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1.
Kardiol Pol ; 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879824

ABSTRACT

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism (APE). Both pharmacological and invasive treatments for CTEPH are available in Poland, and awareness of the disease among physicians is growing. It has been suggested that the COVID-19 pandemic may increase the incidence of CTEPH and facilitate disease detection during more advanced stages of the illness. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation, in cooperation with independent experts in this field, launched the updated statement on algorithm to guide a CTEPH diagnosis in patients with previous APE. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months of effective anticoagulation, particularly when specified risk factors are present. Echocardiography is a main screening tool for CTEPH. A diagnostic workup of patients with significant clinical suspicion of CTEPH and right ventricular overload evident on echocardiography should be performed in reference centers. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Computed tomography pulmonary angiography with precise detection of thromboembolic residues in the pulmonary circulation is important for the planning of a pulmonary thrombendarterectomy. Right heart catheterization definitively confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for the identification of lesions suitable for thromboendarterectomy or balloon pulmonary angioplasty. In this document, a diagnostic algorithm for patients with suspected CTEPH is proposed. With an individualized and sequential diagnostic strategy, each patient can be provided with suitable and tailored therapy provided by the dedicated CTEPH Heart Team.

2.
Eastern Journal of Medicine ; 27(2):343-350, 2022.
Article in English | ProQuest Central | ID: covidwho-1876775

ABSTRACT

Pulmonary hypertension (PH) is a pulmonary vascular disease described by pulmonary arterial vasoconstriction and remodeling , which may lead to an increased pulmonary artery pressure with varying clinical course and severity depending on the etiology and eventually to right heart failure. Because of associated comorbidities, patients with PH are likely to face a potential risk of severe complications and mortality and unfortunately, they may have worse outcomes than other patients. COVID-19 emerges as one of the biggest threats facing society in this century. Besides its many medical consequences, the epidemic has psychological, social, and economic prices. [...]it is essential to understand its pathophysiology and clinical outcomes and to determine appropriate treatment strategies. Pathological characteristics of the endothelial cell structures of PH patients infected with COVID-19, down-regulation of angiotensin-converting enzyme 2 (ACE-2) receptors, which play a fundamental role in both the entry and replication of coronaviruses and also pulmonary arterial hypertension (PAH)-specific drugs used in its treatment may contribute to this (5,6).

3.
Exp Ther Med ; 23(6): 436, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1865585

ABSTRACT

The present study presents the experience gained in the Newborn Intensive Care Unit (NICU) of 'Maria S. Curie' Emergency Clinical Hospital for Children in Bucharest (Romania) after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis of the data for all patients operated on-site between 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, complications and outcomes. An analysis of a control group was used to provide a reference to the survival rate for non-operated patients. The present study is based on data from 10 cases of newborns, surgically operated on, on average, on the fifth day of life. The main reasons for operating on-site included hemodynamical instability and the need to administer inhaled nitric oxide (iNO) and high-frequency oscillatory ventilation (HFOV). There were no unforeseen events during surgery, no immediate postoperative complications and no surgery-related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications were associated with this practice.

