Ventricular Septal Defect Complicating Myocardial Infarction: A Case of Delayed Percutaneous Transcatheter Closure (preprint)

A 57-year-old man suffered chest pain during the COVID-19 pandemic, but he delayed medical treatment due to fear of infection. Four months later, symptoms chest tightness and shortness of breath appeared. Electrocardiogram (ECG) revealed old myocardial infarction; color sonography and myocardial CT revealed apical myocardial defect. He refused surgery and percutaneous transcatheter closure, and follow-up observation. After 22 months, the symptoms of chest tightness and shortness of breath aggravated. He recovered after percutaneous transcatheter closure, and was discharged. This case shows delayed closure is one of the possible options for the patients without severe organ dysfunction or hemodynamic disturbance.

Increased incidence of postmyocardial infarction ventricular septal defects during Covid-19 pandemic: A case series.

INTRODUCTION: Ventricular septal defect (VSD) is one of the mechanical complications of acute myocardial infarction (MI), whose incidence has been decreasing throughout the years because of the emergence of different reperfusion therapy strategies. METHODS: We present a series of seven patients who underwent surgery for post-MI VSD repair in our institution in the period between March 2020 and June 2021. DISCUSSION: During the recent SARS-COV2 pandemic, time to hospital admission increased due to patients being overcautious out of fear of exposing themselves to COVID-19. The increased time to hospital admission, with associated late reperfusion therapy and delayed PCI, is closely related to an augmented incidence of post-myocardial infarction mechanical complications such as ventricular septal defects. For this reason, we witnessed an increase in the incidence of post-MI VSD. CONCLUSION: Fear of exposure to SARS-COV2 in the medical environment was a major source of concern for all our patients. The target of hospital policy should be to reassure patients of freedom from COVID in the emergency department and cardiac wards in order to prevent such dreadful complications.

Risk of Myopericarditis following COVID-19 mRNA vaccination in a Large Integrated Health System: A Comparison of Completeness and Timeliness of Two Methods (preprint)

Purpose: How completely do hospital discharge diagnoses identify cases of myopericarditis after an mRNA vaccine? Methods: We assembled a cohort 12 to 39 years old patients, insured by Kaiser Permanente Northwest, who received at least one dose of an mRNA vaccine (Pfizer BioNTech or Moderna) between December 2020 and October 2021. We followed them for up to 30 days after their second dose of an mRNA vaccine to identify encounters for myocarditis, pericarditis or myopericarditis. We compared two identification methods: A method that searched all encounter diagnoses using a brief text description (e.g., ICD-10-CM code I40.9 is defined as acute myocarditis, unspecified). We searched the text description of all inpatient or outpatient encounter diagnoses (in any position) for myocarditis or pericarditis. The other method was developed by the Centers for Disease Control and Preventions Vaccine Safety Datalink (VSD), which searched for emergency department visits or hospitalizations with a select set of discharge ICD-10-CM diagnosis codes. For both methods, two physicians independently reviewed the identified patient records and classified them as confirmed, probable or not cases using the CDCs case definition. Results: The encounter methodology identified 14 distinct patients who met the confirmed or probable CDC case definition for acute myocarditis or pericarditis with an onset within 21 days of receipt of COVID-19 vaccination. Three of these 14 patients had an ICD-10 code of I51.4 Myocarditis, Unspecified which was overlooked by the VSD algorithm. The VSD methodology identified 11 patients who met the CDC case definition for acute myocarditis or pericarditis. Seven (64%) of the eleven patients had initial care for myopericarditis outside of a KPNW facility and their diagnosis could not be ascertained by the VSD methodology until claims were submitted (median delay of 33 days; range of 12-195 days). Among those who received a second dose of vaccine (n=146,785), we estimated a risk as 95.4 cases of myopericarditis per million second doses administered (95% CI, 52.1 to 160.0). Conclusion: We identified additional valid cases of myopericarditis following an mRNA vaccination that would be missed by the VSDs search algorithm, which depends on select hospital discharge diagnosis codes. The true incidence of myopericarditis is markedly higher than the incidence reported to US advisory committees. The VSD should validate its search algorithm to improve its sensitivity for myopericarditis.

Repeated pregnancies in uncorrected double outlet right ventricle: a rare occurrence.

Pregnancy in a woman with double outlet right ventricle, ventricular septal defect, and pulmonary stenosis is presented. Her previous two pregnancies ended in fetal losses. In the current pregnancy, she had thrombocytopenia, placenta previa, and severe fetal growth restriction. She underwent an emergency caesarean section followed by post-partum haemorrhage and COVID-19 infection. Literature review has been performed.

Right-sided infective endocarditis in association with a left-to-right shunt complicated by haemoptysis and acute renal failure: a case report.

