COVID - 19 Vaskulopati , Post- COVID - 19 Fenomeni ve Kalp Damar Cerrahisi

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Ahmet AKGÜL
İstanbul Üniversitesi-Cerrahpaşa Sağlık Bilimleri Fakültesi, Gerontoloji Bölümü, İstanbul
Article Language: TR
COVID-19 pandemisi döneminde tıp literatürüne 2 yeni kavram kazandırdık: COVID19 Vaskülopati ve Post-COVID-19 Fenomeni.

''Annals of Thoracic Surgery'' Dergisinde çok yakın bir süre önce yayınlanan 'Acute aortic dissection surgery in patient with COVID-19' yazımız ile birlikte doğan bu kavramların birisi SARS-CoV-2 virüsünün yaptığı biyolojik etkilerden bahsederken, diğeri ise aynı virüsün yaptığı sosyo-psikolojik etkilerden bahsetmektedir.1

SARS-CoV-2 viremisi sırasında neredeyse tüm vasküler yapılar etkilenmektedir. Bu yalnızca arterler değil, venler ve hatta lenf damarlarında da tutulumlar olmaktadır. Bu etkilerin bazılarını makroskopik olarak ameliyathanede gözlemlerken, bazılarını da mikroskopik olarak laboratuvarlarda görmekteyiz. Bazı bulguları 'bugün' eş zamanlı görürken, bazılarına da 'dün'den kalan bulgularla otopsilerde şahit olmaktayız, kesinlikle en fazlasını da 'yarın' göreceğiz. Bilgi ve tecrübelerimizle şu ana kadar SARSCoV-2 viremisinin yaptığı vasküler hasarı ve damar duvarında oluşturduğu remodeling tablosunun çok değişkenlik gösterdiğini gördük. Kimi hasta taburcu olduktan sonra derin ven trombozu geçirirken,2 kimi hastanın arter duvarında yırtılmalara yol açtığını, 3 kimi hastada kılcal damar tutulumu varken, kimi hastada damarı besleyen damar olan Vasa Vasorum bozulurken, kimi hastada büyük damar endotel hücrelerinde hasara neden olduğunu4 tespit ettik. Büyük olasılıkla akciğerdeki zararlı etkisinin en büyük nedenlerinden birinin de alveollerin hava değişimini sağlayan kılcal damarlarda olduğu görülecektir. Belki de viremi sırasında bu patolojilerin hepsi oluşmaktadır. İşte tüm bu değişiklikleri içinde bulunduran kavram 'COVID-19 VASCULOPATHY'sidir.

Virüs çok büyük bir sıklıkla solunum yolundan girmekte ve çoğunun inandığı gibi ana hedef akciğer görünmekte ama ana hedefin 'damar' olup olmadığı şu an için bilinmemektedir. Kişisel görüşüm ana hedefin damar olduğudur.

COVID-19 hastalığı 2019 yılının son ayında ortaya çıkmıştır yani 2019 yılının bize acı bir hediyesidir. Bir sonraki yıl olan 2020'de bize bir 'olgu' ortaya koymuştur: POST- . COVID-19 PHENOMENNON. Tanımında '19' geçmesine rağmen bu fenomeni 2020 bize sunmuştur. Nedir bu fenomen?

Bu yazdığım yazının tarihinden birkaç gün önce çok meşhur bir sanatçımızı kalp hastalığından dolayı kaybettik. Sanatçımızın zaten uzun yıllardır kalp hastalığı olması ve bu nedenle kalp pilinin takılı olması bilgisine ulaştık. Sanatçımızın kaybına neden olan bu değildi, nedeni kalp pilinin kontrol etme süresi gelmiş olmasına rağmen COVID-19 hastalığından korktuğu için hastaneye veya doktoruna gitmek istememesiydi. Zaten bu dönemde birçok hasta (yalnızca kronik olanlar değil, akut durumda olanlar da dahil) hastaneye gitmekten çekindi ve hâlâ direnmekteler.5 Bu 'korku' yalnızca hastalar için değil sağlık çalışanları için de geçerli oldu. Yapılacak ameliyatlarda morbidite ve mortalite riski yükseldiğinden, cerrahlar için de rutinde yapılacak ameliyatlar için çekinceler başladı, işte tüm bu psiko-sosyal olaylar için kullandığımız kavramımız da POST-COVID-19 Fenomeni'dir.

