An infection-oriented approach for thoracic endovascular aortic repair in a SARS-CoV-2 positive patient. A case report.
Identifieur interne : 000D11 ( Main/Corpus ); précédent : 000D10; suivant : 000D12An infection-oriented approach for thoracic endovascular aortic repair in a SARS-CoV-2 positive patient. A case report.
Auteurs : Giovanni Rossi ; Stefano Aldo Ferrari ; Simona Sommaruga ; Lorenzo Muzzarelli ; Stefania PiconiSource :
- Annali italiani di chirurgia [ 2239-253X ] ; 2020.
English descriptors
- KwdEn :
- Anesthesia, Local (MeSH), Aneurysm, Dissecting (complications), Aneurysm, Dissecting (surgery), Antibiotic Prophylaxis (MeSH), Anticoagulants (therapeutic use), Antiviral Agents (therapeutic use), Aortic Aneurysm, Thoracic (complications), Aortic Aneurysm, Thoracic (surgery), Betacoronavirus (isolation & purification), Blood Vessel Prosthesis Implantation (methods), COVID-19 (MeSH), Contraindications, Procedure (MeSH), Coronavirus Infections (complications), Coronavirus Infections (drug therapy), Coronavirus Infections (prevention & control), Coronavirus Infections (transmission), Darunavir (therapeutic use), Diabetes Mellitus, Type 2 (complications), Drug Therapy, Combination (MeSH), Endovascular Procedures (methods), Enoxaparin (therapeutic use), Female (MeSH), Humans (MeSH), Hydroxychloroquine (therapeutic use), Infection Control (methods), Infectious Disease Transmission, Patient-to-Professional (prevention & control), Intraoperative Complications (prevention & control), Intubation, Intratracheal (adverse effects), Middle Aged (MeSH), Nasopharynx (virology), Operating Rooms (MeSH), Pandemics (prevention & control), Patient Isolation (MeSH), Pneumonia, Viral (complications), Pneumonia, Viral (drug therapy), Pneumonia, Viral (prevention & control), Pneumonia, Viral (transmission), Ritonavir (therapeutic use), SARS-CoV-2 (MeSH), Spinal Cord Ischemia (prevention & control), Vertebral Artery (surgery).
- MESH :
- chemical , therapeutic use : Anticoagulants, Antiviral Agents, Darunavir, Enoxaparin, Hydroxychloroquine, Ritonavir.
- adverse effects : Intubation, Intratracheal.
- complications : Aneurysm, Dissecting, Aortic Aneurysm, Thoracic, Coronavirus Infections, Diabetes Mellitus, Type 2, Pneumonia, Viral.
- drug therapy : Coronavirus Infections, Pneumonia, Viral.
- isolation & purification : Betacoronavirus.
- methods : Blood Vessel Prosthesis Implantation, Endovascular Procedures, Infection Control.
- prevention & control : Coronavirus Infections, Infectious Disease Transmission, Patient-to-Professional, Intraoperative Complications, Pandemics, Pneumonia, Viral, Spinal Cord Ischemia.
- surgery : Aneurysm, Dissecting, Aortic Aneurysm, Thoracic, Vertebral Artery.
- transmission : Coronavirus Infections, Pneumonia, Viral.
- virology : Nasopharynx.
- Anesthesia, Local, Antibiotic Prophylaxis, COVID-19, Contraindications, Procedure, Drug Therapy, Combination, Female, Humans, Middle Aged, Operating Rooms, Patient Isolation, SARS-CoV-2.
Abstract
CASE REPORT
A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery.
DISCUSSION
By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery.
CONCLUSIONS
A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient.
KEY WORDS
COVID-19, Dissection, TEVAR.
