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1.
Rheumatology (United Kingdom) ; 61(SUPPL 1):i51, 2022.
Article in English | EMBASE | ID: covidwho-1868374

ABSTRACT

Background/Aims Vaccine-associated autoimmunity is not infrequent, pertaining to either the cross-reaction between antigens or the action of adjuvant. This issue is more inexplicable to the COVID-19 vaccine, because of nucleic acid formulation and the hastened development process inflicted by the urgent pandemic condition. Here we are presenting a young patient who developed a significant abnormal autoimmune profile immediately post covid vaccination. Methods A 31-year-old IT engineer was referred to Rheumatology with postvaccine arthralgia. He had a history of recent aortic root aneurysm repair after having chest pain on exertion. Echocardiography showed dilated aortic root with significant aortic regurgitation, CT aortogram confirmed spiral type A dissection. He underwent an emergency cardiothoracic surgery in October 2020, followed by an uneventful recovery. He received the first dose of Pfizer COVID-19 vaccine on 2nd February, the very next day he developed painful ankles, knees, left hip, and right shoulder. Blood tests showed elevated CRP of 45, ESR 34, rheumatoid factor positive at 92, anti-CCP >340, ANA 13, ds-DNA 202, U1RNP positive, anti-SM antibody positive, Ro and La antibodies positive, antiJo1 antibody positive, with normal complements. He denied any swelling of the joints. No history of hair loss, photosensitive skin rashes, Raynaud's, sicca symptoms, oro-genital ulceration, or cracking of the skin. There were no constitutional symptoms, chest pain, or bowel issues. He was previously labeled as asthmatic, which is stable after surgery. He doesn't smoke or drinks alcohol. There was no family history of autoimmune conditions. On examination, he has tenderness across both hands and wrists with palmar erythema but no synovitis. He has painful right shoulder abduction with left hip pain on flexion and extension. Cardiovascular and GI examination was unremarkable apart from sternotomy scar and metallic valvular heart sounds. His dipstick urinalysis was negative for blood and protein. In recent x-rays hands and feet were normal. We agreed on a trial a tapering course of prednisolone started with 20mg daily. Three weeks later in follow-up, he reported partial response to steroids. His inflammatory markers were coming down. We have started azathioprine as a steroid-sparing agent. Results This gentleman with negative autoimmune screening prior to cardiothoracic surgery expressed florid newly detected autoantibodies straightaway after the COVID-19 vaccine. This is suggestive of undifferentiated connective tissue disease with the likelihood of overlap syndrome between rheumatoid arthritis and SLE. Conclusion COVID-19 vaccination showed a beacon of light to end the pandemic by achieving herd immunity. There is an excusable socioeconomic rush towards mass vaccination without long-term safety analysis, however, it is also crucial that any vaccine licensing process should entail meticulous scrutiny of the human proteome against vaccine peptide sequences. This will minimize the risks of acute autoimmune reactions to inoculation and future chronic autoimmune pathology.

2.
Cureus ; 14(4): e24348, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1863276

ABSTRACT

Coronary artery dilatation has been observed with coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C), which is more common in those with Kawasaki-like disease. MIS-C is a clinical syndrome in children and adolescents; its signs and symptoms, as well as cardiac manifestations, are similar to Kawasaki diseases, such as coronary artery dilation, coronary aneurysms, and ventricular dysfunction. The occurrence of coronary artery dilatation in asymptomatic pediatric patients following COVID-19 infection has not been well documented in the literature. Thus, in this article, we present four cases of coronary artery dilation in children with a past history of COVID-19 infection who had very few or no symptoms and were referred to us for vague chest pain and palpitation. As a result, a high index of suspicion is required, and any patient complaining of chest pain and palpitation with a history of COVID-19 exposure should not be ignored and be given proper coronary artery evaluation. This article also raises the question of whether every child infected with COVID-19 should have an echocardiogram.

