Hepatic manifestations of COVID-19 and effect of remdesivir on liver function in patients with COVID-19 illness.

COVID-19 has emerged as a major global health crisis since the first cases were reported in China in December 2019. Remdesivir is the only broad-spectrum antiviral approved by the US Food and Drug Administration to treat hospitalized patients with COVID-19 infection. Although the adverse effects of remdesivir are largely unknown, data from randomized controlled trials have demonstrated its deleterious effect on the liver. This review briefly addresses the hepatic manifestations of COVID-19 infection and the data regarding the efficacy and adverse effects of remdesivir on liver function when used in patients hospitalized with COVID-19. Through a literature search, we identified five randomized controlled trials, two case reports, and one case series, including a total of 2375 patients. Although mild transaminase elevation has been reported as a feature of COVID-19, there has been a concern of hepatotoxicity associated with the use of remdesivir. Based on the limited available data regarding the adverse effects of remdesivir on hepatic function, it is prudent to exercise caution by evaluating baseline liver function, avoiding the use of potentially hepatotoxic drugs, and closely monitoring liver function when using remdesivir in patients hospitalized with COVID-19.

ST Elevation in a Patient With COVID-19 Infection-Associated Fever: A Case of Brugada Pattern.

Coronavirus disease 2019 (COVID-19) is a global pandemic presenting with various cardiovascular manifestations. Although Brugada pattern ST-segment elevation (STE) is well described in patients admitted with febrile illness, the implication of recognizing this abnormality in patients with COVID-19 is critical in providing appropriate care for the patient and also reducing the exposure of healthcare professionals to the risk of infection. We report a patient with COVID-19 infection presenting with STE due to fever-related unmasking of Brugada pattern, who was managed conservatively.

Common Arterial Trunk: Physiology, Imaging, and Management.

Common arterial trunk (CAT), or truncus arteriosus, is a rare form of cyanotic congenital heart disease and is highly associated with DiGeorge syndrome (microdeletion 22q11.2). Prenatal diagnosis is highly feasible, allowing proper delivery planning and postnatal management. The clinical presentation is highly variable depending on the anatomical variation; however, most commonly presenting with mild cyanosis and significant tachypnea, although these patients can often go undetected in the immediate newborn period. Transthoracic echocardiography is adequate for diagnosis and detailed anatomical delineation in the majority. Additional imaging modalities such as cardiac catheterization, computed tomography angiography, or cardiac magnetic resonance imaging can be helpful in those with more complex pulmonary artery (PA) or aortic anatomy, or in the older repaired. The surgical management of CAT is complete repair in the neonatal period with resection of branch PAs from the CAT with placement of a right ventricular (RV)-to-PA conduit and patch closure of the ventricular septal defect. Overall surgical outcomes are excellent in most centers, with the expectation that the child will eventually outgrow the RV-to-PA conduit and require reoperation. Other potential reoperations or postsurgical interventions in addition to the RV-to-PA conduit may involve the truncal valve or branch PAs.

Down Syndrome with Complete Atrioventricular Septal Defect, Hypertrophic Cardiomyopathy, and Pulmonary Vein Stenosis.

The prevalence of congenital heart disease in infants with Down syndrome is 40%, compared with 0.3% in children who have normal chromosomes. Atrioventricular and ventricular septal defects are often associated with chromosomal aberrations, such as in trisomy 21, whereas hypertrophic cardiomyopathy is chiefly thought to be secondary to specific gene mutations. We found only one reported case of congenital hypertrophic cardiomyopathy and atrioventricular septal defect in an infant with Down syndrome. Here, we report atrioventricular septal defect, hypertrophic cardiomyopathy, and pulmonary vein stenosis in a neonate with Down syndrome-an apparently unique combination. In addition, we discuss the relevant medical literature.

Optical coherence tomography imaging of the patent ductus arteriosus: first known uses in congenital heart disease.

BACKGROUND: Angiography is used to assess ductal morphology and caliber during interventional closure of the ductus arteriosus. We are evaluating the use of optical coherence tomography (OCT) to evaluate ductal anatomy given the potential benefit of superior resolution and lower radiation. METHODS: Standard angiograms were performed on two patients with patent ductus arteriosus prior to device occlusion. OCT was then used to obtain high-resolution three-dimensional vessel reconstructions. Devices were chosen based on angiographic measurements. RESULTS: OCT resulted in excellent three-dimensional anatomic definition, with elliptical narrowest lumenal measurements of 2.2 × 3.1 mm and 1.6 × 2.3 mm, respectively, compared with angiographic measurements of 2.6 and 1.4 mm. CONCLUSIONS: To our knowledge, this is the first reported use of OCT use in pediatric patients outside the coronaries, and in patients with congenital heart disease. We found OCT imaging of the PDA to be feasible, and only used a small amount of additional radiation and contrast. The three-dimensional OCT reconstructions provided additional anatomic information that could potentially improve device selection, and in both cases may have led to choosing larger devices than what was chosen based on angiography. In addition, once the technique is perfected, little or no angiography or fluoroscopy will be required to perform imaging runs, and only a small injection of contrast appears to be sufficient for vessel imaging. However, there are certain limitations to OCT imaging that are unlikely to make it the method of choice specifically for imaging the patent ductus arteriosus, but we have shown its ability to provide high resolution imaging in a relatively simple fashion which may prove useful for other purposes. © 2014 Wiley Periodicals, Inc.