PubMed: 32877380
Links to Exploration step
pubmed:32877380Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">An infection-oriented approach for thoracic endovascular aortic repair in a SARS-CoV-2 positive patient. A case report.</title><author><name sortKey="Rossi, Giovanni" sort="Rossi, Giovanni" uniqKey="Rossi G" first="Giovanni" last="Rossi">Giovanni Rossi</name></author><author><name sortKey="Ferrari, Stefano Aldo" sort="Ferrari, Stefano Aldo" uniqKey="Ferrari S" first="Stefano Aldo" last="Ferrari">Stefano Aldo Ferrari</name></author><author><name sortKey="Sommaruga, Simona" sort="Sommaruga, Simona" uniqKey="Sommaruga S" first="Simona" last="Sommaruga">Simona Sommaruga</name></author><author><name sortKey="Muzzarelli, Lorenzo" sort="Muzzarelli, Lorenzo" uniqKey="Muzzarelli L" first="Lorenzo" last="Muzzarelli">Lorenzo Muzzarelli</name></author><author><name sortKey="Piconi, Stefania" sort="Piconi, Stefania" uniqKey="Piconi S" first="Stefania" last="Piconi">Stefania Piconi</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32877380</idno><idno type="pmid">32877380</idno><idno type="wicri:Area/Main/Corpus">000D11</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000D11</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">An infection-oriented approach for thoracic endovascular aortic repair in a SARS-CoV-2 positive patient. A case report.</title><author><name sortKey="Rossi, Giovanni" sort="Rossi, Giovanni" uniqKey="Rossi G" first="Giovanni" last="Rossi">Giovanni Rossi</name></author><author><name sortKey="Ferrari, Stefano Aldo" sort="Ferrari, Stefano Aldo" uniqKey="Ferrari S" first="Stefano Aldo" last="Ferrari">Stefano Aldo Ferrari</name></author><author><name sortKey="Sommaruga, Simona" sort="Sommaruga, Simona" uniqKey="Sommaruga S" first="Simona" last="Sommaruga">Simona Sommaruga</name></author><author><name sortKey="Muzzarelli, Lorenzo" sort="Muzzarelli, Lorenzo" uniqKey="Muzzarelli L" first="Lorenzo" last="Muzzarelli">Lorenzo Muzzarelli</name></author><author><name sortKey="Piconi, Stefania" sort="Piconi, Stefania" uniqKey="Piconi S" first="Stefania" last="Piconi">Stefania Piconi</name></author></analytic><series><title level="j">Annali italiani di chirurgia</title><idno type="eISSN">2239-253X</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anesthesia, Local (MeSH)</term><term>Aneurysm, Dissecting (complications)</term><term>Aneurysm, Dissecting (surgery)</term><term>Antibiotic Prophylaxis (MeSH)</term><term>Anticoagulants (therapeutic use)</term><term>Antiviral Agents (therapeutic use)</term><term>Aortic Aneurysm, Thoracic (complications)</term><term>Aortic Aneurysm, Thoracic (surgery)</term><term>Betacoronavirus (isolation & purification)</term><term>Blood Vessel Prosthesis Implantation (methods)</term><term>COVID-19 (MeSH)</term><term>Contraindications, Procedure (MeSH)</term><term>Coronavirus Infections (complications)</term><term>Coronavirus Infections (drug therapy)</term><term>Coronavirus Infections (prevention & control)</term><term>Coronavirus Infections (transmission)</term><term>Darunavir (therapeutic use)</term><term>Diabetes Mellitus, Type 2 (complications)</term><term>Drug Therapy, Combination (MeSH)</term><term>Endovascular Procedures (methods)</term><term>Enoxaparin (therapeutic use)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Infection Control (methods)</term><term>Infectious Disease Transmission, Patient-to-Professional (prevention & control)</term><term>Intraoperative Complications (prevention & control)</term><term>Intubation, Intratracheal (adverse effects)</term><term>Middle Aged (MeSH)</term><term>Nasopharynx (virology)</term><term>Operating Rooms (MeSH)</term><term>Pandemics (prevention & control)</term><term>Patient Isolation (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Pneumonia, Viral (drug therapy)</term><term>Pneumonia, Viral (prevention & control)</term><term>Pneumonia, Viral (transmission)</term><term>Ritonavir (therapeutic use)</term><term>SARS-CoV-2 (MeSH)</term><term>Spinal Cord Ischemia (prevention & control)</term><term>Vertebral Artery (surgery)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anticoagulants</term><term>Antiviral Agents</term><term>Darunavir</term><term>Enoxaparin</term><term>Hydroxychloroquine</term><term>Ritonavir</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Intubation, Intratracheal</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Aneurysm, Dissecting</term><term>Aortic Aneurysm, Thoracic</term><term>Coronavirus Infections</term><term>Diabetes Mellitus, Type 2</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Betacoronavirus</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Blood Vessel Prosthesis Implantation</term><term>Endovascular Procedures</term><term>Infection Control</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Coronavirus Infections</term><term>Infectious Disease Transmission, Patient-to-Professional</term><term>Intraoperative