SARS–CoV–2 infection as a possible risk factor for acute infective native valve endocarditis complicated by intracardiac abscesses

Objective. To study the clinical features of SARS–CoV–2 infection as a possible risk factor for the development of acute infective native valve endocarditis complicated by intracardiac abscesses and its mechanisms, including the persistence of SARS–CoV–2 infection in the cardiovascular system in the long term after its transmission. Materials and methods. The cohort retrospective study conducted at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.07.2020 to 01.07.2022 included 64 patients with infective endocarditis complicated by intracardiac abscesses, which in 18 of them was associated with SARS–CoV–2 infection. All patients showed a clear link between the onset of cardiac symptoms and SARS–CoV–2 infection. The average time to seek medical care after SARS–CoV–2 infection was (2 ± 1.2) months. The study patients (n=64) were divided into two groups: Group 1 – 18 (28.1%) patients with infective native valve endocarditis complicated by intracardiac abscesses with SARS–CoV–2 infection and Group 2 – 46 (71.8%) patients with infective native valve endocarditis complicated by intracardiac abscesses without SARS–CoV–2 infection. The average age of patients was (48.7 ± 1.4) years. Results. The diagnosis of SARS–CoV–2 was confirmed in all patients by bacteriological examination of oropharyngeal and nasopharyngeal material by polymerase chain reaction. The diagnosis of infective endocarditis complicated by intracardiac abscesses was confirmed according to the modified Duke University criteria. According to transthoracic, transesophageal echocardiography and computed tomography, massive vegetation of the aortic valve was detected in 38 (59.4%) patients, mitral valve – in 8 (12.5%), aortic, mitral and tricuspid valves – in 18 (28.1%). Intracardiac abscesses were recorded in all 64 (100%) patients, 9 (14.1%) of whom had fistulisation in the right heart. The frequency of inflammatory lung disease and aortic valve abscesses differed statistically significantly between the study groups of patients – p=0.001 and p=0.002, respectively. In all patients, the intracardiac anatomy was restored using an autopericardium. Conclusions. At the stage of hospitalisation of patients with systemic inflammatory response syndrome, the effectiveness of care depends on the timely diagnosis of complications of the underlying disease. Most current reports on SARS–CoV–2 contain only brief descriptions of cardiovascular manifestations in these patients. Given the enormous burden this disease places on the healthcare industry and the significant adverse prognostic impact of cardiac involvement with infective endocarditis, further research is needed to understand the frequency, mechanisms, clinical presentation and various cardiovascular manifestations in patients with SARS–CoV–2.