4.
Hematology, Transfusion and Cell Therapy ; 43:S531-S532, 2021.
Article in English | EMBASE | ID: covidwho-1859743

ABSTRACT

Aims: To collect data about COVID-19 in CML patients from Brazilian centers and their outcomes. Methods: Observational, multicentric, ongoing register study. Hematologists from private and public CML reference centers from different regions of Brazil were invited to report their cases of COVID-19 in CML patients. Those centers are responsible for the care of approximately 3030 CML patients. Results: Between March 2020 and July 2021, 16 institutions contributed to this analysis, and reported 73 COVID-19 cases in CML patients (pts). Eight-five % were from the South and Southeast regions, 11% from Northeast. The median age was 50 years (22-79), with 33% of the pts older than 60. Male patients were predominant (60%). The median time of CML diagnosis was 9 years (0-29). Most of the pts were in first line therapy (57.5%), 27% in second line and 11% in third line. Current CML treatment at COVID-19 was: imatinib (46,5%), nilotinib (22%), dasatinib (16%), post-transplant (4%), asciminib (1%), ponatinib (1%), treatment-free remission (2%), no treatment (7%). COVID-19 grade: asymptomatic (4%), mild (66%), moderate (12%), severe/critical (16%). CML status at COVID: AP/BC (3%), CP (12,4%), hematologic response (11%), complete cytogenetic response (4%), MMR (34%), MR4.0 (8%), MR4.5 (27%). Eleven patients interrupted treatment temporarily during COVID. COVID-19 was confirmed by RT-PCR of oral and nasal swab collection (68%) or rapid/serologic test (32%). Comorbidities were present in 34 pts, most common were: hypertension (33%), diabetes (14%), chronic renal failure (4%), chronic obstructive pulmonary disease/emphysema (5.5%), pulmonary hypertension (1). Hospitalization occurred in 30% of the cases, 18% in an intensive care unit, 8% with mechanical ventilation. Treatment received for COVID-19: antibiotics (31%), steroids (16%), chloroquine (5.5%), oseltamivir (4%);ivermectin (8%): heparin (3%). Sixty-nine patients recovered, 4 died from COVID-19 (5,4%): one 42 year old newly diagnosed male patient with high leukocytes counts and with a simultaneous bacterial infection, two 70-year old patients treated with imatinib, both in MR4.5, and one 31-year old male patient treated with nilotinib, after imatinib and dasatinib failure, with hematologic response. A fifth patient in the accelerated phase died 2 months after discharge, from disease progression and pulmonary infection. All cases occurred before vaccination. There was one case of re-infection, in a patient treated with imatinib. Discussion: Conclusions: the majority of COVID-19 cases in the CML population was mild, but there were 2 deaths of young patients with active disease and two deaths in elderly patients, one of them with comorbidities. The mortality in CML was lower than observed in other hematologic cancers.

5.
Modern Pathology ; 35(SUPPL 2):1302, 2022.
Article in English | EMBASE | ID: covidwho-1857148

ABSTRACT

Background: The acute autopsy findings associated with COVID-19, due to the novel coronavirus SARS-CoV-2, are well documented. However, the long term sequelae of COVID-19 are still being elucidated. One significant sequela of patients who survive COVID-19 is pulmonary hypertension. Indeed, several groups have reported pathologic pulmonary hypertensive changes in patients who have undergone lung transplantation. The purpose of this study was to determine the frequency of pulmonary hypertensive changes at autopsy as well as identify associated factors. Design: We retrospectively examined 22 autopsies from patients who died of COVID-19 at our institution. Demographic information collected included age, sex, ethnicity, pre-existing medical conditions, BMI, whether the patient was on a ventilator, as well as treatment. All H&E lung autopsy slides were examined, in addition to MOVAT and VVG stained slides where appropriate. Small arteries (<100 microns in diameter) were evaluated for the presence/absence of medial hypertrophy, intimal thickening, recanalized thrombi, and plexiform lesions according to the Heath and Edwards grade. The COVID-19 autopsy lungs were also evaluated for the presence/absence of diffuse alveolar damage, pneumonia as well as thrombi. Results: Pathologic findings consistent with pulmonary hypertension were identified in 6 of the 22 COVID-19 lungs identified. Two patients had both medial hypertrophy as well as intimal thickening (Heath and Edwards grade 2), whereas four patients had only medial hypertrophy (Heath and Edwards grade 1). Of the six patients with pulmonary hypertensive changes, 4/6 patients also had pulmonary vascular thrombi, 5/6 patients had previously been on the ventilator, 3/6 patients had pneumonia by pathologic examination, and 4/6 patient had DAD by pathologic examination. None of the six patients had known pulmonary hypertension prior to their terminal hospital admission. Conclusions: In our retrospective review of COVID-19 autopsy lungs, 27% of lungs demonstrated pathologic features suggestive of pulmonary hypertension. As expected, most patients had early (Grade 1, medial hypertrophy) pulmonary hypertensive changes. Vascular thrombi, history of ventilation, pneumonia and DAD were all commonly associated with pathologic pulmonary hypertension. Movat and/or VVG stains are useful to help identify these pathologic changes. We hypothesize there will be an increase in pulmonary hypertension in long-term survivors of COVID-19.