BACKGROUND: Infective endocarditis has a relevant clinical impact due to its high morbidity and mortality rates. Right-sided endocarditis has lower complication rates than left-sided endocarditis. Common complications are multiple septic pulmonary embolisms, haemoptysis, and acute renal failure. Risk factors associated with right-sided infective endocarditis are commonly related to intravenous drug abuse, central venous catheters, or infections due to implantable cardiac devices. However, patients with congenital ventricular septal defects might be at high risk of endocarditis and haemodynamic complications. CASE PRESENTATION: In the following, we present the case of a 23-year-old man without a previous intravenous drug history with tricuspid valve Staphylococcus aureus endocarditis complicated by acute renal failure and haemoptysis caused by multiple pulmonary emboli. In most cases, right-sided endocarditis is associated with several common risk factors, such as intravenous drug abuse, a central venous catheter, or infections due to implantable cardiac devices. In this case, we found a small perimembranous ventricular septal defect corresponding to a type 2 Gerbode defect. This finding raised the suspicion of a congenital ventricular septal defect complicated by a postendocarditis aneurysmal transformation. CONCLUSIONS: Management of the complications of right-sided infective endocarditis requires a multidisciplinary approach. Echocardiographic approaches should include screening for ventricular septal defects in patients without common risk factors for tricuspid valve endocarditis. Patients with undiagnosed congenital ventricular septal defects are at high risk of infective endocarditis. Therefore, endocarditis prophylaxis after dental procedures and/or soft-tissue infections is highly recommended. An acquired ventricular septal defect is a very rare complication of infective endocarditis. Surgical management of small ventricular septal defects without haemodynamic significance is still controversial.

Covid 19 and ECMO support after neonatal congenital heart surgery: a case report (preprint)

Coronavirus disease (COVID-2019) causes respiratory and systemic disease, has led to a sudden epidemic that affects people of all ages. The presence of cardiovascular comorbidities is associated with a higher risk of death. Therefore, patients with congenital heart disease represent a high risk population. When respiratory failure develops and mechanical ventilation is not sufficient due to Covid 19, extracorporeal membrane oxygenation (ECMO) may use as a form of rescue therapy. In this article, we present a newborn who required ECMO support for acute respiratory failure in the early postoperative period due to coronavirus 2 (SARS-CoV-2) after the aortic arch repair and ventricular septal defect closure operation. To the best of our knowledge, this patient was the first neonate case of SARS-CoV-2 infection after congenital heart surgery and was the youngest patient to receive ECMO support.

COVID-19 pneumonia in an infant with a hemodynamically significant ventricular septal defect.

Reports thus far suggest a mild course for acute COVID-19 infection in children; however, its effects in vulnerable paediatric populations, including children with haemodynamically significant congenital heart disease, have rarely been reported. We therefore report on a 4-month-old Hispanic male with a moderate sized conoventricular ventricular septal defect and pulmonary overcirculation who presented with COVID-19-associated pneumonia.

Impact of SARS-CoV-2 on Fetal Malformation During Pregnancy: A Case Report of Fetal Autopsy (preprint)

Background: Little is known about the impact of SARS-CoV-2 on fetal anomalies. Case presentation: We described a case report of fetal anomalies during second-trimester (25+3 weeks) pregnancy. The fetal autopsy was found with abnormal heart anatomy (including ventricular septal defect, oval hole valve missing, and pericardial effusion), polycystic kidney, and acute chorioamnionitis. Conclusions: SARS-CoV-2 infection in second-trimester pregnancy not the direct factor resulted in congenital defects, and multiple risk factors contribute to these changes.   

Bell's palsy in a pediatric patient with hyper IgM syndrome and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Bell's palsy is an acute facial paralysis with known association to viral infections. We describe a medically complex 6-year-old male with hyper IgM syndrome who presented with unilateral facial droop and positive SARS-CoV-2 RT-PCR. This is the first reported pediatric case of Bell's palsy in the setting of SARS-CoV-2 infection.

A Series of Frustrations of Fever for Congenital Heart Disease: Case Report (preprint)

Background: Fever, dry cough and fatigue are the most common symptoms of the coronavirus disease-2019 (COVID-19). During the COVID-19 pandemic in China, we treated a patient with fever and finally diagnosed congenital heart disease.Case presentation: An 18-year-old lady came to the fever clinic with a complaint about the symptoms of fever, dry cough and dyspnea for 15 days. She had a travel history of epidemic area two weeks ago. She had a low fever and dry cough accompanied with chest tightness and fatigue. Eventually she diagnosed ventricular septal defect complicated by infective endocarditis. Two months after surgery, the patient returned to normal social life and physical activity.Conclusion: Early surgical treatment is an effective strategy for ventricular septal defect patients complicated with IE, which can improve the early survival rate of patients.