean postoperative length of ICU stay was 3.39 (95% confidence interval (CI): 0.38, 6.39) and mean postoperative length of hospital stay was 17.88 (95% CI: 14.57, 21.19). Conclusion: This systematic review and meta-analysis investigated studies of limited quality which characterized cardiac surgery in COVID-19 positive patients and demonstrates that these patients have poor outcomes. Further issues to be explored are effects of COVID-19 on decisionmaking in cardiac surgery, and effects of COVID-19 on the cardiovascular system at a cellular level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

Gupta

Leslie

Hewitt

et al. 2022

ANZ Journal of Surgery

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“…Lung bilateral ground-glass opacities Type A aortic dissection Aortic transection above commissures and distally before the innominate a. +28mm Dacron graft + distal anastomosis sutured with pledgets in order to affix dissection flap to aortic wall ALIVE discharged on 14th post-operative day with anti-aggregant On admission(test not specified) Azouz [37] 56 F Not reported Acute ischemic stroke (right middle cerebral a. occlusion); On 2nd day abdominal pain + vomiting free-floating aortic arch thrombous + superior mesenteric a. occlusion Endovascular thrombectomy + open resection small bowel NOT SPECIFIED Positive on admission Mori [14] 54 M Family history for aortic aneurysm and dissection Sudden onset chest pain, no respiratory symptoms 52 mm dilated Aortic root and arch intramural hematoma + ground‐glass opacities in the lung Valve‐sparing root+ hemiarch replacement (dacron) + coronary bypass ALIVE discharged on 6 po day Positive on admission (PCR) 82 F Atrial fibrillation, sick sinus syndrome, diastolic heart failure, pacemaker, COPD sudden onset chest pain and facial weakness, anuria and acute kidney injury, no COVID symptoms on admission Type A aortic dissection Ascending aorta and hemiarch replacement + coronary sinus reconstruction ALIVE (renal failure requiring dialysis, COVID-19 pos 66 p.o.day) Positive 66 days p.o (respiratory symptoms) Mamishi [18] 14 M Williams Syndrome supravalvular aortic stenosis, coronary involvement Fever, shortness of breath and cough Type A aortic dissection Exitus before surgery EXITUS (acute dissection after 3 weeks steroid therapy for COVID treatment) Positive on admission Tabaghi [16] 47 F None Fever, dry cough and bloody diarrhea Type A aortic dissection Exitus before surgery EXITUS cardiac arrest before surgery Positive on admission Shergill [19] 71 M None Fever, dry cough, diarrhea 2 weeks. Acute Chest pain (left side) ...…”

Section: Resultsmentioning

confidence: 99%

“…Because vascular acute complications have occurred in known COVID-19 patient during hospitalization due to the infectious condition, there is a need to assess any concomitant clinical condition (including vascular acute syndromes) that may occur in COVID-19 patients and not merely viewing them as purely infectious patients [16] .…”

Section: Discussionmentioning

confidence: 99%

Aortic Pathology During COVID - 19 Pandemics. Clinical Reports in Literature and Open Questions on the two Co-Occurring Conditions

Silvestri

Recchia

2021

Annals of Vascular Surgery

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Introduction Cardiovascular involvement in SARS-CoV-2 infection has emerged as one of viral major clinical features during actual pandemic; limb arterial ischemic events, venous thrombosis, acute myocardial infection and stroke have occurred in patients. Acute aortic conditions have also been described, followed by interesting observations on cases, hypothesis, raised since the emergence of the pandemics. Methods a review of cases in literature of aortic pathology in patients with clinically suspected/microbiologically confirmed COVID-19 infection has been carried out to analyze anagraphic data, clinical presentation, treatment options and outcome. Results 17 cases have been included. Mean age of patients was 58.6±15.2years, with a male to female ratio of 12:15 (70.5% vs 29.5%). Comorbidities were reported in 11 cases (64.7%), but in 5 cases (29.4%) no previous pathology was signaled in history. Hypertension was the most frequently reported comorbidity, in 8 cases, (47%), followed by renal pathology (17.6%), coronary artery disease (17.6%), previous aortic surgery (11.7%) and arrhythmia (11.7%); but also cerebrovascular disease, diabetes, autoimmune conditions, previous neoplasia and arrhythmia were reported once each. Fever and thoracic pain were the most frequently reported findings at presentation (8 cases, 47% each), followed by respiratory symptoms (6, 35.2%), low lymphocyte count (17.6%), features related to aneurysm rupture, ischemic stroke, abdominal pain and acute renal insufficiency. Reported aortic pathology included: type A aortic dissection (11 cases; 64.7%); new pathology of previous aortic graft (2 cases, 11.7%); 2 aortitis, one associated with type A aortic dissection; 1 thoraco-abdominal aortic aneurysm, 1 ruptured aortic aneurysm and 1 aortic embolizing thrombosis. Open surgery was carried out in 10 cases (58.8%), endovascular treatment in 3 (17.6%). Three patients (17.6%) died before surgery. Exitus was reported in 4 cases, with a total mortality of 23.5%. Conclusions Acute aortic events have occurred during pandemic in patients with clinically suspected/microbiologically confirmed COVID-19 infection. Confounding clinical features at presentation, the importance of anamnestic details (as previous vascular graft implant), the observed surgical and post-operatory challenges may suggest the need to consider the implications of the possible link between acute aortic events and SARS-CoV-2 infection, in order to promptly correctly diagnose the patient and respond to specific needs.

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The Potential Involvement of SARS‐CoV‐2 in the Immuno‐Pathogenesis of a Type A Aortic Dissection Case

Alizadehasl

Eslami

Vakili

et al. 2022

Clinical Case Reports

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Since the first emergence of the novel coronavirus in December 2019 in Wuhan, China, and the subsequent pandemic, the disease has become a major matter of concern for global health and affected millions of people all over the world. SARS coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, targets the upper and lower respiratory tracts in most cases. Their involvement would cause pneumonia with symptoms such as dry cough, dyspnea, fever, sputum production, and rhinorrhea. 1 One of the significant complications related to this virus is the ability of the disease to affect other organs with a wide range of signs and symptoms. Gastrointestinal manifestations (e.g., nausea, vomiting, diarrhea, anorexia, etc.), neurological manifestations (e.g., anosmia, ageusia, headache, altered mental status, dizziness, etc.), and multiorgan dysfunction (e.g., metabolic or electrolyte imbalance, etc.) may occur in COVID-19 patients. 2 In this case presentation, we aim to focus on the cardiovascular complications of COVID-19. They can present in different forms and severities, from nonspecific palpitations and chest tightness to life-threatening events such as left ventricular dysfunction (heart failure), acute

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Acute Type a Aortic Dissection in a Patient With COVID-19

Cited by 16 publications

References 20 publications

Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

Aortic Pathology During COVID - 19 Pandemics. Clinical Reports in Literature and Open Questions on the two Co-Occurring Conditions

The Potential Involvement of SARS‐CoV‐2 in the Immuno‐Pathogenesis of a Type A Aortic Dissection Case

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