3.
Int J Neurosci ; : 1-4, 2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-1860526

ABSTRACT

BACKGROUND AND IMPORTANCE: COVID-19 is a viral infection that mainly affects the respiratory tract, but can also cause multiple inflammatory reactions, including neurological and cerebrovascular manifestations. We report the case of a COVID-19 patient who developed 'de novo' multiple cerebral aneurysms with no risk factors for aneurysm formation. CLINICAL PRESENTATION: A 55-year-old man with SARS-CoV-2 infection came to our attention for left eye blindness accompanied by ptosis, palpebral chemosis and retro-orbital pain. Brain CT and CT-angiography were negative for hemorrhages and for vascular malformations. Repeated intracerebral hemorrhages and neurological deterioration then occurred, and a new CT-angiography showed multiple intracranial aneurysms that were not present before. CONCLUSION: Intracranial aneurysm formation as a complication of COVID-19 has not been previously reported. As other viral infections do, COVID-19 may be able to determine a vascular damage that can ultimately lead to development of an aneurysm. It is reasonable to hypothesize an involvement of the renin-angiotensin system as a pathogenic mechanism. A conservative therapy aiming at inflammatory modulation and vascular damage prevention may be warranted in these patients.

4.
Lung India ; 39(SUPPL 1):S138, 2022.
Article in English | EMBASE | ID: covidwho-1857681

ABSTRACT

Background: Post COVID -19 infection has wide range of presentation, cavitation and fungal infections were very common in these patients especially when they are immune compromised. This is a case study of a post covid patient with cavitary consolidation and Rasmussen's aneurysm secondary to invasive aspergillus infection. Case Study: A 62 year old gentleman, hypertensive, diabetic and survivor of severe COVID-19 infection presented with low grade fever, breathlessness and cough with expectoration. The CT scan showed bilateral cavitary consolidation . Sputum examination showed aspergillus growth and MTB negative. Serum galactomannan was positive. While getting treated with antifungal therapy for invasive aspergillus infection, he had one episode of massive haemoptysis. CT angiography showed Rasmussen aneurysm and planned for bronchial artery embolization. But the patient was not willing for any urgent intervention and got discharged on request after stabilisation, warning signs were explained. After 5 days patient had massive haemoptysis followed by circulatory collapse. Patient could not be saved even after resuscitation measures and emergency intubation. Discussion: Rasmussen's aneurysm is a pseudo-aneurysmal dilatation of a branch of pulmonary artery secondary to chronic inflammation in a contiguous cavity. The reported incidence of such pathology is around 5% in cavitary lesions. It may ruptures into the cavity, producing massive haemoptysis. Conclusion: Rasmussen aneurysm itself is a very dangerous entity irrespective of its etiology. Early interventions to prevent the fatal haemoptysis is the management strategy as conservative treatment may not give us enough time to act at the time of emergency.

5.
Lung India ; 39(SUPPL 1):S132, 2022.
Article in English | EMBASE | ID: covidwho-1857294

ABSTRACT

Background: We report a rare case of solitary peripheral pulmonary artery aneurysm in a patient who was evaluated for haemoptysis. Incidentally, his total antibodies were positive for Coronavirus 2019 infection. Patient underwent right lower lobectomy uneventfully. Peripheral pulmonary artery aneurysms arising from segmental or intrapulmonary branches are extremely rare. Untreated, the majority end fatally due to sudden rupture and exsanguination. The purpose of this article is to report our rare case and review the pertinent literature. Case Study: A 40-year-old man presented with an episode of haemoptysis. He had a history of intermittent mild grade fever, cough and dyspnea lasting for a month. He had no history of haemoptysis in the past. He had no pre-existing medical conditions or Coronavirus 2019 (COVID-19) infection. His clinical examination was unremarkable. Blood investigations were within normal limits. Reverse transcription polymerase chain reaction test was negative for COVID-19 infection, but his total antibodies test was elevated -117 (biologicalreference range <1.0). 2D Echocardiography was normal. Chest radiography showed a solitary pulmonary lesion in the right lower lung zone [Figure 1a].A computed tomography of the chest plain and contrast confirmed the presence of a 3.7 cm-3.6 cm, well-defined, circumscribed and densely enhancing lesion in apicoposterior segment of right lower lobe. It is seen along the course of descending branch of the right pulmonary artery. Areas of consolidation are also seen in apicoposterior segment. Postcontrast study shows heterogenous enhancement of this lesion suggestive of an aneurysm. The rest of lung parenchyma was normal [Figure 1b and c].The diagnosis of a solitary peripheral pulmonary artery aneurysm (PAA) was considered and right lower lobectomy was performed through posterolateral thoracotomy. Discussion: The estimated incidence of PAA is 1 in 14 000 autopsies, and these lesions can be central aneurysms and peripheral aneurysm. An aneurysm can be true or pseudo aneurysm. In this patient, an aneurysm is a true aneurysm and origin may be idiopathic or post-inflammatory with superadded fungal infection in thrombus, post-COVID-19 infection. Long-term follow up is required to observe the future course Conclusion: True solitary peripheral PAA is an extremely rare entity. A high degree of suspicion is needed for diagnosing PAAs on imaging. Intervention is mandatory as soon as the diagnosis is made, to prevent rupture and death. PAA has been managed most often by lobectomy but occasionally by pulmonary artery repair or endovascular approach.

