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2.
J Am Heart Assoc ; 11(9): e023516, 2022 May 03.
Article in English | MEDLINE | ID: covidwho-1807753

ABSTRACT

Background This study sought to better understand the experiences of adults with congenital heart disease throughout the pandemic. Objectives were to determine (1) psychological distress before and throughout the pandemic; (2) changes in day-to-day functioning; and (3) the percentage of adults with congenital heart disease who experienced COVID-19 related symptoms, underwent testing, and tested positive. Methods and Results This was a cross-sectional study paired with retrospective chart review. A web-based survey was distributed to patients between December 2020 and January 2021. Patients reported on psychological distress across 5 categories (Screening Tool for Psychological Distress; depression, anxiety, stress, anger, and lack of social support), whether they experienced symptoms of COVID-19 and/or sought testing, and changes to their work and social behavior. Five hundred seventy-nine survey responses were received, of which 555 were linked to clinical data. Patients were aged 45±15 years. The proportion of patients reporting above-threshold values for all Screening Tool for Psychological Distress items significantly increased during the early pandemic compared with before the pandemic. Stress returned to baseline in December 2020/January 2021, whereas all others remained elevated. Psychological distress decreased with age, and women reported persistently elevated stress and anxiety compared with men during the pandemic. A consistent trend was not observed with regard to American College of Cardiology/American Heart Association anatomic and physiologic classification. Fifty (9%) patients lost employment because of a COVID-19-related reason. COVID-19 symptoms were reported by 145 (25%) patients, 182 (31%) sought testing, and 10 (2%) tested positive. Conclusions A substantial proportion of adults with congenital heart disease reported clinically significant psychological distress during the pandemic.


Subject(s)
COVID-19 , Heart Defects, Congenital , Psychological Distress , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Depression/psychology , Female , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/epidemiology , Humans , Male , Pandemics , Retrospective Studies , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , United States
3.
Methodist Debakey Cardiovasc J ; 18(2): 106-107, 2022.
Article in English | MEDLINE | ID: covidwho-1766194

ABSTRACT

A 52-year-old female was admitted to our hospital in April 2021 with dyspnea. She was discharged from the hospital 3 weeks ago due to the diagnosis of pneumonia caused by coronavirus disease 2019 (COVID-19). Physical examination revealed an oxygen desaturation of 82%. The patient underwent computed tomography angiography (CTA) that showed a ground-glass pattern and a giant left atrial appendage ( Figure 1A ). Film array respiratory panel was negative, and pulmonary aspergillosis was diagnosed after bronchoscopy. Cardiac magnetic resonance corroborated the huge left atrial appendage ( Figure 1B ). No other structural or functional heart abnormalities were diagnosed. A giant left atrial appendage is a rare cardiac anomaly that can be congenital or acquired. In the literature, it is called a left atrial appendage aneurysm. The dilatation can be generalized or focused. Although it can occur in all age groups, it is predominant in patients in their 30s to 50s and most common in females.1 Patients can be asymptomatic or present with symptoms such as palpitations, chest pain, or dyspnea. A number of recent cases in the literature have highlighted the diagnostic utility of CTA.2 While there is no standard treatment for this condition, surgical resection is the most frequent therapy. Another option reported in the literature is anticoagulant treatment for select cases.3 Closure of the left atrial appendage is a more recent and emerging intervention that can be considered. In our patient, we initiated anticoagulant therapy to reduce the risk of thromboembolic events; however, we recommended left atrial appendage occlusion or surgical resection after completing the treatment for pulmonary aspergillosis.


