Severe COVID-19 is a multisystem inflammatory disorder and knowledge and experience with severe acute respiratory failure in infected patients has grown considerably since reports of the first few cases. Little is known about the effect of SARS-CoV-2 on the heart, and there has been a suggestion from published literature that fulminant cardiac failure with or without respiratory failure may occur several weeks following infection. A young man presented after a recent viral illness. He was found to be in severe cardiogenic shock and was implanted with an emergency biventricular assist device, which also incorporated an extracorporeal membrane oxygenator. He stabilised soon thereafter and despite an intracerebral haemorrhage, which resolved, and bleeding into the trachea following percutaneous tracheostomy, he survived to explant and was successfully stepped down to a rehabilitation unit on postoperative day 50. He tested positive for SARS-CoV-2 antibodies when the test became available on postoperative day 33. We envisage there will be many more such presentations of acute COVID-19-associated cardiogenic shock and we recommend clinicians consider this diagnosis when presented with an acutely unwell patient with an unclear diagnosis, following a viral illness. These patients should be discussed as early as possible with a transplant/mechanical circulatory support team.
Coronary artery bypass grafting (CABG) remains the preferred revascularization modality for the elective treatment of patients with complex three vessel coronary artery disease. There is evidence that the use of additional arterial grafts such as right internal mammary artery (RIMA) and Radial Artery (RA); are associated with improved long-term patency. Stenosis of arterial grafts can occur in some patients postoperatively. We describe the first use of OCT in the evaluation of suspected conduit stenosis in Total Arterial Revascularisation.