6.
Lung India ; 39(SUPPL 1):S36-S37, 2022.
Article in English | EMBASE | ID: covidwho-1857287

ABSTRACT

Background: A pseudoaneurysm is an abnormal dilatation or outpouching of the artery which is lined only by the tunica adventitia. Pulmonary artery Pseudoaneurysm is very uncommon and associated with high mortality. Usually congenital but the acquired causes include trauma and infrequently infections mainly bacterial and fungal. Pulmonary mucormycosis is a rare opportunistic fungal infection seen in immunocompromised patients with diabetes, chronic renal failure, malignancies and is one of the most uncommon causes of pseudoaneurysm. Less than 30 cases have been reported worldwide for mucormycosis causing pulmonary artery pseudoaneurysm. Case 1: A 52 year old female who was COVID 19 positive 2 months back, admitted in RICU with recurrent hemoptysis and breathlessness. She is known Diabetic and Hypertensive. As her hemoptysis was persisting she underwent bronchoscopy and a soft mass was noticed in the right lower lobe bronchus which bleeds on touch. Bronchoalveolar lavage sent for microbiology confirmed Mucormycosis. CTPA done post bronchoscopy revealed pseudoaneurysm involving right descending pulmonary artery. Injection Amphotericin B started and surgical resection of right lower lobe done. Case 2: A 65 year old male, diabetic presented with cough and hemoptysis for 20 days with fever. CT thorax was suggestive of necrotising pneumonia in left lower lobe. As his hemoptysis was persisting Bronchoalveolar lavage was taken and the bronchoscopy showed a small swelling in the left lowerlobe bronchus. CECT Thorax was later done which confirmed descending pulmonary artery pseudoaneurysm. Treatment was same as for case 1. Discussion: Fungal pneumonia is a rare acquired cause of pulmonary artery pseudoaneurysm. The pseudoaneurysms are thin walled and easily ruptures producing massive hemoptysis. Infection accounts for 33% of the causes for pseudoaneurysms. Infective causes include pyogenic bacteria like S. pyogenes, S. aureus, Klebsiella and fungus like Mucor, and Aspergillus. Infection leads to chronic inflammation of vessel and leads to weakening of vessel wall which causes the internal layers to rupture. Mucor has the potential to cause direct invasion of the vessel wall leading to pseudoaneurysm. Conclusion: Pulmonary Artery Pseudoaneurysm and Pulmonary mucormycosis are individually uncommon clinical entities, but Pulmonary Artery Pseudoaneurysm due to underlying mucormycosis is a rare condition with a limited description in the literature. A high index of suspicion for both the clinician and radiologist is required and should be suspected in patients with underlying immunosuppression who develop hemoptysis. Pulmonary Artery Pseudoaneurysm can be successfully treated with embolization, but if mucormycosis is confirmed surgical resection is the only option.