Bu kitabımızda yazılan yazılarda da ismi yazılı olarak geçmese de her iki kavramın etkilerini göreceksiniz.

Prof. Dr. Ahmet AKGÜL
Editör

KAYNAKLAR

1. Akgul A, Turkyilmaz S, Turkyilmaz G, Toz H. Acute aortic dissection surgery in patient with Covid-19. Ann Thorac Surg. 2020;S0003-4975(20)30941-3.
2. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438-e440.
3. Gulko E, Overby P, Ali S, Mehta H, Al-Mufti F, Gomes W. Vessel Wall Enhancement and Focal Cerebral Arteriopathy in a Pediatric Patient with Acute Infarct and COVID-19 Infection. AJNR Am J Neuroradiol. 2020 Aug 13. doi: 10.3174/ajnr.A6778.
4. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8.
5. Akgul A. Online Counselling for New Onset Symptoms/Signs in 65+ Patients with Lympho-Venous Diseases in the Era of COVID-19. Turkiye Klinikleri J Med Sci. 2020;40(2):125-6.
We presented two new terms related on COVID-19 to Medical Literature during pandemic: COVID-19 VASCULOPATHY and POST-COVID-19 PHENOMENNON.

These two terms were emerged in our case entitled ''Acute aortic dissection surgery in patient with COVID-19'', which was published in Annals of Aortic Surgery Journal. One of these terms covers the biological effects of SARS-CoV-2, whereas the other terms represents the socio-psychological consequences of COVD-19.1
Almost every vessel is effected during SARS-CoV-2 viremia. These vessels are not limited to arterial system, but veins and lymphatic systems as well. Some of the effects may be seen macroscopically during surgery in operating rooms and some may be observed microscopically in laboratories. Some structural changes may be simultaneously seen 'today', some of which that occurred 'yesterday' may be observed during autopsies, but the more changes would be recognized 'tomorrow'. Our experiences show us a wide spectrum of changes are occurred both in the lumen and in the vessel wall during SARS-CoV-2 viremia. For instance, some treated-patients following COVID-19 developed deep vein thrombosis after discharge,2 some of patients has dissection on vessel walls,3 some of them has capillary involvement and some has remodeling on Vasa vasorum and most of them have endothelial damage.4 Probably, the well-recognized damage on the lungs might be due capillary vessels which surrounds alveoli. So these all vascular changes may be covered in the term of COVID-19 VASCULOPATHY.

SARS-Co-V-2 frequently enters into the body via pulmonary system and for now, the primary targeted organ seems lungs whereas I believe the primary target for SARS-Co-V2 is the vessel.

COVID-19 was first identified in the end of 2019. Additionally, the year 2020 presents another case, might be named as 'Post-COVID-19 Phenomennon', shows avoidance to referring to hospital for diagnosis and/or treatments among patients due to threaten of coronovirus exposure.5 This 'threaten' is not only for patients but health workers as well. Some surgeons show hesitance to perform operations even on routine cases due to high morbidity and mortality. All of these psycho-social effects of COVID-19 are covered by the term of Post-COVID-19 Phenomennon.

This book shows the effect of these two terms in the chapters.

Prof. Dr. Ahmet AKGÜL
Editor

REFERENCES

1. Akgul A, Turkyilmaz S, Turkyilmaz G, Toz H. Acute aortic dissection surgery in patient with Covid-19. Ann Thorac Surg. 2020;S0003-4975(20)30941-3.
2. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438-e440.
3. Gulko E, Overby P, Ali S, Mehta H, Al-Mufti F, Gomes W. Vessel Wall Enhancement and Focal Cerebral Arteriopathy in a Pediatric Patient with Acute Infarct and COVID-19 Infection. AJNR Am J Neuroradiol. 2020 Aug 13. doi: 10.3174/ajnr.A6778.
4. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8.
5. Akgul A. Online Counselling for New Onset Symptoms/Signs in 65+ Patients with Lympho-Venous Diseases in the Era of COVID-19. Turkiye Klinikleri J Med Sci. 2020;40(2):125-6.

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