Subject(s)
Atrial Appendage , COVID-19 , Heart Aneurysm , Heart Defects, Congenital , Pulmonary Aspergillosis , Anticoagulants , Atrial Appendage/diagnostic imaging , Dyspnea/etiology , Female , Heart Aneurysm/surgery , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Humans , Middle Aged , Pulmonary Aspergillosis/pathology
4.
G Ital Cardiol (Rome) ; 23(2): 90-99, 2022 Feb.
Article in Italian | MEDLINE | ID: covidwho-1765601

ABSTRACT

Clinical management of adult patients with congenital heart disease (GUCH) is a difficult task for multiple reasons, which include their own pathology and clinical history complexity, diagnostic complexity and organization of care. GUCH specialists are present in very small numbers and are concentrated in few centers, thus generating considerable transfer problems for patients. During the COVID-19 pandemic, telemedicine has become the standard of care, ensuring health assistance continuity, and implementing communication channels between patients and health professionals. We suggest to stratify GUCH patients into three groups, which correspond to different levels of risk (low, moderate and high, respectively) to develop complications over time, using a GUCH-specific multiparametric complexity score; so, each patient pathway will be defined according to the specific group, with indication of site, timing and type of clinical and instrumental evaluations, including virtual visits and consults. In conclusion, practical tools are provided for the implementation of updated care pathways for GUCH patients, who finally are inserted in a new model of care in which even if in-person visit still represents the crucial moment of each patient care pathway, on the other hand, telemedicine incorporation could contribute to improving and making even more complete and effective GUCH patient care.


Subject(s)
COVID-19 , Heart Defects, Congenital , Telemedicine , Adult , Critical Pathways , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/therapy , Humans , Pandemics
7.
Genes (Basel) ; 13(2)2022 02 07.
Article in English | MEDLINE | ID: covidwho-1715230

ABSTRACT

Left ventricular noncompaction (LVNC) is a highly heterogeneous primary disorder of the myocardium. Its clinical features and genetic spectrum strongly overlap with other types of primary cardiomyopathies, in particular, hypertrophic cardiomyopathy. Study and the accumulation of genotype-phenotype correlations are the way to improve the precision of our diagnostics. We present a familial case of LVNC with arrhythmic and thrombotic complications, myocardial fibrosis and heart failure, cosegregating with the splicing variant in the FHOD3 gene. This is the first description of FHOD3-dependent LVNC to our knowledge. We also revise the assumed mechanism of pathogenesis in the case of FHOD3 splicing alterations.


Subject(s)
Cardiomyopathies , Cardiomyopathy, Hypertrophic , Heart Defects, Congenital , Isolated Noncompaction of the Ventricular Myocardium , Cardiomyopathies/genetics , Cardiomyopathy, Hypertrophic/complications , Formins , Heart Defects, Congenital/pathology , Humans , Isolated Noncompaction of the Ventricular Myocardium/diagnostic imaging , Isolated Noncompaction of the Ventricular Myocardium/genetics , Myocardium
8.
Cells ; 11(3)2022 01 28.
Article in English | MEDLINE | ID: covidwho-1690348

ABSTRACT

Advances in human pluripotent stem cell (hPSC) technology allow one to deconstruct the human body into specific disease-relevant cell types or create functional units representing various organs. hPSC-based models present a unique opportunity for the study of co-occurring disorders where "cause and effect" can be addressed. Poor neurodevelopmental outcomes have been reported in children with congenital heart diseases (CHD). Intuitively, abnormal cardiac function or surgical intervention may stunt the developing brain, leading to neurodevelopmental disorders (NDD). However, recent work has uncovered several genetic variants within genes associated with the development of both the heart and brain that could also explain this co-occurrence. Given the scalability of hPSCs, straightforward genetic modification, and established differentiation strategies, it is now possible to investigate both CHD and NDD as independent events. We will first overview the potential for shared genetics in both heart and brain development. We will then summarize methods to differentiate both cardiac & neural cells and organoids from hPSCs that represent the developmental process of the heart and forebrain. Finally, we will highlight strategies to rapidly screen several genetic variants together to uncover potential phenotypes and how therapeutic advances could be achieved by hPSC-based models.