6.
Am J Respir Crit Care Med ; 2022 May 18.
Article in English | MEDLINE | ID: covidwho-1854571
7.
Cardiology in the Young ; 32(SUPPL 1):S198-S199, 2022.
Article in English | EMBASE | ID: covidwho-1852339

ABSTRACT

Introduction: COVID-19 has had a significant impact on all aspects of pulmonary arterial hypertension (PAH), from diagnosis and management to an increased risk of death in patients with PAH. Pandemic made it necessary to revisit the manner in which patients receive care to decrease risk of contracting the virus. Methods: Eight Tertiary Paediatric Centres participating in the paediatric arm of the registry Database of Pulmonary Hypertension in the Polish Population (BNP-PL) took part in this multi-centre cross-sectional observational study. Eligible children were diagnosed with PAH before March 20, 2020, the day the pandemic was officially announced by the Polish government. All parents of children with PAH in the BNP-PL were invited to take part in an anonymous electronic questionnaire. It comprised of several question panels: demographic data, fear of COVID-19 and other pandemic related problems, standard anxiety scale (GAD-7), presence of alarming symptoms, which had appeared or exacerbated since March 20, 2020. Data collection was seized on the September 09, 2020. Results: We have received 62 responses (response rate 77%), 4 were incomplete. The remaining 58 were further analysed. Ninety-five percent of the responders were women (n=55) at a median age of 41 years. Ninety-five percent of the parents were afraid of possible negative consequences of the SARS-CoV-2 on their children's health including death in 77%. Sixty to 71% of the parents were also afraid of various potential problems resulting from re-organising health-care system. As a result, 72% of parents had symptoms of anxiety as assessed by GAD-7, noticeably 34% in moderate-tosevere degree. No cases of COVID-19 were reported in the studied group of children. Conclusions: The impact of COVID-19 on health care delivery and on society at large is going to be felt for years to come. This information is vital to provide prognostic information on cardiac health after COVID-19, to inform long-term clinical care pathways, and to guide lifestyle recommendations. COVID-19 pandemic had an overall negative impact on children with PAH and their families. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for children with PAH, with emphasis on psychosocial well-being.

8.
Cardiology Letters ; 30(5):246-249, 2021.
Article in Slovak | EMBASE | ID: covidwho-1822530

ABSTRACT

Background: A pandemic caused by a new coronavirus particularly threatens the high risk groups of patients, incuding those with pulmonary arterial hypertension. We evaluated the occurrence of COVID-19 in the group of patients with pulmonary arterial hypertension (PAH), course of disease, mortality and the attitude of patients to vaccination. Data collection. During the period of two weeks before May 15th 2021 we collected, by analysis of documentation and telephone survey, data on adult patients managed from 01.03. 2020 to 15.05.2021 in 3 centers for PAH and the Children‘s Cardiac Centre. Information on deceased patients was provided by medical staff from the particular PAH centre. Results: Out of the total number of 168 adult patients (mean age of 54 ± 22 years, 121 females) 32 (19%) had COVID-19 infection during the first or second wave of the epidemic in Slovakia. During this time period 12 patients died and 1 one lung transplantation was performed. 3 of the 12 patients who died suffered from COVID-19 infection. Of the 32 patients infected 7 (21%) were hospitalized, 10 needed oxygen, one artifitial ventilation, and 3 (9%) patients died. Only 74 (47.7%) were vaccinated to date of data collection, although the availability of vaccination for this group of patients was not limited. Conclusion: Despite the fact that PAH is a severe lung and heart disease with a poor prognosis, the course of the disease and mortality were better than could be expected. Results are limited by low patient numbers, but 6% mortality in people with a mean age of 54 years may still be considered high. Vaccination is low despite good access to the vaccine and clear recommendations. Tab. 2, Ref. 15, on-line full text (Free, PDF) www.cardiologyletters.sk.