Complications</term><term>Pandemics</term><term>Pneumonia, Viral</term><term>Spinal Cord Ischemia</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Aneurysm, Dissecting</term><term>Aortic Aneurysm, Thoracic</term><term>Vertebral Artery</term></keywords><keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Nasopharynx</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Anesthesia, Local</term><term>Antibiotic Prophylaxis</term><term>COVID-19</term><term>Contraindications, Procedure</term><term>Drug Therapy, Combination</term><term>Female</term><term>Humans</term><term>Middle Aged</term><term>Operating Rooms</term><term>Patient Isolation</term><term>SARS-CoV-2</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>CASE REPORT</b></p><p>A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery.</p></div><div type="abstract" xml:lang="en"><p><b>DISCUSSION</b></p><p>By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient.</p></div><div type="abstract" xml:lang="en"><p><b>KEY WORDS</b></p><p>COVID-19, Dissection, TEVAR.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32877380</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>10</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>18</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">2239-253X</ISSN><JournalIssue CitedMedium="Internet"><Volume>91</Volume><PubDate><Year>2020</Year></PubDate></JournalIssue><Title>Annali italiani di chirurgia</Title><ISOAbbreviation>Ann Ital Chir</ISOAbbreviation></Journal><ArticleTitle>An infection-oriented approach for thoracic endovascular aortic repair in a SARS-CoV-2 positive patient. A case report.</ArticleTitle><Pagination><MedlinePgn>273-276</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0003469X20033916</ELocationID><Abstract><AbstractText Label="CASE REPORT" NlmCategory="METHODS">A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery.</AbstractText><AbstractText Label="DISCUSSION" NlmCategory="CONCLUSIONS">By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient.</AbstractText><AbstractText Label="KEY WORDS" NlmCategory="UNASSIGNED">COVID-19, Dissection, TEVAR.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rossi</LastName><ForeName>Giovanni</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Ferrari</LastName><ForeName>Stefano Aldo</ForeName><Initials>SA</Initials></Author><Author ValidYN="Y"><LastName>Sommaruga</LastName><ForeName>Simona</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Muzzarelli</LastName><ForeName>Lorenzo</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Piconi</LastName><ForeName>Stefania</ForeName><Initials>S</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>Italy</Country><MedlineTA>Ann Ital Chir</MedlineTA><NlmUniqueID>0372343</NlmUniqueID><ISSNLinking>0003-469X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000925">Anticoagulants</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D017984">Enoxaparin</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>O3J8G9O825</RegistryNumber><NameOfSubstance UI="D019438">Ritonavir</NameOfSubstance></Chemical><Chemical><RegistryNumber>YO603Y8113</RegistryNumber><NameOfSubstance UI="D000069454">Darunavir</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000772" MajorTopicYN="N">Anesthesia, Local</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000784" MajorTopicYN="N">Aneurysm, Dissecting</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019072" MajorTopicYN="N">Antibiotic Prophylaxis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000925" MajorTopicYN="N">Anticoagulants</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017545" MajorTopicYN="N">Aortic Aneurysm, Thoracic</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="Y">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019917" MajorTopicYN="N">Blood Vessel Prosthesis Implantation</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000075204" MajorTopicYN="N">Contraindications, Procedure</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName><QualifierName UI="Q000635" MajorTopicYN="N">transmission</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000069454" MajorTopicYN="N">Darunavir</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003924" MajorTopicYN="N">Diabetes Mellitus, Type 2</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004359" MajorTopicYN="N">Drug Therapy, Combination</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D057510" MajorTopicYN="N">Endovascular Procedures</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017984" MajorTopicYN="N">Enoxaparin</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017053" MajorTopicYN="N">Infection Control</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017758" MajorTopicYN="N">Infectious Disease Transmission, Patient-to-Professional</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007431" MajorTopicYN="N">Intraoperative