Medicina

Research

16 pages, 1576 KiB

Open AccessArticle

The Effectiveness of Antiplatelet Therapy and the Factors Influencing It in Patients with Acute Coronary Syndrome before and during the COVID-19 Pandemic

by Ovidiu-Ionut Anchidin, Stefan Horia Rosianu, Ancuta Nemes, Mihai Aldica, Dan Blendea, Adrian Molnar, Horatiu Moldovan and Dana Pop

Medicina 2023, 59(1), 84; https://doi.org/10.3390/medicina59010084 - 30 Dec 2022

Cited by 2 | Viewed by 1740

Abstract

Background and Objectives: Dual antiplatelet therapy (DAPT) is essential in the treatment of patients with acute coronary syndrome (ACS). The objective of this study was to evaluate the effectiveness of antiplatelet medication in our practice and to investigate the factors that influence it. [...] Read more.

Background and Objectives: Dual antiplatelet therapy (DAPT) is essential in the treatment of patients with acute coronary syndrome (ACS). The objective of this study was to evaluate the effectiveness of antiplatelet medication in our practice and to investigate the factors that influence it. Materials and Methods: A prospective cohort observational study was conducted, in which 193 patients with ACS were enrolled. The patients were stented in the catheterization laboratory between May 2019 and October 2020, before and during the COVID-19 pandemic, and were receiving DAPT. Their platelet functions were tested using a Multiplate Analyzer. In addition to this, clinical data, demographics, laboratory tests, and cardiovascular risk factors were also analyzed. Results: 43.46% of the patients treated with aspirin were found to be resistant to it. This phenomenon was more common in men (48.17% vs. 31.48%, p = 0.036), and it was associated with being under the age of 50 (OR: 2.08; 95% CI: 1.11–3.90) and weighing over 70 kg (OR: 3.00; 95% CI: 1.21–7.40). Most of the patients treated with clopidogrel were in the optimal treatment window, while about half of the patients treated with ticagrelor had an exaggerated pharmacological response. Among the laboratory parameters, leukocytosis and platelet count were found to be determinants of platelet reactivity for both the aspirin and ticagrelor treatments. Conclusions: Many patients treated with antiplatelet agents are outside of the treatment window. The results obtained showed that low doses of gastro-resistant aspirin tablets are ineffective, and their efficacy can be influenced by various clinical and laboratory factors. Patients receiving ticagrelor have significantly reduced platelet reactivity, influenced only by certain laboratory indicators. The pandemic significantly influenced the results of the platelet aggregation tests only in patients treated with clopidogrel. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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9 pages, 1007 KiB

Open AccessArticle

Hemorrhagic Cardiac Tamponade—An Unusual Threat in the COVID-19 Recovery Phase

by Raluca Ungureanu, Cristian Cobilinschi, Ana-Maria Cotae, Raluca Darie, Radu Tincu, Sorin Constantinescu, Oana Avram, Horatiu Moldovan, Ioana Marina Grintescu and Liliana Mirea

Medicina 2023, 59(1), 3; https://doi.org/10.3390/medicina59010003 - 20 Dec 2022

Cited by 2 | Viewed by 1357

Abstract

Cardiac tamponade is a rare presentation in patients with COVID-19, which may be induced by the associated exacerbated inflammatory response. The onset of cardiac tamponade may be concomitant with the acute phase of the disease or may develop subsequently as a new health [...] Read more.

Cardiac tamponade is a rare presentation in patients with COVID-19, which may be induced by the associated exacerbated inflammatory response. The onset of cardiac tamponade may be concomitant with the acute phase of the disease or may develop subsequently as a new health condition secondary to the disease. We report four cases of cardiac tamponade that occurred late after the acute phase of the disease. One of them may be considered a post-acute complication of the disease, and three of them may be classified as a new health condition induced by COVID-19. Only two cases had a history of severe respiratory distress due to COVID-19. In all four cases, pericardiocentesis was imposed, and surprisingly, in every case, hemorrhagic fluid was evacuated. In this case, series, immune-mediated etiology is supported by histopathological results, where the main identified feature was fibrous pericarditis with inflammatory infiltrate. Only one patient included in this report died, and three of them were discharged after anti-inflammatory treatment was initiated. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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9 pages, 779 KiB

