Mechanical aortic prosthetic thrombosis in a 65-year-old woman with SARS-coV-2 infection

Abstract

A 65-year-old female patient was hospitalized, initially due to an episode of melena. Anticoagulation was suspended, and upper gastrointestinal endoscopy was performed, without detecting bleeding. In 2005, she had late post-operative history of mechanical aortic prosthesis and Bentall and de Bono surgery due to Stanford A aortic dissection; she was a former tobacco user, with obesity and chronic atrial fibrillation under regular use of warfarin. The following day, she had an acute myocardial infarction with ST-segment elevation in the anterior wall; she was submitted to angioplasty with an anterior descending drug-eluting stent, and she received aspirin, clopidogrel 75 mg daily, and anticoagulation with enoxaparin 100 mg every 12 hours. On that occasion, she underwent transthoracic echocardiogram that demonstrated mild ventricular dysfunction (LVEF: 50%) and aortic prosthesis leaflets with preserved mobility; the peak systolic pressure gradient between the left ventricle and the aorta was 58 mmHg, with a mean of 33 mmHg. Two days later, she began to present anosmia, headache, subfebrile temperature, and hypoxemia, and diagnosis of SARS-CoV-2 was confirmed by oropharyngeal swab PCR. Seven days later, while still on full enoxaparin, the patient started presenting atypical chest pain associated with dyspnea. During physical examination, the patient’s overall condition was regular; she had dyspnea, without cyanosis. Pulse was present and full in all 4 limbs, and she had Glasgow score of 15, blood pressure 120/86 mmHg, heart rate 130 bpm, peripheral oximetry 97% while using a nasal oxygen catheter at 3 L/min, and capillary filling time of less than 3 seconds. Ictus cordis was in the left hemiclavicular line, at the level of the fifth intercostal space. She had normophonetic heart sounds, with moderate intensity ejective systolic murmur with metallic click in aortic focus. The patient’s liver was not palpable, and there were mild and sparking crackles in the pulmonary fields bilaterally.