Subject(s)
Heart Defects, Congenital , Neurodevelopmental Disorders , Pluripotent Stem Cells , Cell Differentiation/genetics , Heart Defects, Congenital/genetics , Heart Defects, Congenital/metabolism , Humans , Neurodevelopmental Disorders/genetics , Neurodevelopmental Disorders/metabolism , Organoids/metabolism , Pluripotent Stem Cells/metabolism
11.
Cardiol Young ; 32(1): 31-35, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1635444

ABSTRACT

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic negatively impacted global healthcare. Consequences in Pediatric and Congenital Heart Surgery programmes and mortality of congenital heart patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) is still to be determined. OBJECTIVE: To study the COVID-19 pandemic implications in Brazilian Pediatric and Congenital Heart Surgery programmes. METHODS: We conducted a national online survey covering all states that perform Pediatric and Congenital Heart Surgery from 10 November to 22 November, 2020, using a Google forms questionnaire. We formulated questions related to impact on surgical volume, case-mix, and mortality. Then we asked about short-term post-operative COVID-19 infection and outcomes. RESULTS: We received responses from 46 centres representing all states where there were a Pediatric and Congenital Heart Surgery programme and all high-volume centres across the country. All but one centre experienced a significant decrease in surgical volume, and 23.9% of the responders revealed less than one-quarter of volume decrement. On the other hand, in over 70% of the centres, there was a significant surgical volume reduction. In addition to this, there was a shift in case-mix in 41 centres (89.1%) towards more complex cases. More than one-third of the responders revealed increased mortality in 2020 compared to previous years, and 43.5% of the programmes (20 centres) had at least one patient contaminated by SARS-Cov-2, accounting for 48 patients. Mortality in post-operative infected patients was 45.8% (22 patients). CONCLUSIONS: In general, Brazilian Pediatric and Congenital Heart Surgery programmes were severely affected by decreased surgical volume, unbalanced case-mix towards more complex cases, and increased mortality. Almost half of the programmes related post-operative COVID-19 contamination with high mortality.


Subject(s)
COVID-19 , Heart Defects, Congenital , Brazil/epidemiology , Child , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Pandemics , SARS-CoV-2
12.
J Pediatr Nurs ; 63: 96-101, 2022.
Article in English | MEDLINE | ID: covidwho-1630445

ABSTRACT

PURPOSE: To explore siblings' perceptions of having a brother or sister with congenital heart disease in the UK during the COVID-19 pandemic. DESIGN AND METHODS: Siblings of children with congenital heart disease aged 8-17 years old were interviewed via video call technology between September 2020 and February 2021. We conducted reflexive thematic analysis of these interviews to generate themes. FINDINGS: Interviews took place with 17 siblings, predominantly of white ethnicity n = 15 (86%). Most siblings interviewed were first born in the family n = 15 (88%), and most children with CHD were the youngest n = 15(88%). Four themes were generated; My sibling is vulnerable, what does this mean for my family, I have a responsibility to protect my brother or sister, our family time during the pandemic and adjustment and adaptations to pandemic life. CONCLUSIONS: Siblings identified difficult aspects of the pandemic and these related to concerns about their brother's or sister's vulnerability, family impact, and keeping their sibling safe. They also identified adjustments they made to keep their family functioning throughout the COVID-19 pandemic. Despite the worry and uncertainty siblings experienced, they valued increased family cohesion which helped to mitigate some challenges of the restrictions imposed in the UK. PRACTICE IMPLICATIONS: Honest and open communication is valued by siblings. It is vital to ensure siblings receive the support they need to ensure they keep up with their schooling and social commitments as pandemic related restrictions ease.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adaptation, Psychological , Adolescent , COVID-19/epidemiology , Child , Humans , Male , Pandemics , Qualitative Research , Sibling Relations , Siblings
13.
Pediatr Cardiol ; 43(2): 475-480, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1616115

ABSTRACT

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address the extracardiac anomalies in fetuses with congenital heart disease, post COVID-19 vaccination myocarditis, the use of cardiac magnetic resonance after the Fontan operation, congenitally corrected transposition in adults, robitically assisted congenital heart surgery and the increased risk of congenital heart surgery in patients receiving tracheal surgery during the same admission.


Subject(s)
COVID-19 , Heart Defects, Congenital , Periodicals as Topic , Adult , COVID-19 Vaccines , Child , Heart Defects, Congenital/surgery , Humans , SARS-CoV-2
14.
BMC Cardiovasc Disord ; 21(1): 592, 2021 12 09.
Article in English | MEDLINE | ID: covidwho-1566507

ABSTRACT

BACKGROUND: COVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both. CASE PRESENTATION: A 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated. CONCLUSIONS: This report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.


