1
|
Lohani KR, Sannasi VV, Sidhu HRS, Ooi OC, Hung WP, Chen MQ. Post-COVID-19 Thoracic Aortic Rupture with an Unforeseen Spinal Epidural Hematoma. AORTA (STAMFORD, CONN.) 2023; 11:40-43. [PMID: 36848911 PMCID: PMC9970752 DOI: 10.1055/s-0042-1757799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The importance of prompt diagnosis and early stenting of an aortic rupture cannot be overemphasized. We present a case of thoracic aortic rupture in a middle-aged gentleman who had recently suffered coronavirus disease 2019. The case was further complicated by the development of an unexpected spinal epidural hematoma.
Collapse
Affiliation(s)
- Kush R. Lohani
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore,Address for correspondence Kush R. Lohani, MBBS, MS (Gen Surgery) Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System1 Jurong East Street 21, Singapore 609606Singapore
| | - Vikram V. Sannasi
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Harvinder R. S. Sidhu
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Oon C. Ooi
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Wu P. Hung
- Department of Orthopedic Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Min Q. Chen
- Division of Vascular Surgery, Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| |
Collapse
|
2
|
Ahmad SA, Khalid N, Chhabra L, Kayani WT, Helmy T. Stanford Type A Aortic Dissection in A Patient with Primary Antiphospholipid Syndrome and Coronavirus Disease 2019. AORTA (STAMFORD, CONN.) 2023; 11:47-49. [PMID: 36848913 PMCID: PMC9970749 DOI: 10.1055/s-0042-1757952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Acute aortic dissection is one of the most lethal diseases, affecting the lining of the aortic wall. We describe a case of Stanford Type A aortic dissection in a patient with underlying primary antiphospholipid syndrome (APS) complicated by coronavirus disease 2019 (COVID-19). APS is characterized by recurrent venous and/or arterial thrombosis, thrombocytopenia, and rarely vascular aneurysms. The hypercoagulable milieu attributable to APS and the prothrombotic state from COVID-19 posed a challenge in achieving optimal postoperative anticoagulation in our patient.
Collapse
Affiliation(s)
- Sarah A. Ahmad
- Section of Cardiothoracic Surgery, Saint Francis Medical Center, Monroe, Louisiana
| | - Nauman Khalid
- Section of Interventional Cardiology, Saint Francis Medical Center, Monroe, Louisiana,Address for correspondence Nauman Khalid, MD Section of Interventional Cardiology, St. Francis Medical Center309 Jackson Street, Monroe, LA 71201
| | - Lovely Chhabra
- Section of Cardiology, Westchester Medical Center Network Advanced Physician Services, New York, New York
| | - Waleed T. Kayani
- Section of Interventional Cardiology, Baylor College of Medicine, Houston, Texas
| | - Tarek Helmy
- Section of Interventional Cardiology, Louisiana State University Health Shreveport, Louisiana
| |
Collapse
|
3
|
Krzelj K, Anic D. Aortic Dissection and COVID-19 Pneumonia in a Pregnant Woman at 34 Weeks of Gestation. Tex Heart Inst J 2023; 50:490619. [PMID: 36735917 PMCID: PMC9969779 DOI: 10.14503/thij-22-7854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between 0.1% and 0.3% of all aortic dissections occur during pregnancy. Arterial hypertension, connective tissue disorders, and congenital cardiovascular anomalies-including bicuspid aortic valves-are well-known risk factors. The causality between pregnancy and aortic dissection is unclear, but there have been some observations that COVID-19 illness may increase the risk. This report describes a pregnant woman at 34 weeks of gestation who had a bicuspid aortic valve and experienced an acute aortic dissection while ill with COVID-19 pneumonia. Computed tomography confirmed a type A aortic dissection and bilateral patchy pulmonary opacities. Cesarean delivery was performed, followed by replacement of the aortic valve with a mechanical aortic prosthesis and reconstruction of the ascending aorta and hemiarch. The intraoperative course was uneventful, and the patient was successfully weaned from mechanical ventilation after 51 hours. COVID-19 during pregnancy seems to increase the risk for aortic dissection, although there is no evidence base for an association. Because guidelines for diagnosis and treatment in such complex cases are lacking, care from a multidisciplinary team is crucial for successful outcomes.