9.
Journal of Clinical Neonatology ; 11(2):65-70, 2022.
Article in English | EMBASE | ID: covidwho-1822508

ABSTRACT

Background: Multisystem inflammatory syndrome in children (MIS-C) is a well-known entity that occurs 3-4 weeks after COVID-19. A similar entity in newborns, known as Multisystem Inflammatory Syndrome in Newborns (MIS-N), is also described. However, the epidemiology, case definition, clinical presentations, and outcomes of MIS-N are still being updated. The presence of SARS CoV 2 antibodies in both the mother and the neonate suggests transplacental transfer of IgG antibodies causing cytokine storm and multisystem inflammatory syndrome in newborns (MIS-N). Aims and Objectives: To investigate the clinical characteristics, laboratory parameters, outcomes, and treatment modalities of neonates with multisystem inflammatory syndrome due to transplacental transfer of SARS CoV 2 antibodies. Materials and Methods: The study included eighteen consecutive neonates who met the MIS-C criteria. Following prior ethical clearance and consent from parents or guardians, socio-demographic data, lab parameters, clinical parameters, and treatment given were documented, tabulated, and analysed. Results: All of the 18 neonates had fever. The most common system involved was the respiratory system (15/18), followed by the cardiovascular system with coronary artery dilatations (10/18) and persistent pulmonary hypertension (4/18). All 17 cases (17/18) responded favourably to intravenous immunoglobulins (2 gm/kg) and intravenous dexamethasone (0.15 mg/kg). D-Dimers decreased significantly after treatment, with a p value of 0.01. One case with more than three systems involved (respiratory, CVS, CNS, and renal involvement) (1/18) resulted in death. Conclusion: A high index of suspicion is warranted in critically ill neonates, especially with fever, multisystem involvement and positive SARS CoV 2 antibodies. Fever may be a soft pointer to the diagnosis as fever is rare in neonates with other illnesses. Followup antibody titres are needed to document if there is any relationship between level of antibodies and disease. Safety of vaccination also needs to be addressed as antibodies are implicated in the etiopathogenesis of MIS-N.

10.
Nitric Oxide ; 124: 39-48, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1821426

ABSTRACT

Inhaled nitric oxide (iNO) is a potent vasodilator approved for use in term and near-term neonates, but with broad off-label use in settings including acute respiratory distress syndrome (ARDS). As an inhaled therapy, iNO reaches well ventilated portions of the lung and selectively vasodilates the pulmonary vascular bed, with little systemic effect due to its rapid inactivation in the bloodstream. iNO is well documented to improve oxygenation in a variety of pathological conditions, but in ARDS, these transient improvements in oxygenation have not translated into meaningful clinical outcomes. In coronavirus disease 2019 (COVID-19) related ARDS, iNO has been proposed as a potential treatment due to a variety of mechanisms, including its vasodilatory effect, antiviral properties, as well as anti-thrombotic and anti-inflammatory actions. Presently however, no randomized controlled data are available evaluating iNO in COVID-19, and published data are largely derived from retrospective and cohort studies. It is therefore important to interpret these limited findings with caution, as many questions remain around factors such as patient selection, optimal dosing, timing of administration, duration of administration, and delivery method. Each of these factors may influence whether iNO is indeed an efficacious therapy - or not - in this context. As such, until randomized controlled trial data are available, use of iNO in the treatment of patients with COVID-19 related ARDS should be considered on an individual basis with sound clinical judgement from the attending physician.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Administration, Inhalation , COVID-19/drug therapy , Humans , Infant, Newborn , Nitric Oxide , Respiratory Distress Syndrome/drug therapy , Retrospective Studies
11.
Am J Respir Crit Care Med ; 205(5): 495-506, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1816972

ABSTRACT

The term "advanced sarcoidosis" is used for forms of sarcoidosis with a significant risk of loss of organ function or death. Advanced sarcoidosis often involves the lung and is described as "advanced pulmonary sarcoidosis" (APS), which includes advanced pulmonary fibrosis, associated complications such as bronchiectasis and infections, and pulmonary hypertension. Although APS affects a small proportion of patients with sarcoidosis, it is the leading cause of poor outcomes, including death. Here we review the major patterns of APS with a focus on the current management as well as potential approaches for improved outcomes for this most serious sarcoidosis phenotype.