Open AccessArticle

Pericardial Involvement in Severe COVID-19 Patients

by Mihai Lazar, Ecaterina Constanta Barbu, Cristina Emilia Chitu, Ana-Maria-Jennifer Anghel, Cristian-Mihail Niculae, Eliza-Daniela Manea, Anca-Cristina Damalan, Adela-Abigaela Bel, Raluca-Elena Patrascu, Adriana Hristea and Daniela Adriana Ion

Medicina 2022, 58(8), 1093; https://doi.org/10.3390/medicina58081093 - 12 Aug 2022

Cited by 9 | Viewed by 2522

Abstract

Background and Objectives: SARS-CoV-2 has an extensive tissue tropism due to its ability to attach to the surfaces of cells through different receptors, leading to systemic complications. In this article, we aim to present the prevalence of pericardial effusions in patients with [...] Read more.

Background and Objectives: SARS-CoV-2 has an extensive tissue tropism due to its ability to attach to the surfaces of cells through different receptors, leading to systemic complications. In this article, we aim to present the prevalence of pericardial effusions in patients with severe COVID-19, to identify the risk factors/predictors for pericardial involvement, and to evaluate its impact on overall mortality. Materials and Methods: We enrolled 100 patients with severe COVID-19 in our observational cohort study and divided them in two groups: Group A (27 patients with pericardial effusion) and Group B (73 patients without pericardial effusion). We recorded demographic and lifestyle parameters, anthropometric parameters, clinical parameters, inflammation markers, respiratory function parameters, complete blood count, coagulation parameters, and biochemical serum parameters. All patients were evaluated by computer tomography scans within 48 h of admission. Results: The median age was 61 years in both groups and the male/female ratio was 3.5 vs. 2.8 in Group A vs. Group B. We identified mild pericardial effusion (3–4 mm) in 62.9% patients and moderate pericardial effusion (5–9 mm) in 37.1% patients, with a median value of 4 [3;6] mm. The patients with pericardial effusion presented with higher percentages of obesity, type-2 diabetes mellitus, arterial hypertension, and congestive heart failure, without statistical significance. Increased values in cardiac enzymes (myoglobin, CK, CK-MB) and LDH were statistically associated with pericardial effusion. The overall mortality among the participants of the study was 24% (24 patients), 33.3% in Group A and 20.8% in Group B. Conclusions: Pericardial effusion has a high prevalence (27%) among patients with severe forms of COVID-19 and was associated with higher mortality. Pericardial effusion in our study was not associated with the presence of comorbidities or the extent of lung involvement. Overall mortality was 60% higher in patients with pericardial effusion. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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Review

Jump to: Research, Other

24 pages, 5068 KiB

Open AccessReview

Narrative Review of New Insight into the Influence of the COVID-19 Pandemic on Cardiovascular Care

by Any Axelerad, Alina Zorina Stuparu, Lavinia Florenta Muja, Silviu Docu Axelerad, Silvia Georgeta Petrov, Anca Elena Gogu and Dragos Catalin Jianu

Medicina 2022, 58(11), 1554; https://doi.org/10.3390/medicina58111554 - 29 Oct 2022

Cited by 1 | Viewed by 1801

Abstract

Background and Objectives: The purpose of this paper was to perform a literature review on the effects of the COVID-19 pandemic on cardiothoracic and vascular surgery care and departments. Materials and Methods: To conduct this evaluation, an electronic search of many [...] Read more.

Background and Objectives: The purpose of this paper was to perform a literature review on the effects of the COVID-19 pandemic on cardiothoracic and vascular surgery care and departments. Materials and Methods: To conduct this evaluation, an electronic search of many databases was conducted, and the resulting papers were chosen and evaluated. Results: Firstly, we have addressed the impact of COVID-19 infection on the cardiovascular system from the pathophysiological and treatment points of view. Afterwards, we analyzed every cardiovascular disease that seemed to appear after a COVID-19 infection, emphasizing the treatment. In addition, we have analyzed the impact of the pandemic on the cardiothoracic and vascular departments in different countries and the transitions that appeared. Finally, we discussed the implications of the cardiothoracic and vascular specialists’ and residents’ work and studies on the pandemic. Conclusions: The global pandemic caused by SARS-CoV-2 compelled the vascular profession to review the treatment of certain vascular illnesses and find solutions to address the vascular consequences of COVID-19 infection. The collaboration between vascular surgeons, public health specialists, and epidemiologists must continue to investigate the impact of the pandemic and the response to the public health issue. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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Other

