Dieter, Robert S.

Significant progress has been made in treating Coronavirus disease (COVID) – an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ominous turn in the pandemic is the evolving public health crisis emanating from persistent SARS-CoV-2 infection and its associated long-term impact. Long COVID or post–COVID syndrome describes protean symptoms that persist at least 3 months after the onset of acute illness and last for at least 2 months in individuals with a history of confirmed SARS-CoV-2 infection. Long COVID has become a public health concern. Millions of infected individuals are now facing chronic multi-organ failures, including neuropsychiatric, cardiovascular, pulmonary, and kidney complications. In general, the cause of long COVID syndrome is unclear but factors such as prolonged activation of immune responses, and viral persistence triggering transcription dysregulation of genes associated with normal thrombotic disease may play a role in cardiovascular complications. Although inflammatory biomarkers are reported in other disorders, it remains unclear whether similar biomarkers are associated with cardiovascular manifestations following COVID. Medications such as sulodexide directed at glycocalyx and coagulation have demonstrated benefits for long COVID in smaller studies. Here, we describe the outcomes of the symposium on the underlying cardiovascular mechanisms of the long COVID.

The association between bicuspid aortic valve (BAV) and ascending aorta aneurysm is well described. Replacement of the ascending aorta is now being considered at 4.5 cm. We identified patients confirmed with BAV who underwent elective aortic valve replacement (AVR) with a mechanical St Jude Bioprosthesis from 1994 to 2000 who were ≤65 years of age at the time of surgery. Follow-up imaging was obtained by computed tomography (CT) angiography or echocardiography. A total of 225 patients who underwent AVR were identified; 60 patients had a BAV. Of all, 36 (60%) patients with BAV returned for follow-up imaging of their ascending aorta. Eight patients (22%) had diameters classifiable as aneurysmal (>4.5 cm) that developed within 9.6 ± 4.1 years from implant and requiring surgery. Of all, 7 patients (12%) died within 5.9 ± 2.5 years from their implant date. Lifelong serial monitoring of the ascending aorta for patients with BAV should be the standard of care.