Der Internist
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Review
[Anticoagulation in coronavirus disease 2019 (COVID-19): confirmed and controversial aspects].
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high risk of microvascular immunothrombosis as well as symptomatic and incidental thromboembolisms, predominantly in the venous system but also in the arterial system. This explains among other things the high cardiovascular morbidity and mortality of the patients. ⋯ Apart from the established indications for treatment, an intensified or therapeutic dose prophylaxis should be considered very cautiously in these critically ill patients, also due to the increased bleeding complications. The routine continuation of prophylactic anticoagulation after discharge from hospital is currently not recommended.
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Atrial septal defects (ASD) following endovascular mitral valve clipping are potentially hemodynamically relevant complications. Immediate closure with an occluder can represent a safe and effective treatment. An 81-year-old female patient suffering from severe dyspnea due to previously known severe mitral valve regurgitation was scheduled for elective mitral valve clipping. The clip was successfully implanted. Removal of the transseptal cannula resulted in a sudden drop in oxygen saturation and systolic blood pressure as well as an immediate increase in central venous pressure. An iatrogenic left-right shunt was observed at the atrial level with a relevant shunt volume. Immediate closure using an atrial septal occluder successfully restored the oxygen saturation and hemodynamic parameters. ⋯ An increase in central venous pressure, reduction of systolic blood pressure or oxygen saturation after withdrawal of the transseptal cannula during mitral valve clipping should always be further investigated regarding a possible ASD.
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Case Reports
[Pneumonia, endocarditis of two valves and pulmonary artery embolism in a 26-year-old male patient].
A 26-year-old male patient presented with left-sided pneumonia, endocarditis of the tricuspid and pulmonary valves and a pulmonary artery embolism. In 2004 a Ross operation was performed because of congenital aortic valve stenosis. ⋯ Under antibiotic treatment with levofloxacin and doxycycline there was an improvement of the symptoms and a normalization of the inflammation parameters. The treatment of the endocarditis was successful.