7.
Lung India ; 39(SUPPL 1):S79-S80, 2022.
Article in English | EMBASE | ID: covidwho-1856943

ABSTRACT

Introduction: Pseudoaneurysm of the pulmonary artery (PAP) is a rare cause of hemoptysis with a wide array of aetiologies. This case report discusses our clinical experience of PAP associated with pulmonary mucormycosis (PM) in a COVID survivor. Case Report: A 58-year-old gentleman presented with a 1-week history of high-grade fever and progressive dry cough. Four weeks before his presentation, he was treated for mildly symptomatic COVID-19 infection with unusually high doses of steroids. On admission, a chest x-ray and CT chest showed a cavitatory lesion in the right lower lobe. He underwent a FOB with BAL and endobronchial biopsy, which were inconclusive. On day 5 of his hospital admission, he had an episode of massive hemoptysis leading to hemodynamic instability. CT showed an increase in the size of the cavity and a pulmonary angiogram showed the descending segmental branch of the right pulmonary artery traversing through the consolidative cavitating lesion with focal dilatation of the same measuring up to 1.5 x 1.9 cm. Consistent hemostasis couldn't be achieved after gluing an interlock coiling of pseudoaneurysm, hence he underwent video-assisted thoracic surgery for right lower lobectomy and stump ligation of the right lobar pulmonary artery. Lobectomy specimen on histopathology revealed large areas of necrosis with aseptate fungal hyphae. He responded well to antifungal therapy during follow on 4th week post discharge. Conclusion: Mucormycosis is characterized by angioinvasion, vessel thrombosis, and subsequent tissue thrombosis. Pseudoaneurysm formation is rarely seen in PM and can be associated with fatal hemoptysis. Irrational use of systemic steroids in the management of COVID makes the patient more vulnerable to an otherwise rare disease.

8.
Cardiology in the Young ; 32(SUPPL 1):S124, 2022.
Article in English | EMBASE | ID: covidwho-1852349

ABSTRACT

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of SARS-CoV-2 infection, with an incidence of about 1:100'000 children. According to published case series, between 10% and 40% of MIS-C develop coronary artery modifications, mainly hyperechogenicity, with a lower incidence of aneurysm. Evolution and outcome of coronary artery aneurysm post MIS-C is unknown. Methods: We report the case of a 10-year old male with medium left anterior descending coronary artery (LAD) aneurysm (diameter of 6.2 mm, z-score +7.9) and small right coronary artery (RCA) aneurysm (z-score +2.9) detected one week after his hospital admission for hypotensif shock in the context of MIS-C and positive serologies for SARS-CoV-2. He didn't meet diagnosis criteria for Kawasaki disease. He was treated with 2 g/kg immunoglobulin (administered after coronary artery dilatation was observed, as the recognition and definition of MIS-C was contemporary with our case), corticosteroids and anakinra. He rapidly normalized his initial mild LV dysfunction and cardiac enzymes elevation. Results: Since discharge, the patient was treated with antiplatelet therapy (100 mg aspirin daily) and carefully followed up in outpatient cardiology. On echocardiography, coronary artery dimensions progressively regressed, prompting a control computed tomography (CT) 6 months after MIS-C episode. CT confirmed LAD and RCA dimension near-normalization, compared to the fusiform dilatations 6 months ago : LAD maximal diameter of 3.7 mm (z-score +2.3), RAD maximal diameter of 4 mm (zscore +1.8). Moreover, no coronary stenosis was observed. Conclusions: Coronary artery aneurysm in the context of MIS-C probably represents a post-infectious vasculitis. This case illustrates a regression of coronary artery dilatation after a few months. Further research is needed to assess if this finding reflects a generalisable outcome and to study the effect of medical treatment on the evolution of coronary artery dilatation post MIS-C.

9.
Hellenic Journal of Vascular and Endovascular Surgery ; 3(3):86-88, 2021.
Article in English | EMBASE | ID: covidwho-1849352

ABSTRACT

We report a rare case of a patient who presented in our department with a ruptured 7,5cm infrarenal abdominal aortic aneurysm. The patient was hemodynamically unstable, and we proceeded immediately with an open repair procedure with successful result. Rapid antigen test for COVID-19 was negative but one day after the PCR test from bronchial secretions turned positive. Fortunately, no transmission of the disease was noted. Rapid antigen test result is insufficient and full protective measures should be implemented in all emergent situations to avoid COVID-19 spread.

10.
Front Pediatr ; 10: 856911, 2022.
Article in English | MEDLINE | ID: covidwho-1847198

ABSTRACT

As a result of the COVID-19 pandemic, telemedicine has become an important branch of healthcare worldwide. Apart from their undeniable advantages, the virtual visits lack physical examination, which can lead to important diagnostic mistakes. We hereby present a case of a pediatric patient whose weight gain, initially attributed to a sedentary lifestyle was, in fact, due to sub-acute right heart failure in the context of a ruptured sinus of Valsalva aneurysm. The condition was not diagnosed until the patient presented at the emergency. The boy was successfully treated with two percutaneous interventions and returned to his previous stature.

