The Association of Acute Aortic Dissection and COVID-19 Infection: A Case Report

Yıl 2022, , 47 - 51, 28.08.2022

Erkut Etçioğlu , Yasin Canbolat , Fatih Mergen , Muhammet Raşit Aydın

https://doi.org/10.29228/HMJ.19

Öz

COVID-19, caused by SARS-CoV-2, is an infection that can infect many organs and systems, and may reveal different clinical situations according to the organs and systems involved. One of the targets of SARS-CoV-2 is the cardiovascular system. Many infectious diseases can potentially cause aneurysm or dissection by inducing lesions in aorta or directly involvement. A 57-year-old male patient was admitted to our emergency department with complaints of sharp and stabbing pain in the chest and back. The patient stated that his current complaint began 1 h prior to that and had increased over time. On the thorax computerized tomography (CT), a dissection covering the ascending aorta, descending aorta, and aortic arch (De Bakey type 1, Stanford type A) was detected. At the same time, real-time reverse transcription polymerase chain reaction (RT-PCR) test was applied to the patient upon the detection of ground glass areas in the lung basal regions on the thorax CT and detected positive. COVID-19 can cause fatal damage to the cardiovascular system. Clinicians should keep in mind the COVID-19 and cardiovascular system relationship.

Anahtar Kelimeler

Aortic Dissection, COVID-19, Emergency Department, SARS-CoV-2

Akut Aort Diseksiyonu ve COVID-19 Enfeksiyonu Birlikteliği: Olgu Sunumu

Öz

SARS-CoV-2'nin neden olduğu COVID-19, birçok organ ve sistemi enfekte edebilen, tutulduğu organ ve sistemlere göre farklı klinik tablolar ortaya çıkarabilen bir enfeksiyondur. SARS-CoV-2'nin hedeflerinden biri de kardiyovasküler sistemdir. Birçok bulaşıcı hastalık, aortta lezyonlar oluşturarak veya doğrudan tutulum yaparak potansiyel olarak anevrizma veya diseksiyona neden olabilir. 57 yaşında erkek hasta göğüs ve sırtta keskin, saplayıcı tarzda ağrı şikayeti ile acil servisimize başvurdu. Hasta mevcut şikayetinin bundan 1 saat önce başladığını ve giderek arttığını belirtti. Toraks bilgisayarlı tomografisinde (BT) asendan aorta, desendan aorta ve arkus aortayı kapsayan bir diseksiyon (De Bakey tip 1, Stanford tip A) tespit edildi. Aynı zamanda toraks BT'de akciğer bazal bölgelerinde buzlu cam alanları saptanması üzerine hastaya gerçek zamanlı polimeraz zincir reaksiyonu (RT-PCR) testi uygulandı ve pozitif saptandı. COVID-19 kardiyovasküler sistemde ölümcül hasara neden olabilir. Klinisyenler; COVID-19 ve kardiyovasküler sistem ilişkisini mutlaka akıllarında tutmalıdırlar.

Anahtar Kelimeler

Aort Diseksiyonu, COVID-19, Acil Servis, SARS-CoV-2

Kaynakça

• Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses 2020; 12(4): 372. doi: 10.3390/v12040372.
• Scialo F, Daniele A, Amato F, Pastore L, Matera M.G, Cazzola M, et al. ACE2: The major cell entry receptor for SARS-CoV-2. Lung 2020; 198(6):867-77. doi: 10.1007/s00408-020-00408-4.
• Gheblawi M, Wang K, Viveiros A, Nguyen Q, Zhong JC, Turner AJ, et al. Angiotensin-Converting Enzyme 2: SARS-CoV-2 receptor and regulator of the renin-angiotensin system: Celebrating the 20th anniversary of the discovery of ACE2. Circ Res 2020; 126: 1456-74. doi: 10.1161/CIRCRESAHA.120.317015.
• Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J 2018; 39: 739-49. doi: 10.1093/eurheartj/ehx319.
• Silvestri V, Recchia GE. Aortic pathology during COVID-19 pandemics. Clinical reports in literature and open questions on the two co-occurring conditions. Ann Vasc Surg 2021; 75: 109-19. doi:10.1016/j.avsg.2021.02.037.
• Bima P, Pivetta E, Nazerian P, Toyofuku M, Gorla R, Bossone E, et al. Systematic review of aortic dissection detection risk score plus d-dimer for diagnostic rule-out of suspected acute aortic syndromes. Acad Emerg Med 2020; 27:1013-27. doi:10.1111/acem.13969.
• Mamishi S, Navaeian A, Shabanian R. Acute aortic dissection in a patient with Williams syndrome infected by COVID-19. Cardiol Young 2021; 31: 132-4. doi:10.1017/S1047951120003236.
• Manenti A, Farinetti A, Manco G, Mattioli A. Vasculitis and aortitis: COVID-19 challenging complications. Journal of Vascular Surgery 2021; 347-8. doi:10.1016/j.jvs.2020.08.029.
• Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323:1061-9. doi:10.1001/jama.2020.1585.
• Akgul A, Turkyilmaz S, Turkyilmaz G, Toz H. Acute aortic dissection surgery in a patient with COVID-19. Ann Thorac Surg 2021; 111: 1-3. doi:10.1016/j.athoracsur.2020.06.005.