Zivkovic Igor, Milacic Petar, Mihajlovic Vladimir, Krasic Stasa, Lesanovic Jelena, Peric Miodrag, Zdravkovic Djordje
Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia.
Department of Radiology, Dedinje Cardiovascular Institute, Belgrade, Serbia.
Cardiovasc Diagn Ther. 2021 Apr;11(2):467-471. doi: 10.21037/cdt-20-1010.
The 44-year-old female was admitted to the hospital due to the severe pain in the right arm. Doppler ultrasonography revealed occlusion of the right brachial and right common carotid artery. Subsequently, computed tomography (CT) scan confirmed the occlusion of the right brachial and common carotid artery, and revealed pedunculated floating ascending aortic mass. The floating thrombus in ascending aorta is a rare and potentially very dangerous pathological condition. Although aetiology is still unclear, ascending aorta atherosclerosis and coagulation disorder are probably the most common reasons. Hypercoagulable state, high level of antiphospholipid antibody and factor VIII are closely relating with vascular thrombosis. Since the outbreak of the coronavirus-2019 (COVID-19) pandemic, increasing evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might produce hypercoagulable state with subsequent thrombosis and thromboembolism. The infection elevated the level of factor VIII in the blood and, consequently, increased the risk of adverse thrombotic and embolic events. Additionally, endothelial inflammation and injury mediated by coronavirus represent an additional risk factor. According to literature, this is the first case of the floating ascending aorta thrombus in the patient with SARS-CoV-2 infection. The thrombus' fragile structure and high blood velocity through the ascending aorta significantly increases cerebral and peripheral embolization incidence, with potentially fatal outcome. Due to frequent adverse events, urgent surgical extirpation is the best therapy option. We presented successfully surgically treated giant floating thrombus in the ascending aorta and aortic arch in a patient with recent SARS-CoV-2 infection with acute right arm ischemia due to embolic complication.
一名44岁女性因右臂剧痛入院。多普勒超声检查显示右肱动脉和右颈总动脉闭塞。随后，计算机断层扫描（CT）证实右肱动脉和颈总动脉闭塞，并发现有蒂的升主动脉漂浮肿块。升主动脉漂浮血栓是一种罕见且潜在非常危险的病理状况。虽然病因仍不清楚，但升主动脉动脉粥样硬化和凝血障碍可能是最常见的原因。高凝状态、抗磷脂抗体水平升高和因子VIII与血管血栓形成密切相关。自2019冠状病毒病（COVID-19）大流行爆发以来，越来越多的证据表明，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可能导致高凝状态，随后发生血栓形成和血栓栓塞。感染使血液中因子VIII水平升高，从而增加了不良血栓形成和栓塞事件的风险。此外，冠状病毒介导的内皮炎症和损伤是另一个危险因素。据文献报道，这是首例SARS-CoV-2感染患者出现升主动脉漂浮血栓的病例。血栓的脆弱结构以及通过升主动脉的高血流速度显著增加了脑和外周栓塞的发生率，可能导致致命后果。由于频繁发生不良事件，紧急手术切除是最佳治疗选择。我们成功地为一名近期感染SARS-CoV-2且因栓塞并发症导致急性右臂缺血的患者手术治疗了升主动脉和主动脉弓内的巨大漂浮血栓。