Complications</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007442" MajorTopicYN="N">Intubation, Intratracheal</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009305" MajorTopicYN="N">Nasopharynx</DescriptorName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009873" MajorTopicYN="N">Operating Rooms</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D010356" MajorTopicYN="N">Patient Isolation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName><QualifierName UI="Q000635" MajorTopicYN="N">transmission</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019438" MajorTopicYN="N">Ritonavir</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020760" MajorTopicYN="N">Spinal Cord Ischemia</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014711" MajorTopicYN="N">Vertebral Artery</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="ita"><AbstractText>Nel marzo 2020 una donna di 64 anni si è presentata presso il nostro pronto soccorso con sincope, anosmia, lieve dispnea e dolore toracico. Riferiva inoltre febbricola nei giorni precedenti, ma al momento del ricovero era apiretica e la sua saturazione di ossigeno in aria ambiente era 93%. Una TC del torace (eseguita per escludere una tromboembolia polmonare) ha evidenziato una dissezione aortica acuta di tipo B e una polmonite interstiziale bilaterale, con successiva positività del tampone naso-faringeo per SARS-CoV-2. La dissezione aortica era estesa longitudinalmente per circa 6 cm, con un tear di entrata situato subito distalmente rispetto all’origine dell’arteria succlavia sinistra. Come per tutte le sindromi aortiche acute, la paziente è stata trasferita in terapia intensiva per monitoraggio invasivo della pressione arteriosa; in questo caso è stata pianificata una stanza singola con isolamento da contatto e per droplets. Secondo il protocollo interno è stata impostata una terapia antivirale ed una profilassi antibiotica ed antitrombotica. La somministrazione di ossigeno a basso flusso attraverso occhialini nasali era sufficiente per mantenere una saturazione > 94%. Una scansione TC dopo 24 ore non ha mostrato cambiamenti nell’estensione della dissezione, ma la paziente continuava a riferire dolore toracico nonostante la terapia analgesica per cui è stato deciso di sottoporla a trattamento chirurgico. In anestesia locale (senza intubazione oro-tracheale e con un anestesista in stand-by fuori dalla stanza) ed utilizzando una sala di emodinamica (per la indisponibilità delle sale operatorie, trasformate in terapia intensiva per i pazienti COVID-19) la lesione è stata esclusa mediante il posizionamento di una endoprotesi toracica con copertura intenzionale dell’origine della succlavia di sinistra senza rivascolarizzazione. L’angiografia finale ha mostrato la completa esclusione della dissezione e l’assenza di endoleak. In base al nostro protocollo infettivologico, per l’intera durata della procedura alla paziente è stata applicata una mascherina chirurgica al fine di limitare la diffusione di droplets e l’ossigenoterapia è stata somministrata tramite occhialini nasali. Il personale presente all’interno della sala di emodinamica è stato ridotto al minimo (tre chirurghi vascolari ed un infermiere di sala operatoria) per abbattere il rischio infettivo e l’impiego di dispositivi di protezione individuale. Oltre alla divisa, al camice piombato ed agli occhiali schermati, il personale presente nella stanza era dotato di un doppio camice chirurgico, due paia di guanti, visiera protettiva, maschera FFP2 e copri scarpe. La procedura si è svolta regolarmente e circa 6 ore dopo il termine la paziente è stata trasferita nel reparto di malattie infettive. Non si sono verificate complicanze chirurgiche né respiratorie e la paziente è stata dimessa in quattordicesima giornata post-operatoria. Al fine di evitare la mobilizzazione della paziente al di fuori del reparto di malattie infettive e data la risoluzione delle algie toraciche ed il decorso post-operatorio favorevole, il controllo angio-TC non è stato eseguito durante il ricovero ma è stato programmato a distanza di circa sei mesi dall’intervento.</AbstractText></OtherAbstract></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>3</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>3</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32877380</ArticleId><ArticleId IdType="pii">S0003469X20033916</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/CovidChloroV1/Data/Main/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000D11 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Corpus/biblio.hfd -nk 000D11 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Sante
|area= CovidChloroV1
|flux= Main
|étape= Corpus
|type= RBID
|clé= pubmed:32877380
|texte= An infection-oriented approach for thoracic endovascular aortic repair in a SARS-CoV-2 positive patient. A case report.
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Corpus/RBID.i -Sk "pubmed:32877380" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a CovidChloroV1
| This area was generated with Dilib version V0.6.38. |  |