Hyepereosiniphilic syndrome and COVID-19: 2 case reports.

BACKGROUND: Nearly half of the patients with hypereosinophilic syndrome (HES) have cardiovascular involvement, a major cause of mortality. COVID-19 infection can lead to cardiac involvement, negatively impacting the clinical course and prognosis. We reported two patients with HES complicated by COVID-19, with cardiac involvement and valve replacement. CASE PRESENTATION: Our first patient was a 27-year-old woman admitted due to dyspnea and signs of heart failure. She had severe mitral stenosis and mitral regurgitation on the echocardiogram. Corticosteroid therapy improved her symptoms initially, but she deteriorated following a positive COVID-19 test. A repeated echocardiogram showed right ventricular failure, severe mitral regurgitation, and torrential tricuspid regurgitation and, she underwent mitral and tricuspid valve replacement. Our second patient was a 43-year-old man with HES resulted in severe tricuspid stenosis, which was improved with corticosteroid treatment. He underwent tricuspid valve replacement due to severe valvular regurgitation. He was admitted again following tricuspid prosthetic mechanical valve thrombosis. Initial workups revealed lung involvement in favor of COVID-19 infection, and his PCR test was positive. CONCLUSION: COVID-19 infection can change the clinical course of HES. It may result in a heart failure exacerbation due to myocardial injury and an increased risk of thrombosis in prosthetic valves or native vessels due to hypercoagulability.

Anomalous left atrial chorda and its association with mitral regurgitation.

Anomalous left atrial chorda is associated with mitral regurgitation. A young woman presenting for mitral valve repair with the diagnosis of mid-segment (A2) of anterior mitral leaflet prolapse causing severe mitral regurgitation. Transesophageal echocardiography examination in pre-bypass period showed an anomalous chorda attaching A2 to the left atrial roof, tethering the anterior mitral leaflet toward the atrial wall. Surgical findings confirmed the abnormally attached chordae and an absence of normal chorda of A2 segment. The anomalous chorda was resected and neo-chordae placed between the A2 segment and papillary muscles and annulus strengthened with an annuloplasty ring.

A successful double valve repair on an interesting background: Case report.

Aortic regurgitation in a bicuspid aortic valve is a complex entity that involves not only the semilunar valve but also the structure of the aortic root which is functionally and pathologically in a very close relationship to it. Considering repairing a bicuspid valve mandates a mindful involvement of all related structures concurrently. Here, we report an interesting case of both bicuspid aortic valve and mitral valve regurgitation in a patient with a history of infective endocarditis, that was successfully managed by double valve repair.

Fatal Staphylococcus Aureus Endocarditis Misdiagnosed as Multisystem Inflammatory Syndrome in Children.

We present a case of a 10-year-old male with Staphylococcus aureus mitral endocarditis who was initially misdiagnosed with multisystem inflammatory syndrome associated with coronavirus disease 2019, with eventual fatal outcome due to brain hemorrhage after cardiac intervention. Our case differs from recent studies, in which microbleeds did not increase the risk of hemorrhagic stroke or global mortality risk.

Expedited MitraClip: Rapid Evaluation, Treatment, and Discharge in the COVID-19 Era.

Undertreatment of patients with severe mitral regurgitation (MR) has been exaggerated during the coronavirus disease of 2019 (COVID-19) pandemic. Expedited workup and shortened post-procedural hospital stay after percutaneous mitral valve repair (PMVR) would be incredibly helpful to relieve the constrain in the era of the COVID-19 pandemic and immediately afterward. We report a patient who underwent PMVR with a simplified pre-operative workup, a shortened hospital stay, and expedited discharge.

Mitral valve replacement through mini sternotomy after long ECMO course: Case report.

