Insights into Cardiovascular Defects and Cardiac Epigenome in the Context of COVID-19.

Although few in number, studies on epigenome of the heart of COVID-19 patients show that epigenetic signatures such as DNA methylation are significantly altered, leading to changes in expression of several genes. It contributes to pathogenic cardiac phenotypes of COVID-19, e.g., low heart rate, myocardial edema, and myofibrillar disarray. DNA methylation studies reveal changes which likely contribute to cardiac disease through unknown mechanisms. The incidence of severe COVID-19 disease, including hospitalization, requiring respiratory support, morbidity, and mortality, is disproportionately higher in individuals with co-morbidities. This poses unprecedented strains on the global healthcare system. While their underlying conditions make patients more susceptible to severe COVID-19 disease, strained healthcare systems, lack of adequate support, or sedentary lifestyles from ongoing lockdowns have proved detrimental to their underlying health conditions, thus pushing them to severe risk of congenital heart disease (CHD) itself. Prophylactic vaccines against COVID-19 have ushered new hope for CHD. A common connection between COVID-19 and CHD is SARS-CoV-2's host receptor ACE2, because ACE2 regulates and protects organs, including the heart, in various ways. ACE2 is a common therapeutic target against cardiovascular disease and COVID-19 which damages organs. Hence, this review explores the above regarding CHDs, cardiovascular damage, and cardiac epigenetics, in COVID-19 patients.

Case Report: Right Heart Failure Mistaken for Obesity-A Fault of Telemedicine.

As a result of the COVID-19 pandemic, telemedicine has become an important branch of healthcare worldwide. Apart from their undeniable advantages, the virtual visits lack physical examination, which can lead to important diagnostic mistakes. We hereby present a case of a pediatric patient whose weight gain, initially attributed to a sedentary lifestyle was, in fact, due to sub-acute right heart failure in the context of a ruptured sinus of Valsalva aneurysm. The condition was not diagnosed until the patient presented at the emergency. The boy was successfully treated with two percutaneous interventions and returned to his previous stature.

Hemodynamic performance limits of the neonatal Double-Lumen cannula.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is the preferred surgical intervention for patients suffering from severe cardiorespiratory failure, also encountered in SARS-Cov-2 management. The key component of VV-ECMO is the double-lumen cannula (DLC) that enables single-site access. The biofluid dynamics of this compact device is particularly challenging for neonatal patients due to high Reynolds numbers, tricuspid valve location and right-atrium hemodynamics. In this paper we present detailed findings of our comparative analysis of the right-atrial hemodynamics and salient design features of the 13Fr Avalon Elite DLC (as the clinically preferred neonatal cannula) with the alternate Origen DLC design, using experimentally validated computational fluid dynamics. Highly accurate 3D-reconstructions of both devices were obtained through an integrated optical coherence tomography and micro-CT imaging approach. Both cannula configurations displayed complex flow structures inside the atrium, superimposed over predominant recirculation regimes. We found that the Avalon DLC performed significantly better than the Origen alternative, by capturing 80% and 94% of venous blood from the inferior and superior vena cavae, respectively and infusing the oxygenated blood with an efficiency of more than 85%. The micro-scale geometric design features of the Avalon DLC that are associated with superior hemodynamics were investigated through 14 parametric cannula configurations. These simulations showed that the strategic placement of drainage holes, the smooth infusion blood stream diverter and efficient distribution of the venous blood capturing area between the vena cavae are associated with robust blood flow performance. Nevertheless, our parametric results indicate that there is still room for further device optimization beyond the performance measurements for both Avalon and Origen DLC in this study. In particular, the performance envelope of malpositioned cannula and off-design conditions require additional blood flow simulations for analysis.

Implementing Artificial Intelligence and Digital Health in Resource-Limited Settings? Top 10 Lessons We Learned in Congenital Heart Defects and Cardiology.