Subject(s)
Bronchiectasis , Pulmonary Fibrosis , Sarcoidosis, Pulmonary , Sarcoidosis , Humans , Lung , Sarcoidosis, Pulmonary/complications , Sarcoidosis, Pulmonary/drug therapy
13.
Journal of Heart & Lung Transplantation ; 41(4):S393-S393, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783393

ABSTRACT

Lung transplantation (LT) is a lifesaving treatment for Covid-19 related lung disease with early outcomes similar to other indications. Seven patients underwent LT for Covid-19 related lung disease at our center: 5 for ARDS and 2 for IPF exacerbation post SARS-CoV-2 infection. Seven patients (5 men) with single organ failure underwent bilateral LT. Median age was 47 years old. All ARDS cases had poor lung mechanics on invasive mechanical ventilation with radiographic evidence of lung fibrosis: pneumatocele, GGO, consolidations, subpleural reticulations and traction bronchiectasis. vvECMO was bridge to transplant in 5 cases (bridge to recovery in 2). Median ECMO duration for ARDS was 32 days (range 7-99). Median time to LT from Covid diagnosis was 59 days (Q1-IQ3, 54-62). Two patients were post-partum women with ARDS. Explanted pathology showed UIP, DAD, diffuse hemorrhage and one case of fibrosing NSIP. Pulmonary hypertension was seen in 4 cases. One patient did not survive. Organizing pneumonia and granuloma were present in this patient. Most ARDS patients were unable to tolerate lower sedation and consent by a substitute decision-makers was obtained. Post operative ECMO decannulation was possible in all cases. Induction, maintenance immunosuppression and antimicrobials were standard for our program. Donated grafts were from deceased brain death donors and negative for 2019-nCoV. Rehabilitation potential and strong social support were absolute inclusion criteria. All survivors have excellent lung function. In the USA, over 130 LT have listed Covid-19 as the diagnosis indication. Although Covid-19 ARDS makes up for the majority of these LT, other diagnosis are post Covid pulmonary fibrosis and underlying fibrosis with SARS-CoV-2 induced exacerbation. LT for ARDS poses several challenges and is reserved for the minority of carefully selected patients dependent on extracorporeal life support. As others have reported, good short-term survival is described. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

14.
Journal of Clinical and Experimental Hepatology ; 12:S30, 2022.
Article in English | EMBASE | ID: covidwho-1778271

ABSTRACT

Background: Congenital portosystemic venous shunts (CPSS) are uncommon foetal vascular developmental anomalies where splanchnic venous flow bypasses liver. Four cases of CPSS are reported at our centre. Case Summary (1) Eight years old female child presented with Dengue with no features of chronic liver disease and normal liver function test (LFT). Ultrasonography (UGS) abdomen reported an incidental finding of abnormal vascular shunt in liver. Further imaging revealed an anastomosis between portal vein and intrahepatic part of inferior vena cava (IVC), hypoplastic portal vein and multiple nodules in bilateral liver lobes. Interventional Radiologist closed the anastomosis using vascular plug. Child sustained the procedure well. (2) Two months old female patient presented with high GGTP cholestasis, dysmorphism and deranged LFT. On USG abdomen there was intrahepatic portosystemic shunt. MDCT abdomen revealed 2 vascular shunts between left portal vein to middle hepatic vein and left portal vein. Cholestasis responded with symptomatic treatment, hence being followed-up for observation till 1year of age for complications and possibility of spontaneous closure. (3) Twenty-two days old, full term female child presented with convulsions and high GGTP cholestasis with multiple hematomas in brain. LFTs were deranged. 2D-ECHO showed small PFO. USG abdomen suggested a channel between left portal vein and hepatic vein. Patient tested COVID positive hence quarantined now and further evaluation is awaited. (4) One day old, late preterm male baby presented with respiratory distress and pulmonary hypertension with antenatal scan suggesting ductus venous agenesis with hepatic vascular malformation. Patient developed cholestasis with deranged LFT. 2D-ECHO showed PDA and ASD. MDCT abdomen revealed connection between main portal vein and intrahepatic IVC. Conclusions: CPSS has heterogeneous presentation. It can be diagnosed antenatal or postnatal, may be asymptomatic or may present as neonatal cholestasis and may be associated with anomalies. Management may vary from case to case and mainly depends on complications and age of presentation.