INTRODUCTION: Mitral regurgitation (MR) is defined as an abnormal reversal of blood flow from the left ventricle to the left atrium (LA). It is caused by disruption in any part of the mitral valve apparatus. Surgical intervention remains the mainstay of management for severe cases. CASE SUMMARY: We are reporting a case of pneumonia with severe sepsis, that had a complicated hospital course. The patient developed multi-organ failure. Echocardiography on admission showed severe mitral regurgitation. He required early mechanical ventilation and then Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) over 29 days. He might be the first case of Coronavirus Disease 2019 (COVID-19) in our hospital. Mitral valve replacement was done after stabilization of the patient and weaning from the ECMO. DISCUSSION: Our report demonstrates that the use of a long term VV-ECMO as a bridge for stabilization, facilitates management of the critically ill respiratory failure patient with severe MR and patient outcomes. Still the long-term results and the optimal timing of intervention need more research to define. CONCLUSION: Our report demonstrates that the use of a long term VV ECMO facilitates management of patients with respiratory failure associated with severe MR. Future studies focusing on stabilizing such patients, might help to define the optimal timing for intervention in these patients and the long-term outcome.

Severe acute mitral valve regurgitation in a COVID-19-infected patient.

The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.

Anatomic Repair of Left Main Coronary Artery Atresia: Coronary Ostioplasty With Autologous Pulmonary Artery.

BACKGROUND: Left main coronary arterial (LMCA) atresia is a rare coronary arterial anomaly with extremely limited data on the optimal management. We aimed to report our single-surgeon experience of the ostioplasty in patients with LMCA atresia. METHODS: From July 2018 to December 2019, pediatric patients who presented with LMCA atresia and subsequently underwent surgical coronary ostioplasty were recruited into this retrospective study. Concomitant mitral repair was applied when the regurgitation was moderate or more severe. RESULTS: A total of 9 patients diagnosed with LMCA atresia were included. Mitral regurgitation was found in all of them, including 6 (66.7%) severe, 1 (11.1%) moderate, and 2 (22.2%) mild. In addition to ischemic lesions, which were found in 7 (77.8%) patients, structural mitral problems were also common (presented in 7 [77.8%] patients). All the patients underwent coronary ostioplasty with autologous pulmonary arterial patch augmenting the anterior wall of the neo-ostium. Mean aortic cross clamp time and cardiopulmonary bypass time was 88.1 ± 18.9 and 124.6 ± 23.6 minutes, respectively. During a median of 10.9 (range: 3.3 to 17.2) months' follow-up, there was only 1 death at 5 months after surgery. All survivors were recovered uneventfully with normal left-ventricular function; however, with 4 (50.0%) having significant recurrence of mitral regurgitation. CONCLUSIONS: With favourable surgical outcomes, coronary ostioplasty for LMCA atresia may be an option of revascularization. Structural mitral problems presented in majority patients, resulting in the requirement of concomitant mitral repair. However, the optimal technique of mitral repair remains unclear.

A teenager with CHD and coronavirus disease 2019.

A 16-year-old girl with history of treated congenital mitral valve disease and signs of respiratory infection was admitted to our paediatric cardiology department. She was tested positive for severe acute respiratory syndrome coronavirus 2. Despite her severe pre-existing cardiac conditions with pulmonary hypertension, atrial arrhythmias and mitral valve stenosis, the infection did not lead to any cardiac or pulmonary deterioration. In adults, cardiac co-morbidities are known risk factors for a severe course of coronavirus disease 2019 infections. This case illustrates that in children even severe cardiac disease is not necessarily associated with a severe course of coronavirus disease 2019.

Transcatheter Mitral Valve Repair with MitraClip for Severe Mitral Regurgitation and Cardiogenic Shock During the COVID-19 Pandemic.

Transcatheter mitral valve repair with MitraClip (Abbott) is largely an elective procedure. The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed challenges to health care systems; in many cases elective interventions have been curtailed. Patients with severe mitral regurgitation (MR) and cardiogenic shock are high-risk surgical candidates and at risk of a poor outcome without intervention. The American College of Cardiology (ACC) and the Society of Coronary Angiography and Interventions (SCAI) recently proposed joint guidance on triage of structural heart disease (SHD) interventions during the COVID-19 pandemic. We present two illustrative cases of severe MR and cardiogenic shock that were successfully treated with MitraClip amidst the COVID-19 pandemic with good outcomes at short term follow-up.