Surgical treatment of ascending aorta floating thrombus in a patient with recent SARS-CoV-2 infection.

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.