CASE REPORT
A 57-year-old male with history of a full root replacement with a 29-mm Medtronic Freestyle prosthesis in 2005 was admitted to our institution. The patient had severe aortic insufficiency with progredient symptoms of dyspnoea in the last 2 weeks, with a proBNP of 1459 pg/ml and a C reactive protein of 22.8 mg/l at admission. All other laboratory parameters were normal. The preoperative computed tomography (CT) scan showed interstitial infiltration of the left lung that was considered highly suspicious for a COVID-19 infection by three different radiologists [1] (Fig. 1). Additionally, the patient had pleural effusion indicating impending cardiac decompensation (Fig. 2). The patient was tested twice with PCR for COVID-19, but both tests returned negative. As the patient was initially clinically stable under medication, it was decided to postpone further surgical therapy for 2 weeks to in order to perform consecutive repeated testing for COVID-19 infection to safely confirm or rule out infection. Two days later, the patient was readmitted with severe symptoms of heart failure and an increase in N-terminal pro-B-type natriuretic peptide levels to 1646 pg/ml. It was not completely clear if the symptoms including interstitial infiltration had resulted from a COVID-19 infection or from a progression of symptoms from the high-grade aortic insufficiency, or even both. After consulting with the patient, it was decided to perform a transfemoral valve-in-valve implantation with a 29-mm Edwards SAPIEN S3 valve. In adherence to all safety precautions recommended so far, including N95-respirators, the procedure was successfully performed the day after the readmission of the patient. The patient recovered well from the procedure. During the whole hospital stay, it was assumed that the patient was COVID-19-positive, as we could not completely rule out infection. The patient consented to having his information disclosed in this case report.
Figure 1:  Computed tomography scan on admission with interstitial infiltration highly suspicious for a COVID-19 infection.
Figure 2:  Computed tomography scan with pleural effusion.