11.
Acta Neurochir (Wien) ; 2022 May 13.
Article in English | MEDLINE | ID: covidwho-1844388

ABSTRACT

OBJECTIVE: Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes. METHODS: We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid-ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: type A, OA originating separate from the aneurysm; type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. RESULTS: The median follow-up time was 6.8 months (range, 5.3-20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.854, 95% confidence interval [CI] 1.878-12.548, P = 0.001). Visual symptoms at final follow-up correlated with preoperative visual symptoms (OR 22.777, 95% CI 3.115-166.555, P = 0.002). CONCLUSIONS: Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.

12.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-335786

ABSTRACT

Background: pediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City. Methods: This was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiology evaluations, treatment, and clinical outcomes were analyzed. Results: Seventy-five cases fulfilled the case definition criteria for PIMS (median age: 10.9 years, Interquartile range [IQR]: 5.6-15.6). Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms (n = 60) and cluster 2 were those with predominantly respiratory manifestations (n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms. Conclusion: There were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

13.
J Clin Med ; 11(9)2022 May 02.
Article in English | MEDLINE | ID: covidwho-1820306

ABSTRACT

The aim was to evaluate hospitalization rates for aneurysmal subarachnoid hemorrhage (SAH) within an interdisciplinary multicenter neurovascular network (NVN) during the shutdown for the COVID-19 pandemic along with its modifiable risk factors. In this multicenter study, admission rates for SAH were compared for the period of the shutdown for the COVID-19 pandemic in Germany (calendar weeks (cw) 12 to 16, 2020), the periods before (cw 6-11) and after the shutdown (cw 17-21 and 22-26, 2020), as well as with the corresponding cw in the years 2015-2019. Data on all-cause and pre-hospital mortality within the area of the NVN were retrieved from the Department of Health, and the responsible emergency medical services. Data on known triggers for systemic inflammation, e.g., respiratory viruses and air pollution, were analyzed. Hospitalizations for SAH decreased during the shutdown period to one-tenth within the multicenter NVN. There was a substantial decrease in acute respiratory illness rates, and of air pollution during the shutdown period. The implementation of public health measures, e.g., contact restrictions and increased personal hygiene during the shutdown, might positively influence modifiable risk factors, e.g., systemic inflammation, leading to a decrease in the incidence of SAH.

14.
Diagnostics (Basel) ; 12(4)2022 Mar 26.
Article in English | MEDLINE | ID: covidwho-1820198

ABSTRACT

It is well known that coronavirus disease 2019 (COVID-19) can affect the vascular endothelium; however, coronary artery aneurysm complicated by COVID-19 in adults has not yet been reported. Herein, we report a case of a newly developed right coronary artery aneurysm in an adult with recent COVID-19 infection. A 66-year-old man was referred for surgical intervention of the right coronary artery aneurysm. His previous coronary angiograms performed 17 months prior revealed no evidence of coronary aneurysm. However, he was confirmed as having COVID-19 four months prior and thereafter newly diagnosed with right coronary artery aneurysm. The further evaluation of the impact of COVID-19 on the occurrence of coronary artery aneurysm may be necessary, considering the alleged correlation between COVID-19 and vascular complications.

15.
NMC Case Rep J ; 9: 95-100, 2022.
Article in English | MEDLINE | ID: covidwho-1817783

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic continues to spread around the world, and widespread vaccination is considered the most effective way to end it. Although the efficacy of COVID-19 vaccines has been confirmed, their safety remains a concern. In this paper, we report two cases of ruptured vertebral artery dissecting aneurysm (VADA) immediately after messenger RNA (mRNA) anti-COVID-19 vaccination. In Case 1, a 60-year-old woman experienced sudden headache 3 weeks before her first dose of the Moderna mRNA-1273 COVID-19 vaccine. Magnetic resonance imaging showed dilatation of the right vertebral artery (VA) without intracranial hemorrhage. A day after the vaccination, she developed subarachnoid hemorrhage with pulmonary effusion due to a ruptured right VADA. She underwent endovascular internal trapping and parent artery occlusion under general anesthesia. In Case 2, a 72-year-old woman with a previous history of the left VA occlusion due to arterial dissection developed subarachnoid hemorrhage 7 days after the first dose of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine due to a ruptured right VADA and underwent stent-assisted coil embolization under general anesthesia. The postoperative courses of these two cases were uneventful. The accumulation of more cases and further study are warranted to clarify the relationship between COVID-19 mRNA vaccination and ruptured intracranial dissecting aneurysms.

