Vascular Thromboembolism is a Grave Complication of COVID-19

There is ample evidence that the coronavirus can cause fatal blood clots. Angiotensin-converting enzyme 2 (ACE2) receptors act as a gateway for the coronavirus to enter the body and facilitate infection. ACE2 receptors are scientifically linked to disease severity in smokers because nicotine is thought to affect ACE2 expression in different ways. Patients admitted with severe COVID-19 infection with high levels of factor V Leiden are prone to serious damage from blood clots such as deep vein thrombosis or pulmonary embolism. Damage to the vascular endothelium is a complication that can be caused by the coronavirus. It can cause vascular clots, in the formation of which factors such as age, sex, blood type, and underlying diseases are effective. Thrombotic events, especially venous thrombosis, following COVID-19 infection have already been described;nonetheless, data are scarce on arterial thrombosis. Herein we report 4 cases of COVID-19 infection complicated by arterial thrombosis. (Iranian Heart Journal 2022;23(1): 223-227).

Acute progressive arterial thrombosis after coronary artery bypass graft in a COVID-19 patient

The longer the SARS-CoV-2 pandemic takes, the greater the prothrombotic effects of the disease, which varies from venous thromboembolic events to limb arterial thrombosis and stroke. How we deal with the effects of the COVID-19 disease, is still unclear. In this study, researchers will report the clinical presentation, outcome and management of the patient with COVID-19 after coronary artery bypass graft (CABG) surgery, which led to rapid progression of arterial thrombosis. The COVID-19 positive patient underwent emergency CABG, due to developed coronary artery disease. Despite receiving high-dose preoperative Plavix and heparin and also postoperative aspirin, the patient developed progressive thrombosis in both lower extremities 4 days after surgery. It then spread to bilateral iliac arteries, aorta, abdominal and renal artery. Femoral endarterectomy was performed two times for atheromatous plaque removal which was unsuccessful and the patient died few days later due to multi-organ failure. COVID-19 is a risk factor for arterial thrombosis with high mortality and morbidity rate. If thrombosis happens, the prognosis will be poor. Comprehensive treatments have to be started immediately after diagnosis. In patients undergoing surgery for extensive arterial thrombosis due to poor prognosis, not only surgical revascularization is needed but also thrombolysis treatments may be considered as off-label use. As the pandemic continues, new approaches and interventions may be applied. Copyright © 2022 The Author(s);Published by Nickan Research Institute. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Massive pulmonary thromboembolism in patients with COVID-19;report of three cases

COVID-19 is a novel infectious disease, which has challenged people all around the world. As of today, healthcare practitioners and researchers have made great effort to understand the characteristics and clinical presentations of the disease;however, the existing literature is still incomplete in this regard. A growing body of evidence indicates that coagulopathies and thromboembolic events are of utmost importance in COVID-19 patients and are related to poor prognosis. Here, we report three ICU admitted cases of COVID-19, in which massive pulmonary thromboembolism (PTE) occurred a few days after disease onset. Unfortunately, one of the patients did not survive and two were treated;one with thrombectomy and other with antithrombotic agents. It seems that severe cases of COVID-19 are at risk for developing PTE and in-charge physicians should be prepared and plan for anticoagulant prophylaxis using low-molecular-weight heparin (LMWH).

Introducing a method for safe air evacuation from oxygenator in cardiac surgery operating rooms during COVID-19 pandemic

Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guidelines and safety principles. Evacuated air from the exhaust reservoir and oxygenator, after close contact with the patient's blood added contaminated secretions, drain into the operating room, a potential source for contamination. There are two air exhaust ways from the oxygenator in cardiopulmonary bypass (CPB) circuit;which might be the potential carrier of the Covid-19 virus and resulting contamination. In the current design, these two exhausts are connected to one antibacterial and antiviral filter and then they will attach to the ventilator's exhaust port with a three-way connector, in such a way that the contaminated air will be vented outside the operating room. It is recommended to use antibacterial and antiviral filters in the passage way of the contaminated air coming from Reservoir and Oxygenator exhaust, to be directly guided outside the operating room. In this article, this design is fully described.

COVID-19 complicated by massive acute pulmonary embolism: a case report

Introduction: COVID-19 is an emerging disease that has been spread all over the world. Not all the dimensions and manifestations of the disease have yet been fully explored. One such manifestation is vascular thrombosis that occurs in the lungs and other vessels. However, it is often ignored or mistaken for pulmonary manifestations. Herein, we presented a case with dominant pulmonary embolism manifestations. The COVID-19 symptoms were detected in the patient a few days after heart surgery, and he was appropriately treated and discharged. Case Presentation: The patient was a 62-year-old man visiting with the signs and symptoms of pulmonary embolism. In the CT-angiography, massive pulmonary embolism was reported in the right and left pulmonary arteries of the patient. Moreover, the patient's echocardiogram showed a clot in the right ventricle in addition to severe right ventricular dysfunction. The patient underwent emergency heart surgery to remove the clot. In the 3 - 4 postoperative days, the pulmonary manifestations of COVID-19 emerged. The throat swab test was positive for COVID-19, and the patient received treatment. After receiving appropriate treatments for about two weeks, the patient was discharged with good general health. Conclusions: The presented case had the primary pulmonary embolism symptoms. However, in the 2 - 3 postoperative days, he showed the COVID-19 symptoms and received treatment. Pulmonary embolism can be a manifestation of COVID-19.