SARS-COV-2 INFECTION AFTER CTEPH DIAGNOSIS ASSOCIATED WITH VASCULAR TISSUE FRIABILITY DURING PULMONARY THROMBOENDARTERECTOMY

Background: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) affects cardiovascular system due to systemic inflammatory cytokine storm 1 . Herein we describe pulmonary thromboendarterectomy (PTE) after recent SARS-CoV-2 infection. Case: 66 year old male with Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and recent SARS-CoV-2 infection was referred to our center for PTE. He underwent PTE 3 months after resolution of his acute SARS-CoV-2 infection. Intraoperatively, blood vessels were very fragile. Inferior vena cava (IVC) was torn creating a 1.5 cm hole during regular pump suction and the walls of the pulmonary arteries except the adventitia were very easily torn. Chronic clot specimen is shown (Figure 3). Histopathology showed thrombus and vascular intimal wall fragments with myxoid degeneration and lymphoplasmacytic infiltrates. Decision - making: Our patient did not have known risk factors for vascular fragility (Table 1). Although vascular effects of Covid-19 are not entirely understood, there are several case reports showing direct and indirect effects on blood vessels 4-7 . A case series of 12 patients with lung transplantation for Covid-19 infection showed increased tissue fragility and intraoperative bleeding (25%) 8 . Conclusion: We highlight an association of COVID infection with vascular