Artificial intelligence (AI) is one of the key drivers of digital health. Digital health and AI applications in medicine and biology are emerging worldwide, not only in resource-rich but also resource-limited regions. AI predates to the mid-20th century, but the current wave of AI builds in part on machine learning (ML), big data, and algorithms that can learn from massive amounts of online user data from patients or healthy persons. There are lessons to be learned from AI applications in different medical specialties and across developed and resource-limited contexts. A case in point is congenital heart defects (CHDs) that continue to plague sub-Saharan Africa, which calls for innovative approaches to improve risk prediction and performance of the available diagnostics. Beyond CHDs, AI in cardiology is a promising context as well. The current suite of digital health applications in CHD and cardiology include complementary technologies such as neural networks, ML, natural language processing and deep learning, not to mention embedded digital sensors. Algorithms that build on these advances are beginning to complement traditional medical expertise while inviting us to redefine the concepts and definitions of expertise in molecular diagnostics and precision medicine. We examine and share here the lessons learned in current attempts to implement AI and digital health in CHD for precision risk prediction and diagnosis in resource-limited settings. These top 10 lessons on AI and digital health summarized in this expert review are relevant broadly beyond CHD in cardiology and medical innovations. As with AI itself that calls for systems approaches to data capture, analysis, and interpretation, both developed and developing countries can usefully learn from their respective experiences as digital health continues to evolve worldwide.

PERSONALITY TRAITS OF PATIENTS SUFFERING FROM PFO AND ASD AND INFLUENCE OF COVID-19 PANDEMIC TIME FOR PATIENTS SUFFERING FROM CONGENITAL HEART DEFECTS.

OBJECTIVE: Introduction: The work presents a research project carried out in John Paul II Hospital in Cracow in Clinical Department of Cardiac and Vascular Diseases with the Intensive Cardiac Supervision Subdivision, with participation of 100 (50 F, 50 M) patients with congenital heart defects. The purpose of the work is to resolve the issue of personality specifics, and thus the different characteristics of people who suffer from congenital heart defects. Therefore, the following questions should be answered: Is there a relationship between personality traits and the occurrence of a congenital heart defect? What personality traits are characteristic for patients with congenital heart defects? The aim: We aimed to assess personality traits of clients suffering from PFO and ASD. The article also talks about how coronavirus pandemic affects patients with congenital heart disease. PATIENTS AND METHODS: Materials and methods: The research was conducted by psychologist Adrianna Skoczek. We performed a psychological clinical assessment and conducted the psychological tests like Eysenck Personality Questionnaire-Revised Short Version [EPQ-R(S)] and Eysenck's Impulsivity Inventory [IVE] by Hans J. Eysenck and Sybil G. Eysenck, the State-Trait Anxiety Inventory [STAI] by C. D. Spielberger, R. L. Gorsuch, R. E. Lushene describing personality traits of patients. Patients (F=50, M=50), with ASD (n=70) and with PFO (n=30). RESULTS: Results: In people suffering from ASD, the level of declared empathy was statistically significantly higher than the levels of impulsiveness and tendency to risk-taking. In people suffering from PFO, a statistically significant difference was observed only between the level of psychoticism and other variables. The level of declared empathy was statistically significantly higher than the levels of impulsiveness and tendency to risk-taking, a statistically significant difference was found between the analyzed variables - anxiety as a trait and anxiety as a condition. CONCLUSION: Conclusions: The results of the study allowed us to isolate the specific personality traits of patients suffering from congenital heart defects.

Patient care protocols and personal safety measures for health care professionals in cardiac catheterization rooms during the COVID-19 outbreak in the National Institute of Cardiology.

The COVID-19 was first described in late 2019 that quickly became a pandemic affecting every health system as we know it. The high transmissibility among humans represents a well-known high burden of morbidity and mortality not only for cardiovascular patients but also for a higher risk between health care professionals that must deliver high-quality care to them in any scenario, and cardiac catheterization rooms are no exception. This creates a new dilemma, minimize exposure to patients and health care professionals to COVID-19 while maintaining high quality in cardiovascular therapeutics. In order to achieve this, several international recommendations on treatment algorithms modifications and in safety measures in the catheterization room have been published, always aiming to solve this dilemma in the best possible way. Hereby, we present a summary of the most recent treatment algorithms in the most important cardiovascular interventions (acute coronary syndromes, structural and congenital heart diseases) as well as specific safety measures with a step-by-step preparedness before and after any interventional procedure during COVID-19 outbreak. The objective of this document is to inform and to train health care professionals that works in cardiac catheterization rooms on the risks as well on the plan for containment, mitigation, and response to the global situation of COVID-19 infection in order to apply this in their own local work environments.