Collapse
Affiliation(s)
- Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Anic
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
4
|
Abraham B, Mathew SD, Sridharan K. A Systematic Review of Arterial Dissections in COVID-19 Patients. Curr Cardiol Rev 2023; 19:e280622206435. [PMID: 35762547 PMCID: PMC10201876 DOI: 10.2174/1573403x18666220628093303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION COVID-19 is often seen presenting with a myriad of signs and symptoms of multiorgan dysfunction including arterial dissection. METHODS Various theories have been proposed such as endothelial dysfunction triggered by hyperinflammatory response that results in rupture of atherosclerotic plaque and subsequent dissection. RESULTS However, the exact incidence is unknown and only case reports and case series have been published till date. CONCLUSION Here we carried out a systematic analysis of published case reports/series related to dissection of the aorta, coronary, cerebral, vertebral, cervical, renal, and splanchnic arteries.
Collapse
Affiliation(s)
- Betsy Abraham
- Department of Intensive Care, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | | | - Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| |
Collapse
|
5
|
Alizadehasl A, Eslami S, Vakili K, Habibi Khorasani S, Pour Aliakbar H, Nezhadbahram H, Haghazali M. The Potential Involvement of SARS‐CoV‐2 in the Immuno‐Pathogenesis of a Type A Aortic Dissection Case. Clin Case Rep 2022; 10:e05881. [PMID: 35664515 PMCID: PMC9136700 DOI: 10.1002/ccr3.5881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/07/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID‐19) may represent different clinical manifestations with different severities, from mild to severe. Even though the respiratory system is the mainly involved organ, numerous reports have mentioned cardiovascular complications in COVID‐19. Herein, we report a case of type A aortic dissection in a COVID‐19 patient. In the case of severe SARS‐CoV‐2 infection, severe inflammation (i.e., cytokine storm) and downregulation of ACE2 can be associated with aortic dissection.
Collapse
Affiliation(s)
- Azin Alizadehasl
- Head of Cardio‐Oncology Department and Research Center Rajaie Cardiovascular Medical & Research Center Iran University of Medical Science Tehran Iran
| | - Samira Eslami
- Department of Adult Echocardiography Rajaie Cardiovascular Medical and Research Center Tehran Iran
| | - Kimia Vakili
- Student Research Committee Faculty of Medicine, Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Shirin Habibi Khorasani
- Department of Adult Echocardiography Rajaie Cardiovascular Medical and Research Center Tehran Iran
| | - Hamidreza Pour Aliakbar
- Cardiovascular Intervention Research Center Rajaie Cardiovascular, Medical, and Research Center Iran University of Medical Sciences Tehran Iran
| | - Hanieh Nezhadbahram
- Rajaie Cardiovascular, Medical and Research Center Iran University of Medical Sciences Tehran Iran
| | - Mehrdad Haghazali
- Rajaie Cardiovascular, Medical and Research Center Iran University of Medical Sciences Tehran Iran
| |
Collapse
|
6
|
Gupta AK, Leslie A, Hewitt JN, Kovoor JG, Ovenden CD, Edwards S, Chan JCY, Worthington MG. Cardiac surgery on patients with COVID-19: a systematic review and meta-analysis. ANZ J Surg 2022; 92:1007-1014. [PMID: 35373439 PMCID: PMC9111466 DOI: 10.1111/ans.17667] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/15/2022]
Abstract
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 decision‐making in cardiac surgery, and effects of COVID‐19 on the cardiovascular system at a cellular level.
Collapse
Affiliation(s)
- Aashray K Gupta
- Department of Surgery, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Alasdair Leslie
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin C Y Chan
- University of Adelaide, Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | |
Collapse
|
7
|
Ramandi A, Akbarzadeh MA, Khaheshi I, Khalilian MR. Aortic dissection and Covid-19; a comprehensive systematic review. Curr Probl Cardiol 2022; 48:101129. [PMID: 35139402 PMCID: PMC8817949 DOI: 10.1016/j.cpcardiol.2022.101129] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
Coronavirus disease 19 (Covid-19) has been declared as a pandemic disease since March 2020; causing wide array of signs and symptoms, many of which result in increased mortality rates worldwide. Although it was initially known as an acute respiratory disease, Covid-19 is accompanied with several extrapulmonary manifestations, of which the cardiovascular ones are of major importance. Among other cardiovascular complications of Covid-19, aortic dissection has been a significant yet underrated problem. The pathophysiology of aortic dissection consists of various inflammatory pathways, that could be influenced by Covid-19 infection. We herein have reviewed articles inclusive of aortic dissection concurrent with Covid-19 infection in a systematic manner, along with the probable similarities in pathophysiology of aortic dissection with Covid-19 infection.