16.
EJVES Vasc Forum ; 54: 41-43, 2022.
Article in English | MEDLINE | ID: covidwho-1814381

ABSTRACT

INTRODUCTION: Acute thrombosis of an infrarenal abdominal aortic aneurysm (ATAAA) represents an uncommon but catastrophic pathology, which can lead to life threatening complications. This is a report of the infrequent use of an endovascular solution to successfully treat ATAAA in a patient with COVID-19 viral pneumonia and ischaemia induced lower extremity neurological deficits. REPORT: An 89 year old white male, with a history of cardiovascular comorbidities was admitted to the emergency room with dyspnoea associated with the sudden onset of abdominal and back pain followed by partial motor and sensory deficits in both legs. The CT scan showed both an 8 cm infrarenal AAA with middle (inferior mesenteric artery patent) and distal thrombotic occlusion of the sac and non-aneurysmal but thrombosed common iliac arteries. An additional finding was imaging features typical of interstitial pneumonia. After the molecular test detected active COVID-19 infection, the patient was treated as an emergency with an aorto-uni-iliac stent graft and femorofemoral crossover graft. The post-operative course was uneventful with AAA exclusion and disappearance of ischaemic symptoms. There were no vascular complications. At three month follow up the patient remained asymptomatic and was looking after himself. DISCUSSION: This case supports the feasibility and safety of a minimally invasive endovascular procedure to treat ATAAA in selected patients with favourable anatomy and high risk of respiratory complications in the context of the COVID-19 pandemic.

17.
European Journal of Vascular and Endovascular Surgery ; 63(4):666-670, 2022.
Article in English | EMBASE | ID: covidwho-1814380
18.
Pediatr Cardiol ; 2022 Apr 29.
Article in English | MEDLINE | ID: covidwho-1813655

ABSTRACT

Multi-system inflammatory syndrome in children (MIS-C) causes widespread inflammation including a pancarditis in the weeks following a COVID infection. As we prepare for further coronavirus surges, understanding the medium-term cardiac impacts of this condition is important for allocating healthcare resources. A retrospective single-center study of 67 consecutive patients with MIS-C was performed evaluating echocardiographic and electrocardiographic (ECG) findings to determine the point of worst cardiac dysfunction during the admission, then at intervals of 6-8 weeks and 6-8 months. Worst cardiac function occurred 6.8 ± 2.4 days after the onset of fever with mean 3D left ventricle (LV) ejection fraction (EF) 50.5 ± 9.8%. A pancarditis was typically present: 46.3% had cardiac impairment; 31.3% had pericardial effusion; 26.8% demonstrated moderate (or worse) valvar regurgitation; and 26.8% had coronary dilatation. Cardiac function normalized in all patients by 6-8 weeks (mean 3D LV EF 61.3 ± 4.4%, p < 0.001 compared to presentation). Coronary dilatation resolved in all but one patient who initially developed large aneurysms at presentation, which persisted 6 months later. ECG changes predominantly featured T-wave changes resolving at follow-up. Adverse events included need for ECMO (n = 2), death as an ECMO-related complication (n = 1), LV thrombus formation (n = 1), and subendocardial infarction (n = 1). MIS-C causes a pancarditis. In the majority, discharge from long-term follow-up can be considered as full cardiac recovery is expected by 8 weeks. The exception includes patients with medium sized aneurysms or greater as these may persist and require on-going surveillance.