Jump to: Research, Review

12 pages, 2297 KiB

Open AccessSystematic Review

Transcatheter Aortic Valve Replacement vs. Surgical Aortic Valve Replacement for Long-Term Mortality Due to Stroke and Myocardial Infarction: A Meta-Analysis during the COVID-19 Pandemic

by Alexandru Cristian Ion, Liviu Ionut Serbanoiu, Elena Plesu, Stefan Sebastian Busnatu and Catalina Liliana Andrei

Medicina 2023, 59(1), 12; https://doi.org/10.3390/medicina59010012 - 21 Dec 2022

Viewed by 1665

Abstract

Background and objectives: One of the leading causes of mortality and morbidity in people over the age of 50 is stroke. The acceptance of transcatheter aortic valve replacement (TAVR) as a treatment option for severe symptomatic aortic stenosis (AS) has increased as a [...] Read more.

Background and objectives: One of the leading causes of mortality and morbidity in people over the age of 50 is stroke. The acceptance of transcatheter aortic valve replacement (TAVR) as a treatment option for severe symptomatic aortic stenosis (AS) has increased as a result of numerous randomized clinical trials comparing surgical aortic valve replacement (SAVR) and TAVR in high- and intermediate-risk patients, showing comparable clinical outcomes and valve hemodynamics. Materials and Methods: An electronic search of Medline, Google Scholar and Cochrane Central was carried out from their inception to 28 September 2022 without any language restrictions. Results: Our meta-analysis demonstrated that, as compared with SAVR, TAVR was not linked with a lower stroke ratio or stroke mortality. It is clear from this that the SAVR intervention techniques applied in the six studies were successful in reducing cardiogenic consequences over time. Conclusions: A significantly decreased rate of mortality from cardiogenic causes was associated with SAVR. Additionally, when TAVR and SAVR were compared for stroke mortality, the results were nonsignificant with a p value of 0.57, indicating that none of these procedures could decrease stroke-related mortality. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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15 pages, 1260 KiB

Open AccessCase Report

Hybrid Management of an Aortobronchial Fistula after Patch Aortoplasty for Aortic Coarctation in a Patient with SARS-CoV-2 Pneumonia: Case Report and Review of the Literature

by Grigore Tinica, Andrei Tarus, Alberto Bacusca, Raluca Ozana Chistol, Alexandra Cristina Rusu, Mihaela Tomaziu Todosia and Cristina Furnica

Medicina 2022, 58(10), 1385; https://doi.org/10.3390/medicina58101385 - 2 Oct 2022

Viewed by 1901

Abstract

Aortobronchial fistula is a rare cause of repeated hemoptysis and a potentially fatal condition if left untreated. We present the case of a 40-year-old man with repeated hemoptysis, excessive cough, and epistaxis ongoing for several days after SARS-CoV-2 pneumonia diagnosis. The patient had [...] Read more.

Aortobronchial fistula is a rare cause of repeated hemoptysis and a potentially fatal condition if left untreated. We present the case of a 40-year-old man with repeated hemoptysis, excessive cough, and epistaxis ongoing for several days after SARS-CoV-2 pneumonia diagnosis. The patient had a history of patch aortoplasty for aortic coarctation and aortic valve replacement with a mechanical valve for aortic insufficiency due to bicuspid aortic valve at the age of 24. Computed tomography scan performed at presentation revealed a severely dilated ascending aorta, a thoracic aorta pseudoaneurysm at the site of the former coarctation, an aortobronchial fistula suggested by the thickened left lower lobe apical segmental bronchus in contact with the pseudoaneurysm and signs of alveolar hemorrhage in the respective segment. The patient was treated with thoracic endovascular aneurysm repair (TEVAR) after prior hemi-aortic arch debranching and transposition of the left common carotid artery and subclavian artery through a closed-chest surgical approach. Our case report together with a systematic review of the literature highlight the importance of both considering an aortobronchial fistula in the differential diagnosis of hemoptysis in patients with prior history of thoracic aorta surgical intervention, regardless of associated pathology, and of taking into account endovascular and hybrid techniques as an alternative to open surgical repair, which carries a high risk of morbidity and mortality. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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11 pages, 2734 KiB