Collapse
Affiliation(s)
- Alireza Ramandi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Akbarzadeh
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Khalilian
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Alloush TK, Alloush AT, Marzouk F, Abdulghani KO, Shokri HM. Post-COVID isolated subclavian artery dissection with multiple cerebral infarctions. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:114. [PMID: 36212672 PMCID: PMC9526528 DOI: 10.1186/s41983-022-00549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity, yet it also causes multiple organs dysfunction in affected patients. There is a strong evidence that it increases the susceptibility of cerebrovascular strokes in such patients. Besides this prothrombotic complication, arterial dissection can be one of its mechanisms increasing the risks of stroke. Case presentation Herein, we report a case of spontaneous isolated subclavian artery dissection in a COVID-19 patient. Sixty-one-year-old female presented with spontaneous isolated subclavian artery dissection without any traumatic events nor history of connective tissue disorders. She had left upper limb ischemia followed by cerebellar, thalamic and occipital infarctions. Whether this patient’s subclavian artery dissection was triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative. Conclusions Nonetheless, arterial dissection can be one of its complications, it is essential for treating physicians to be attentive for the diversity of COVID-19 clinical manifestations.
Collapse
Affiliation(s)
- Taha K. Alloush
- grid.7269.a0000 0004 0621 1570Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adel T. Alloush
- grid.7269.a0000 0004 0621 1570Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fayez Marzouk
- Departement of Vascular Surgery, The Good Shepherd, Italian and alHaya Hospitals, Cairo, Egypt
| | - Khaled O. Abdulghani
- grid.412093.d0000 0000 9853 2750Department of Neurology and Psychiatry, Helwan University School of Medicine, Cairo, Egypt
| | - Hossam M. Shokri
- grid.7269.a0000 0004 0621 1570Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
9
|
Basheer A, Rasool M, Amin H, Saucier S. Acute aortic dissection in the Marfan syndrome during the COVID-19 epidemic. Proc AMIA Symp 2022; 35:88-90. [PMID: 34970047 DOI: 10.1080/08998280.2021.1973320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
A 17-year-old boy with a recent diagnosis of COVID-19 infection was admitted with acute chest pain due to type A aortic dissection and was subsequently diagnosed with the Marfan syndrome. Literature shows an increased rate of aortic dissection during flu season. The hypothesis is that a cytokine storm triggers the dissection.
Collapse
Affiliation(s)
- Amjad Basheer
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Madiha Rasool
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Hina Amin
- Department of Cardiovascular Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Stephanie Saucier
- Hartford Healthcare Heart & Vascular Institute, Hartford Hospital, Hartford, Connecticut
| |
Collapse
|
10
|
Smith E. Welcome to the 18th volume of Future Cardiology. Future Cardiol 2021; 18:1-3. [PMID: 34844440 DOI: 10.2217/fca-2021-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Eloise Smith
- Future Science Group, Unitec House, 2 Albert Place, London, N3 1QB, UK
| |
Collapse
|
11
|
Hydroxychloroquine/oseltamivir. REACTIONS WEEKLY 2021. [PMCID: PMC8360796 DOI: 10.1007/s40278-021-00668-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
12
|
Unilateral common carotid artery dissection in a patient with recent COVID-19: An association or a coincidence? J Clin Neurosci 2021; 87:26-28. [PMID: 33863528 PMCID: PMC7919518 DOI: 10.1016/j.jocn.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/23/2022]
Abstract
The "Corona Virus Disease 2019 (COVID-19)", caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), progressed rapidly since its first outbreak, and quickly developed into a pandemic. Although COVID-19 mostly presents with respiratory symptoms, researchers have started reporting neurologic manifestations such as cerebrovascular diseases in patients, with COVID-19 as the pandemic has progressed. Herein, we report a case of 38-year-old female patient identified with a left common carotid artery dissection, with COVID-19. Clinicians must keep in mind that COVID-19 can cause vascular complications such as carotid artery dissections in the ensuing period, even after the acute phase, although there is currently a lack of sufficient evidence to identify any causal association between COVID-19 and arterial dissections.
Collapse
|
13
|
Mirtajaddini M, Khajali Z, Naderi N, Rezaeian N. Does myocardial injury rapidly progress in marfan syndrome following COVID-19? Res Cardiovasc Med 2021. [DOI: 10.4103/rcm.rcm_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|