19.
International Journal of Angiology ; : 4, 2022.
Article in English | Web of Science | ID: covidwho-1805727

ABSTRACT

Purpose The aim of the study is to present the success of an endovascular procedure for ruptured abdominal aortic aneurysm (AAA) patient with high-risk non-ST elevation myocardial infarct (NSTEMI) after early percutaneous coronary intervention (PCI). Case Report A 56-year-old man came to our emergency room with a history of early PCI in the previous hospital and received dual antiplatelet therapy (DAPT). His COVID-19 test result was unknown. This patient was then being re-examined and was diagnosed with ruptured AAA. Despite his pending COVID-19 laboratory results, we decided to perform an urgent endovascular aortic repair (EVAR) in this patient, considering his DAPT consumption history. The procedure was successful and the patient's condition after EVAR showed improvements. Conclusion In patients with ruptured AAA with high-risk NSTEMI who just underwent early PCI and recently received DAPT, endovascular procedure can be considered as the treatment of choice since open surgery repair is contraindicated.

20.
Journal of the American College of Cardiology ; 79(15):S11-S12, 2022.
Article in English | EMBASE | ID: covidwho-1796606

ABSTRACT

Background: Moderate to severe coronary calcification results in suboptimal results with increased risk of procedural and future adverse events. Newer high-pressure balloons and atherectomy devices have not shown any superiority over the routine high pressure balloon dilatation. Intravascular lithotripsy (IVL) is the latest technique for treatment of moderate to severe calcific coronary artery disease. IVL converts the electrical energy into mechanical energy with cracking of calcium in both adventitia and intima. DISRUPT CAD III study has shown the short-term outcomes of Intravascular lithotripsy (IVL). However, the experience is limited with this new technique especially for mid-term and long-term outcomes. The Coronary IVL System is a proprietary balloon catheter system designed to enhance stent outcomes by enabling delivery of the calcium disrupting capability of lithotripsy prior to balloon dilatation at low pressures. The Coronary IVL System consists of an IVL Balloon Catheter with two integrated pairs of lithotripsy emitters, a Lithotripsy Generator, and Connector Cable. Methods: Our study is a single centre, observational study done at Apollo hospitals, Visakhapatnam, India, to evaluate the safety, mid-term and long-term effectiveness of Intravascular Lithotripsy (IVL). Subjects who are more than 18 years of age with moderate to severe calcification which require Percutaneous Coronary Intervention (PCI) and are willing to participate in the study are included. Baseline parameters were assessed. Procedural success was defined as no residual stenosis of <30% after stenting. Procedural and postprocedural complications were noted. Usage of adjuvant Atherectomy balloons or devices is noted. Both clinical and angiographic follow up was done. Clinical follow up parameters assessed were MACE which includes cardiac death, MI, target vessel revascularisation (TVR), Target lesion revascularisation (TVR). Any admissions for heart failure or change in functional class are also noted. On follow up, Angiographic assessment was done for In-stent restenosis (>50%) or In segment restenosis (>50%) or any fresh coronary lesions which mandates revascularisation. Results: Out of 35 subjects, only 2 were females. Mean age was 69.9 ± 2.8 years. 15 (42.8%) subjects were Diabetics and 17 (48.5%) were Hypertensives. 2 subjects underwent previous CABG surgery. 10 subjects had left ventricular dysfunction. 2 subjects had renal dysfunction. 29 (82.8%) subjects presented with Acute MI out of which 22 were presented with NSTEMI. 1 subject underwent the procedure during Primary PTCA successfully. Total number of stents implanted were4 1 with a mean stent implantation was 1.17. Rotablation system (Boston Scientific) was used in 2 subjects prior to IVL where the intimal calcium was extensive. OPN NC balloon (Translumina Therapeutics) was used in 6 subjects. Mean stent length was 35.9 ± 9.8 mm. Mean number of pulses delivered was 7.3 ± 1.4. All the subjects had good procedural outcomes with no residual stenosis. Only 1 subject had coronary dissection after IVL which could be stented successfully. 1 subject had an aneurysm in the proximal LAD which could be stented. Subjects were followed up clinically for a mean of 6.23 months. No MACEs were noted. None of them had any Heart failure admissions. 1 subject died of noncardiac cause (respiratory failure due to COVID-19 pneumonia). 7 patients followed up angiographically after a mean follow up of 9.4 months. No significant ISR was noted in any of them. 1 subject underwent repeat target vessel revascularisation (TVR). Another subject underwent revascularisation to another vessel which was planned earlier. Conclusion: Coronary Intravascular lithotripsy (IVL) is a safe and effective method in the treatment of moderate to severe coronary calcific coronary artery disease which is safe and effective with good short-term and mid-term outcomes. However, the data is limited on long-term outcomes.

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