Open AccessCase Report

Delayed Surgical Management of Acute Type A Aortic Dissection in a Patient with Recent COVID-19 Infection and Post-COVID-19 Bronchopneumonia—Case Report and Review of Literature

by Mircea Robu, Diana Romina Marian, Rasvan Vasile, Bogdan Radulescu, Alice Stegaru, Cristian Voica, Claudia Nica, Daniela Gheorghita, Ondin Zaharia, Antoniac Iulian, Angelica Moldovan, Victor Pavel, Horatiu Moldovan and Vlad Anton Iliescu

Medicina 2022, 58(10), 1357; https://doi.org/10.3390/medicina58101357 - 27 Sep 2022

Cited by 3 | Viewed by 1913

Abstract

Ever since it was first described in 1760, acute type A aortic dissection has created difficulties in its management. The recent COVID-19 pandemic revealed that extrapulmonary manifestations of this condition may occur, and recent reports suggested that aortic dissection may be amongst them [...] Read more.

Ever since it was first described in 1760, acute type A aortic dissection has created difficulties in its management. The recent COVID-19 pandemic revealed that extrapulmonary manifestations of this condition may occur, and recent reports suggested that aortic dissection may be amongst them since it shares a common physiopathology, that is, hyper-inflammatory syndrome. Cardiac surgery with cardiopulmonary bypass in the setting of COVID-19-positive patients carries a high risk of postoperative respiratory failure. While the vast majority accept that management of type A aortic dissection requires urgent surgery and central aortic therapy, there are some reports that advocate for delaying surgery. In this situation, the risk of aortic rupture must be balanced with the possible benefits of delaying urgent surgery. We present a case of acute type A dissection with COVID-19-associated bronchopneumonia successfully managed after delaying surgery for 6 days. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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8 pages, 1415 KiB

Open AccessCase Report

Mesenteric Ischemia in a Patient with Essential Thrombocythemia: Does COVID-19 Play Any Role? A Case Report and Overview of the Literature

by Mihail Cotorogea-Simion, Sebastian Isac, Alina Tita, Letitia Toma, Laura Elena Iliescu, Adriana Mercan-Stanciu, Teodora Isac, Anca Bobirca, Florin Bobirca, Cristian Cobilinschi, Maria Daniela Tanasescu and Gabriela Droc

Medicina 2022, 58(9), 1147; https://doi.org/10.3390/medicina58091147 - 24 Aug 2022

Viewed by 1829

Abstract

Introduction: Chronic mesenteric ischemia is a rare entity with non-specific symptomatology; combined with rare etiologies, it could lead to unwarranted surgical indication. Case report: We report the case of an 85-year-old woman, with a history of hypertension, persistent thrombocytosis, atherosclerosis, and recent minor [...] Read more.

Introduction: Chronic mesenteric ischemia is a rare entity with non-specific symptomatology; combined with rare etiologies, it could lead to unwarranted surgical indication. Case report: We report the case of an 85-year-old woman, with a history of hypertension, persistent thrombocytosis, atherosclerosis, and recent minor COVID-19 infection, presenting to the hospital with postprandial abdominal pain and nonspecific clinical examination findings; upon abdominal CT, superior mesenteric artery circumferential thrombosis was revealed. A bone marrow biopsy was performed due to suspected essential thrombocythemia, confirming the diagnosis. An endovascular approach was chosen as therapy option and a stent was placed in the occluded area. Dual antiplatelet and cytoreductive therapies were initiated after the intervention. Clinical course was excellent, with no residual stenosis 1 month after stenting. Conclusions: The therapeutic strategy in elderly patients with exacerbated chronic mesenteric ischemia requires an interdisciplinary approach in solving both the exacerbation and the underlying conditions in order to prevent further thrombotic events. Although the patient presented a thrombotic state, other specific risk factors such as COVID-19 related-coagulopathy and essential thrombocythemia should be considered. Full article

(This article belongs to the Special Issue Advances in Cardiothoracic and Vascular Surgery in the COVID-19 Era)

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