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

Abstract

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.

Aortoarteritis and Severe Aortic Insuffi Ciency in a Patient After Covid-19

“…Moderately depressed left ventricular systolic function was another aspect of the disease, suspicious for myocarditis of immune genesis, caused by COVID-19. There are reports of aortitis and arteritis detected during a pandemic in patients with COVID-19 infection and possibly caused by an autoimmune response to the disease [26].…”

Fatal association of COVID‐19 and acute type A aortic dissection

“…Silvestri et al, 10 reviewed seventeen cases of aortic pathology in patients with clinically suspected or PCR‐confirmed COVID‐19 and also reported hypertension as the most frequent comorbidity; they suggested a potential link between COVID‐19 and aortic dissection. There are some potential mechanisms for arterial pathology in COVID‐19 patients.…”

A Fatal Association of COVID-19 and Acute Type A Aortic Dissection

“…The diagnosis and management of aortic dissection in early stages is of importance since it has numeric manifestations and can mimic other life threatening events such as myocardial infarction and pulmonary embolism 7 . Silvestri et al, reviewed seventeen cases of aortic pathology in patients with clinically suspected or PCR confirmed COVID-19 and also reported hypertension as the most frequent comorbidity; they suggested a potential link between COVID-19 and aortic dissection 8 .…”