15.
Journal of the American College of Cardiology ; 79(9):2935, 2022.
Article in English | EMBASE | ID: covidwho-1768650

ABSTRACT

Background: Venous stents are small mesh tubes used mostly for SVC stenosis, SVC syndrome, May-Thurner syndrome and to a lesser extent for IVC obstruction/stenosis. Even though this procedure can relieve obstruction, it has been associated with a wide variety of complications such as thrombosis, migration, obstruction and fracture. Limited guidelines exist about the use of such stents in the IVC. We present a rare case of IVC stent migration causing RA-AO fistula in a 56 year old female. Case: 56 year old female with a history including Autoimmune thyroiditis, hepatitis, breast cancer, recurrent VTE on warfarin found to have IVC stenosis leading to IVC BMS stent 24 x 70mm Wallstent placement in March 2021 after a new DVT was found while on warfarin, switched to Xarelto, COVID pneumonia in august with SOB with a workup showing extension of the IVC stent to the right atrium. Her fatigue and SOB was initially attributed to COVID pneumonia and she was scheduled to have a repeat TTE as outpatient to follow up on the stent. She continued to have worsening SOB and fatigue even after recovering from COVID PNA. Decision-making: Repeat TTE showed severe MR that was not present before and confirmed the presence of the IVC stent in the RA. TEE showed right atrial-aortic cusp fistula attributed to IVC wallsent extending from RA to Aorta leading to high output state and therefore severe MR carpentier IIIb. The patient was admitted to the hospital where a surgical intervention was entertained, she had LHC and RHC that showed normal coronaries with severe Pulmonary hypertension and Qp/Qs: 1.89. Surgical consultation was obtained and she underwent patch repair of aortic fistula with partial IVC stent removal and MV and TV repair. Conclusion: An arteriovenous fistula involving the coronary arteries and the aorta is rare. Even though IVC stents have the potential to alleviate symptoms caused by large narrowed veins, It is important to recognize complications caused by such stents especially in a patient with new Symptoms of heart failure and Valvular regurgitation as an Iatrogenic cause that requires prompt surgical consultation and intervention.

16.
European Heart Journal, Supplement ; 23(SUPPL F), 2021.
Article in English | EMBASE | ID: covidwho-1766449

ABSTRACT

The proceedings contain 200 papers. The topics discussed include: an ultra-rare case of Hutchinson-Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl;pulse dose corticosteroid improves clinical outcome in pulmonary hypertension patient: a potential of immense affordability and availability medication in suburban area;infected femoral artery pseudoaneurysm with klebsiella pneumoniae bacteremia in injected drug abuser: a case report;cardiac complications in immunocompromised patient : a case report;cardiac arrest in COVID-19 patient presenting with takotsubo cardiomyopathy;cardiac amyloidosis: a great pretender of left ventricular hypertrophy with systemic manifestation;and managing acute decompensated heart failure with exacerbation of chronic obstructive pulmonary disease in rural area: a case report.