Subject(s)
COVID-19 , Fontan Procedure , Gangrene , Mechanical Thrombolysis , Postoperative Complications , Thrombophlebitis , Tricuspid Atresia , Warfarin/therapeutic use , Amputation/methods , Atrial Flutter/drug therapy , Atrial Flutter/etiology , COVID-19/blood , COVID-19/complications , COVID-19/therapy , Fontan Procedure/adverse effects , Fontan Procedure/methods , Gangrene/etiology , Gangrene/surgery , Heart Defects, Congenital/surgery , Humans , Image Processing, Computer-Assisted/methods , Lower Extremity/blood supply , Lower Extremity/pathology , Lower Extremity/surgery , Male , Mechanical Thrombolysis/adverse effects , Mechanical Thrombolysis/methods , Middle Aged , Phlebography/methods , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/etiology , Thrombophlebitis/diagnosis , Thrombophlebitis/etiology , Thrombophlebitis/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Tricuspid Atresia/etiology , Tricuspid Atresia/surgery
15.
Kardiol Pol ; 80(2): 151-155, 2022.
Article in English | MEDLINE | ID: covidwho-1560764

ABSTRACT

BACKGROUND: It is unclear whether patients with adult congenital heart disease (ACHD) should be considered as an increased risk population with poor outcomes when suffering from COVID-19. AIMS: This study aimed to collect clinical outcome data and to identify risk factors of a complicated course of COVID-19 among ACHD patients. METHODS: Among all outpatients who came to medical attention via telemedicine or direct physician contact at our institution between September 1, 2020 and March 31, 2021, we included all with a COVID-19 diagnosis. The incidence of COVID-19, a clinical course of the disease, and outcome were determined. RESULTS: One hundred and four (8.7%) out of 1 197 patients who were seen at our outpatient clinic for ACHD patients met the definition of COVID-19. Most of them reported a mild course of COVID-19 (99 [95.5%]). Five patients (4.5%) experienced severe symptoms and needed hospitalization. Two patients (1.9% of all with a confirmed diagnosis, 40% with severe infection) died. In the multivariable analysis, decreased systemic ventricular systolic function and any significant valve stenosis were predictors of a complicated disease course. CONCLUSIONS: Our study confirmed previous results showing that a physiology-based model, rather than an anatomy-based model, better predicted COVID-19 outcomes among ACHD patients, which is of importance for patients and healthcare providers during the COVID-19 pandemic.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adult , COVID-19 Testing , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Humans , Pandemics , SARS-CoV-2
16.
Pediatr Cardiol ; 43(1): 247, 2022 01.
Article in English | MEDLINE | ID: covidwho-1536295
17.
G Ital Cardiol (Rome) ; 22(11): 871-883, 2021 Nov.
Article in Italian | MEDLINE | ID: covidwho-1496709

ABSTRACT

Pediatric cardiology has matured profoundly over the last 50 years, paralleled by a similar development in pediatric cardiac surgery and cardiac anesthesia. This field of medicine provides structured and effective care for a very heterogeneous group of diseases including congenital heart disease, cardiomyopathies and heart failure, myocarditis, rheumatic heart disease, inherited and acquired arrhythmias, Kawasaki disease and more recently multisystemic inflammatory syndrome of children related to primary infection by SARS-CoV-2. This review summarizes achievements and results in selected topics of pediatric cardiology and cardiac surgery with focused attention to the diagnosis and management of congenital heart diseases.


Subject(s)
COVID-19 , Cardiology , Fontan Procedure , Heart Defects, Congenital , Child , Fontan Procedure/adverse effects , Heart Defects, Congenital/surgery , Humans , SARS-CoV-2
18.
J Investig Med High Impact Case Rep ; 9: 23247096211043398, 2021.
Article in English | MEDLINE | ID: covidwho-1496109

ABSTRACT

A 60-year-old woman presented to the emergency department with worsening shortness of breath and non-productive cough for 1 week, which was preceding a recent COVID-19 infection. At the time the patient thought this was part of the constellation of symptoms of COVID-19, so she stayed home until her symptoms worsened to the point of needing hospitalization. The patient was found to have a rare and complex congenital heart disease that led her to develop acute heart failure precipitated by COVID-19 pneumonia. Medical management and surgical repair were essential in this patient given the late presentation.


