COVID-19 Infection Occurring in The Postoperative Period in A Patient Who Underwent Coronary Artery Surgery

Abstract

1. Abstract While the coronavirus-associated Covid-19 infection remains a risk for people all over the world as a pandemic, it is also a major catastrophic clinical situation for patients undergoing surgery in hospitals. If patients encounter this infection picture, especially after severe operations such as heart surgery, the life-threatening rates increase gradually. In this article, we presented the aortic thrombotic process and lung infection that occurred after a patient undergoing coronary artery surgery was infected with corona virus during clinical follow-up. The patient, who was followed up in the intensive care unit due to lung involvement, did not undergo surgical intervention, since there was no ischemic clinical picture due to peripheral occlusion. However, the patient died due to Covid-19 infection. 2. Introduction In patients infected with Covid-19 disease, the infiltrative infection state and hypercoagulopathic conditions in the lungs generally determine morbidity and mortality. These patients may primarily have infection-related consolidation in the lungs (ground glass appearance), pulmonary embolic conditions, and diffuse intra-body vascular thrombosis [1, 2]. Although the treatment that can be given to patients with Covid-19 disease varies according to the clinical condition of the patient, it consists of globally accepted medications and medical life support treatments that can maintain the patient s vital functions (such as thrombolytic therapy, surgical embolectomy, and use of a ventilator) [2]. 3. Case Report Coronary bypass surgery (internal mammarian artery-left anterior descending coronary artery; aorta-circumflex coronary artery; aorta-right coronary artery) was performed for 3-vessel disease in a 58-year-old male patient. The patient, who survived the postoperative period without any problems, was transferred to the clinic from the intensive care unit on the 2nd day. In the clinic, on the 5th postoperative day, the patient had fever, cough and back pain, and pain and numbness began to occur in his feet. It was determined that respiratory oxygen saturation values decreased from 96 to 88 compared to the previous days. In addition, there was a decrease in the respiratory sounds of the patient with listening. Preoperatively, the distal limb pulses were palpable by hand, but now these pulsations were not palpable, but were evident on Doppler examination. In this clinical condition of the patient, a covid-19 infection was considered and the PCR test was sent. In addition, the patient was monitored by performing intensive breathing exercises, and pressurized oxygen therapy, heparin (enoxaparine 6000), antiviral (Favipiravir 200 mg 2x3), hydroxychloroquine (200 mg 1x1), ascorbic acide (1000 mg 2x1), steroid (metilprednisolon 80 1x1) treatments were started. Chest radiology demonstrated diffuse bilateral consolidation (Figure 1A), and peripheral ground-glass opacification consistent with SARS-CoV-2 infection on computed tomography (Figure 1B). Peripheral computed tomographic angiography was performed because a decrease in peripheral pulses was detected in the patient, who continued intensive medication. On angiography, thrombosed formations were detected starting from the renal levels (Figure 2A) towards the distal, especially in