ABSTRACT
Contemporary reports showed that solid organ transplanted patients who contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have a high mortality rate. There are sparse data about recurrent cellular rejections and the immune response to SARS-CoV-2 virus in patients following heart transplantation. Herein, we report a case of a 61-year-old male post-heart transplant patient who tested positive for COVID-19 and developed mild symptoms four months after transplantation. Thereafter, a series of endomyocardial biopsies showed histological features of acute cellular rejection despite optimal immunosuppression, good cardiac functions and hemodynamic stability. Demonstration of SARS-CoV-2 viral particles by electron microscopy in the endomyocardial biopsy confirmed the presence of the virus in the foci of the cellular rejection, pointing to a possible immunologic reactions to the virus. To our knowledge, there is limited information regarding the pathology of COVID-19 infection in immunocompromised heart transplant patients, and there are no well-established guidelines for the treatment of such patients. Based on the demonstration of SARS-CoV-2 viral particles within the myocardium, we concluded that myocardial inflammation that can be seen on endomyocardial biopsy may be attributed to the host immune response to the virus which mimics acute cellular rejection in newly heart transplant patients. We report this case to increase the awareness of such events post-transplantation, and to gain more knowledge regarding the management of patients with ongoing SARS-CoV-2 infection which proved to be challenging.
ABSTRACT
The COVID-19 Pandemic has put enormous pressure on the healthcare system globally, causing many healthcare organizations all over the world to cancel or stop elective procedures in their cardiac catheterization laboratoires. This delay in elective procedures with no doubt has led to a suspension of patient care primarily to those with severe aortic stenosis, which might place them at higher risk for cardiovascular complications like sudden death and heart failure. Health Care Worker are faced with the uncertainty of contracting infections while performing procedures in patients with a confirmed diagnosis of COVID-19 or suspected cases. This unprecedented situation is very challenging for the safety of Health Care Worker. Hence, in this article, we aim to summarize some of the current guidelines as to how to triage patients in need for Trans Catheter Aortic Valve Implantation (TAVI), during this ongoing pandemic, and will address some necessary considerations related to the preparation of catheterization laboratories and personal during the COVID-19 pandemic.
ABSTRACT
Cardiac surgeons during this pandemic crisis have a responsibility to ensure that essential elective cardiac operations are provided at their centers to the public, at the same time, they have to face administrative demands as well as the infection prevention guidelines and restrictions to protect themselves and their patients. Here, we describe the patient and procedures characteristics that we recommend to protect our patients and the healthcare workers.