17.
Cardiovascular Journal of Africa ; 33(SUPPL):61, 2021.
Article in English | EMBASE | ID: covidwho-1766887

ABSTRACT

Introduction: Studies show that children account for only 1-5% of diagnosed COVID-19 cases, they have milder disease than adults and deaths are extremely rare. The complete clinical picture of pediatric COVID-19 has not yet been fully reported or defined. Additionally, the South African pediatric population has unique clinical characteristics and risk implications and needs investigating. We aimed to characterize COVID-19 in Cape Town children. Methods: The UCT COVID-19 pediatric repository is a prospective cohort recruited via convenience sampling at 3 Western Cape Hospitals. All patients ≤ 18 years who test COVID-19 positive are eligible for inclusion in the study. Results: To date 227 participants, 56%(125/227) male with median age 2 years (IQR:0-6), have been enrolled. Only 28(12%) participants were in contact with a confirmed COVID-19 positive case, 67% of these, were first degree relatives, 28% second degree relatives and 6% health care workers. Comorbidities were present in 125(56%) participants. Of 32 recorded comorbidities, congenital heart disease (CHD), found in 7% of participants, ranked third. CHD subtypes included PDA (4), Tetralogy of Fallot (3), AVSD (2), Pulmonary atresia with VSD (2), truncus arteriosus (1), Coarctation of the Aorta (1), Congenital aortic valve stenosis (1), and ASD (1). Other cardiac comorbidities were, cardiomyopathy (2), primary pulmonary hypertension (1) and rhabdomyoma (1). On presentation 173 (76%) were symptomatic. Predominant symptoms included cough 40%, history of fever 36%, documented fever 34%, difficulty breathing 28%, and nausea or vomiting 20%. On examination, 65% had abnormal heart rates, 47% abnormal respiratory rates, 35% were in respiratory distress and 24% were hypoxic. Of the 227 patients, 169(74%) were admitted to hospital and 33 (15%) were admitted to ICU. In the ICU 79% of patients required non-invasive and 24% invasive ventilation, median length of ICU admission was 3 days (IQR:2-7.5). During admission 38(17%) patients developed COVID-19 complications: secondary infection 10%, sepsis 4%, MIS-C 2%, and myocarditis or new onset heart failure 1%) and 2(0.9%) died, including one patient with AVSD, who presented with severe pulmonary hypertension and acute heart failure post cardiac surgery. Conclusion: We present the initial findings of the UCT pediatric COVID-19 registry. We anticipate that these data will help to complete the clinical picture of COVID-19 in the South African pediatric population.

18.
Heart Lung and Circulation ; 30:S260, 2021.
Article in English | EMBASE | ID: covidwho-1747968

ABSTRACT

Background: Mechanical prosthetic valve thrombosis is an uncommon but serious complication associated with high mortality and morbidity. Conventionally, prosthetic valve thrombosis is treated with surgical intervention, but recent literature has shown that slow-infusion of low-dose fibrinolytic therapy could be of equal efficacy. Case: A 27-year-old lady presented to the emergency department with a three-week history of worsening shortness of breath on background of mechanical mitral valve replacement for rheumatic mitral stenosis. She had recently been non-compliant with international normalised ratio (INR) checks for warfarin dosing in the setting of local lockdown for the COVID-19 pandemic. Transthoracic echocardiography revealed mechanical mitral valve thrombosis resulting in an immobile medial disc and severely restricted lateral disc, associated with severely elevated mitral inflow gradient (mean 42mmHg at 98 beats per minute) and severe pulmonary hypertension (right ventricular systolic pressure of 92mmHg). After discussion in a multidisciplinary cardiology and cardiothoracic surgical conference, the patient was treated with three daily doses of slow-infusion low-dose fibrinolytic therapy (25mg alteplase over six hours). On day three, there was complete resolution of symptoms, associated with resolution of valve thrombosis on repeat echocardiography. There were no bleeding or embolic complications, and the patient was discharged home three days later. Conclusions: This case highlights the utility of slow-infusion low-dose fibrinolytic therapy in the management of mechanical prosthetic valve thrombosis. This conservative approach may be a useful alternative in patients with high pre-operative surgical risk.

