Post-COVID-19 Pulmonary Fibrosis: Facts-Challenges and Futures: A Narrative Review.

Patients with coronavirus disease 2019 (COVID-19) usually suffer from post-acute sequelae of coronavirus disease 2019 (PASC). Pulmonary fibrosis (PF) has the most significant long-term impact on patients' respiratory health, called post-COVID-19 pulmonary fibrosis (PC19-PF). PC19- PF can be caused by acute respiratory distress syndrome (ARDS) or pneumonia due to COVID-19. The risk factors of PC19-PF, such as older age, chronic comorbidities, the use of mechanical ventilation during the acute phase, and female sex, should be considered. Individuals with COVID-19 pneumonia symptoms lasting at least 12 weeks following diagnosis, including cough, dyspnea, exertional dyspnea, and poor saturation, accounted for nearly all disease occurrences. PC19-PF is characterized by persistent fibrotic tomographic sequelae associated with functional impairment throughout follow-up. Thus, clinical examination, radiology, pulmonary function tests, and pathological findings should be done to diagnose PC19-PF patients. PFT indicated persistent limitations in diffusion capacity and restrictive physiology, despite the absence of previous testing and inconsistency in the timeliness of assessments following acute illness. It has been hypothesized that PC19-PF patients may benefit from idiopathic pulmonary fibrosis treatment to prevent continued infection-related disorders, enhance the healing phase, and manage fibroproliferative processes. Immunomodulatory agents might reduce inflammation and the length of mechanical ventilation during the acute phase of COVID-19 infection, and the risk of the PC19-PF stage. Pulmonary rehabilitation, incorporating exercise training, physical education, and behavioral modifications, can improve the physical and psychological conditions of patients with PC19-PF.

Mitral valve annular dilatation caused by left atrial myxoma.

We report a case of mitral valve annular dilatation caused by a large left atrial myxoma. A 69-year-old woman presented in pulmonary oedema. She was found to have a large left atrial myxoma prolapsing into the left ventricle in diastole causing severe functional mitral stenosis. At operation, the myxoma was completely excised from its attachment to the atrial septum. The mitral valve looked anatomically normal but the mitral annulus was dilated. The intraoperative Trans Oesophageal Echocardiogram (TOE) on weaning from cardiopulmonary bypass confirmed a dilated mitral annulus with moderate mitral regurgitation (MR). We elected not to place an annuloplasty ring in anticipation of improvement with postoperative remodelling. However, mitral regurgitation worsened after discharge becoming moderately severe and remains so after 1 year follow-up despite optimal medical treatment. This case suggests that annular dilatation can result from mechanical dilatation by a large left atrial myxoma. Intraoperative mitral valve annuloplasty should be considered in the presence of moderate MR as postoperative remodelling does not occur.

Aortic valve lipoma.

Cardiac lipoma (especially on the aortic valve) is extremely rare. We report a patient suffering from shortness of breath, chest pain, and recent presyncopal episodes who was found to have a mass on the aortic valve with mild aortic regurgitation. The patient had an uneventful aortic valve replacement.

Management of life-threatening subcutaneous emphysema using subcutaneous penrose drains and colostomy bags.

Subcutaneous emphysema is a common complication post cardiothoracic surgery. Severe subcutaneous emphysema may cause respiratory obstruction and sometimes tracheostomy or intubation is required. We report a case of massive subcutaneous emphysema following aortic valve replacement. It was not relieved with initial bilateral chest tubes, but the subcutaneous Penrose drains produced a dramatic improvement and provided effective decompression of the subcutaneous emphysema. We also describe the colostomy bags, which covered the drains. These were useful for keeping the area sterile and measuring the amount of air through the individual drains.

Misplacement of hemodialysis catheter to brachiocephalic artery required urgent sternotomy.

OBJECTIVE: The cuffed, tunnelled hemodialysis catheterization through the right internal jugular vein is widely used for mid- to long-term hemodialysis for patients with renal failure. The purpose of this report is to address the potentially lethal complication among the variety of surgical problems in conjunction with this procedure. The case also illustrates the potential pitfalls in the management of renal failure. METHODS: A 65-year-old woman had a misplaced 14F-sized hemodialysis catheter insertion to the ascending aorta via the neck of brachiocephalic artery. The patient underwent urgent removal of the catheter through median sternotomy. RESULTS: It was found that the catheter went into the brachiocephalic artery just 1-2 cm distally from the aortic arch. She recovered slowly despite the fact that she developed a cerebellar infarct, which was thought to be caused by a thromboembolism from the catheter, she also developed heart failure, pneumonia and septic shock postoperatively. CONCLUSIONS: Arterial catheter misplacement inside of the chest is a potentially lethal complication. Open surgical treatment should be considered for the major chest arterial injury.