Subject(s)
COVID-19 , Heart Defects, Congenital , Dyspnea , Emergency Service, Hospital , Female , Heart Defects, Congenital/complications , Humans , Middle Aged , SARS-CoV-2
19.
Resuscitation ; 167: 12-21, 2021 10.
Article in English | MEDLINE | ID: covidwho-1479724

ABSTRACT

AIM: We aimed to characterize extracorporeal CPR (ECPR) outcomes in our center and to model prediction of severe functional impairment or death at discharge. METHODS: All ECPR events between 2011 and 2019 were reviewed. The primary outcome measure was severe functional impairment or death at discharge (Functional Status Score [FSS] ≥ 16). Organ dysfunction was graded using the Pediatric Logistic Organ Dysfunction Score-2, neuroimaging using the modified Alberta Stroke Program Early Computed Tomography Score. Multivariable logistic regression was used to model FSS ≥ 16 at discharge. RESULTS: Of the 214 patients who underwent ECPR, 182 (median age 148 days, IQR 14-827) had an in-hospital cardiac arrest and congenital heart disease and were included in the analysis. Of the 110 patients who underwent neuroimaging, 52 (47%) had hypoxic-ischemic injury and 45 (41%) had hemorrhage. In-hospital mortality was 52% at discharge. Of these, 87% died from the withdrawal of life-sustaining therapies; severe neurologic injury was a contributing factor in the decision to withdraw life-sustaining therapies in 50%. The median FSS among survivors was 8 (IQR 6-8), and only one survivor had severe functional impairment. At 6 months, mortality was 57%, and the median FSS among survivors was 6 (IQR 6-8, n = 79). Predictive models identified FSS at admission, single ventricle physiology, extracorporeal membrane oxygenation (ECMO) duration, mean PELOD-2, and worst mASPECTS (or DWI-ASPECTS) as independent predictors of FSS ≥ 16 (AUC = 0.931) and at 6 months (AUC = 0.924). CONCLUSION: Mortality and functional impairment following ECPR in children remain high. It is possible to model severe functional impairment or death at discharge with high accuracy using daily post-ECPR data up to 28 days. This represents a prognostically valuable tool and may identify endpoints for future interventional trials.


Subject(s)
Cardiopulmonary Resuscitation , Extracorporeal Membrane Oxygenation , Heart Arrest , Heart Defects, Congenital , Aged, 80 and over , Child , Humans , Retrospective Studies , Treatment Outcome
20.
Pediatr Cardiol ; 43(3): 541-546, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1460299

ABSTRACT

The aim of the current study is to investigate hospitalization outcomes of COVID-19 positive children and adults with moderate or severe congenital heart disease to children and adults without congenital heart disease. Retrospective review using the Vizient Clinical Data Base for admissions of patients with an ICD-10 code for COVID-19 from April 2020 to March 2021. Admissions with COVID-19 and with and without moderate or severe congenital heart disease (CHD) were stratified into pediatric (< 18 years) and adult (≥ 18 years) and hospital outcomes were compared. There were 9478 pediatric COVID-19 admissions, 160 (1.7%) with CHD, and 658,230 adult COVID-19 admissions, 389 (0.06%) with CHD. Pediatric admissions with COVID-19 and CHD were younger (1 vs 11 years), had longer length of stay (22 vs 6 days), higher complication rates (6.9 vs 1.1%), higher mortality rates (3.8, 0.8%), and higher costs ($54,619 vs 10,731; p < 0.001 for all). Adult admissions with COVID-19 and CHD were younger (53 vs 64 years, p < 0.001), had longer length of stay (12 vs 9 days, p < 0.001), higher complication rates (8 vs 4.8%, p = 0.003), and higher costs ($23,551 vs 13,311, p < 0.001). This appears to be the first study to report the increased hospital morbidities and costs for patients with CHD affected by COVID-19. Our hope is that these findings will help counsel patients moving forward during the pandemic.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adult , Child , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Hospitalization , Hospitals , Humans , Length of Stay
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