19.
Thoracic and Cardiovascular Surgeon ; 70(SUPPL 2), 2022.
Article in English | EMBASE | ID: covidwho-1747134

ABSTRACT

Background: While SARS-CoV-2 infections in children are usually mild to asymptomatic, severe disease manifestation has been described in patients with comorbidities. We aimed to assess the risk for severe disease courses in children and adolescents with underlying cardiovascular disease (CVD). Method: Analysis of the national prospective registry for children and adolescents hospitalized with a SARS-CoV-2 infection from March 2020 to April 2021. Regression analyses were used to estimate the risk for severe disease course defined as admission to a pediatric intensive care unit (PICU) or death. Results: Overall 1,501 hospitalized children were included in the registry with confirmed SARS-CoV-2 infection. Of these, 73 had underlying CVD (median age = 12 [IQR: 3-15];49 [67%] male). Also, 33/73 (45%) had relevant associated comorbidities including syndromic disease in 20/73 (27%), including 7 patients with trisomy 21. Congenital heart disease (CHD) was present in 32 (44%) and pulmonary hypertension (PH) in 9 (12%) patients. Eleven of 32 underwent cardiac surgery for their CHD. Analysis of the PH subgroup showed that the need for intensive care therapy (56 vs. 16%;p = 0.006) and ventilatory support (56 vs. 11%, p < 0.001) was higher in the PH group. Two children (3%) died in the non-PH cohort (both on a palliative care track). In addition, one child (11%) with PH died 4 weeks after confirmed SARS-CoV-2 infection from vasculitis with brainstem involvement. Overall, CVD was associated with an increased risk for PICU admission (RR = 3.0;95% CI: 1.84-4.93). In the CVD subgroup analysis, male gender (OR = 9.2;95% CI: 1.1-74.8;p = 0.04), syndromic disease (OR = 4.4;1.3-14.5;p = 0.02), trisomy 21 (OR = 14;2.4-82.4;p = 0.004), respiratory disease (OR = 7.7;2.2-26.7;p = 0.001), or PH (OR = 6.8;1.5-29.6;p = 0.01) were significantly associated with disease severity requiring PICU support. In addition, a trend toward increased risk for CHD was found (OR = 3.3;0.99-10.8;p = 0.052). Patients after cardiac surgery showed a significantly increased risk (OR = 4.3;1.1-17.0;p = 0.04). Conclusion: Children and adolescents with CVD are at higher risk of severe SARS-CoV-2 course. During SARS-CoV2- infection, children with associated disease, syndromes, or PH had a significantly higher risk for intensive care support compared with patients with other associated CVD. Although overall mortality and morbidity of hospitalized SARS-CoV-2 children is low, these vulnerable cohorts may require specific attention and prevention measures.

20.
Open Forum Infectious Diseases ; 8(SUPPL 1):S512, 2021.
Article in English | EMBASE | ID: covidwho-1746364

ABSTRACT

Background. SARS-CoV-2 causes a severe respiratory illness known as COVID-19. Treatment options in the early portion of the COVID-19 pandemic included the use of antiretroviral agents i.e. protease inhibitors (PIs) such as lopinavir (LPV) that had been shown to have activity against the main proteases of SARS-CoV-2 in vitro but with very limited clinical data. Prior to the use of PIs, HIV testing would be indicated to ensure that patients who were not previously diagnosed with HIV would start appropriate HIV treatment. In this unique situation, HIV testing would be utilized not based on traditional HIV risk factors. Methods. We performed a retrospective search from a specific systems database of patients admitted to Yale-New Haven Health System (YNHHS) with a diagnosis of COVID-19 infection. We identified a subset of patients who were HIV tested. Most were done prior to initiating PI treatment. Demographics, comorbidity scores and specific underlying conditions were also tabulated. We performed Kruskal Wallis and Chi-Squared analysis to test for significance between HIV- and HIV+ patients. Results. The total no. of patients admitted to the YNHHS with COVID-19 infection between the period from January 6, 2020 to January 6, 2021 was 5776. A cohort 964 (16.7%) patients were screened for HIV. Much of the testing occurred in the early COVID periods (Figure 1) when PIs were considered as part of the treatment algorithm. Sixty-seven (0.07%) patients tested HIV+ with 3 (0.003%) being newly diagnosed (Fig 2). Compared to HIV- patients, HIV+ were more likely to be identified as Black, with higher mean Elixhauser Comorbidity scores and significant associations with conditions such as hypertension, pulmonary disease, complicated diabetes, liver disease, renal failure and depression (Table 1). These co-morbidities have been correlated with higher risk of hospitalization for people living with HIV (PWH). Figure 2. COVID Admission and HIV Status The graph represents HIV testing results over the entire study period. Table 1. Demographics and Comorbidites Represents demographics and comorbidities of HIV- & HIV+ patients Figure 1. COVID Admissions and HIV Testing COVID admissions over time and the performance of HIV testing Conclusion. This is one of the first reports on targeted HIV testing for patients not using identifiable traditional HIV risk factors who were admitted to a large healthcare system for COVID19 infections. The percentage of newly HIV diagnosed patients from this cohort was considered to be < known HIV infection rates for our population. The majority of PWH were already established in care prior to their COVID19 diagnosis.

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