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(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension (PH) center from 2013 to 2021. (3) Results: seven pregnancies in six women with PAH, ranging from low to high risk and 21 to 37 years old. Half had known pre-existing PAH before pregnancy. One had a multifetal gestation, and one was pregnant twice under our care. PH medical therapy and serial clinical assessment throughout pregnancy were implemented with focused attention on optimizing right heart function. Delivery was planned by a multidisciplinary team involving PH cardiology, maternal fetal medicine, and obstetric anesthesiology. Patients delivered between 31 and 40 weeks of gestation; five of the seven were via cesarean section. All received regional anesthesia and were monitored in the PH intermediate step-down unit after delivery until discharge. In all cases, delivery was without complications with excellent outcomes for the mother and child. (4) Conclusions: Multidisciplinary and tailored management of PAH in pregnancy, emphasizing optimized right heart function prior to delivery, can result in excellent clinical outcomes in a referral PH center.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a debilitating viral infection and, to date, 628,903 people have died from it, numbers that cannot yet be compared to the 50 million who died in the 1918 flu pandemic. As COVID-19 became better understood, cardiovascular manifestations associated with it were identified. This led to a complete healthcare restructuring with virtual clinics and changes to the triaging of critically ill patients. There are a lot of questions over how COVID-19 affects patients with heart failure (HF) as this condition is a leading cause of cardiovascular death. This review describes the cardiovascular implications of COVID-19 and new practices surrounding the use of telehealth to follow up and triage patients with HF. Current practices supported by medical societies, the role of angiotensin-converting enzyme inhibitors and, finally, a brief note regarding the management of advanced HF patients will also be discussed.
ABSTRACT
IMPORTANCE: As the Coronavirus disease 2019 (COVID-19) pandemic accelerates, our hospitals have become overwhelmed. OBJECTIVE: To describe detection of COVID-19 in asymptomatic hospitalized individuals awaiting advanced therapies for HF and the management of complications of COVID-19. DESIGN: We present a unique case report of hospital-acquired COVID-19 in a patient on temporary mechanical circulatory support. MAIN OUTCOME: Despite intensive care and monitoring, he developed rapid progression of hypoxic respiratory failure which led to his death. CONCLUSION: This case highlights various considerations for a patient with temporary MCS. It illustrates the high risk for development of COVID-19 for vulnerable hospitalized patients.
Subject(s)
Coronavirus Infections , Cross Infection , Heart Failure , Heart-Assist Devices , Pandemics , Pneumonia, Viral , Asymptomatic Infections , Betacoronavirus , COVID-19 , Clinical Deterioration , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Cross Infection/complications , Cross Infection/diagnosis , Fatal Outcome , Heart Failure/complications , Heart Failure/therapy , Hospitalization , Humans , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , SARS-CoV-2Subject(s)
Coronavirus Infections , Heart Failure , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Humans , New York City/epidemiology , Pulmonary Artery , SARS-CoV-2Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Shock, Cardiogenic/virology , Systemic Inflammatory Response Syndrome/virology , Adult , COVID-19 , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2 , Sex Factors , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/therapy , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Young AdultABSTRACT
BACKGROUND: Orthotopic heart transplantation (OHT) recipients may be particularly vulnerable to coronavirus disease 2019 (COVID-19). OHT during the pandemic presents unique challenges in terms of feasibility and safety. METHODS: Chart review was performed for consecutive OHT recipients with COVID-19 and waitlisted patients who underwent OHT from March 1, 2020 to May 15, 2020. RESULTS: Of the approximately 400 OHT recipients followed at our institution, 22 acquired COVID-19. Clinical characteristics included median age 59 (range, 49-71) years, 14 (63.6%) were male, and median time from OHT to infection was 4.6 (2.5-20.6) years. Symptoms included fever (68.2%), gastrointestinal complaints (55%), and cough (46%). COVID-19 was severe or critical in 5 (23%). All patients had elevated inflammatory biomarkers. Immunosuppression was modified in 85% of patients. Most (nâ¯=â¯16, 86.4%) were hospitalized, 18% required intubation, and 14% required vasopressor support. Five patients (23%) expired. None of the patients requiring intubation survived. Five patients underwent OHT during the pandemic. They were all males, ranging from 30 to 59 years of age. Two were transplanted at United Network of Organ Sharing Status 1 or 2, 1 at Status 3, and 2 at Status 4. All were successfully discharged and are alive without allograft dysfunction or rejection. One contracted mild COVID-19 after the index hospitalization. CONCLUSION: OHT recipients with COVID-19 appear to have outcomes similar to the general population hospitalized with COVID-19. OHT during the pandemic is feasible when appropriate precautions are taken. Further study is needed to guide immunosuppression management in OHT recipients affected by COVID-19.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Graft Rejection/prevention & control , Heart Failure/surgery , Heart Transplantation/methods , Immunosuppression Therapy/methods , Immunosuppressive Agents/therapeutic use , Pneumonia, Viral/complications , Aged , COVID-19 , Coronavirus Infections/epidemiology , Feasibility Studies , Female , Heart Failure/complications , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Transplantation, Homologous , Treatment OutcomeABSTRACT
As health systems worldwide grapple with the coronavirus disease-2019 (COVID-19) pandemic, patients with durable LVAD support represent a unique population at risk for the disease. This paper outlines the case of such a patient who developed COVID-19 complicated by a "cytokine storm" with severe acute respiratory distress syndrome and myocardial injury and describes the challenges that arose during management.
ABSTRACT
There is a desperate search to discover effective therapies against coronavirus disease-2019 (COVID-19). Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) comprise a unique population whose clinical course may provide insights into the effects of antiretroviral therapy on COVID-19. We describe the case of a patient with HIV/AIDS on left ventricular assist device support who was hospitalized and recovered from COVID-19. (Level of Difficulty: Intermediate.).