1. Which pediatric and grown up CHD groups are at major risk for COVID-19 infection?

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AEPC TEACHING COURSES FOR TRAINEES

1. Which pediatric and grown up CHD groups are at major risk for COVID-19 infection?

Despite the large number of cases with COVID-19, little is known about the risk and effects in children as well as adults with congenital heart disease (CHD). However, It seems that children have substantially better prognosis than adults with cardiovascular risk factors.

According to a recent multicenter cross-sectional study from 46 centers within US and Canada the overall ICU mortality of COVID-19 in children is less than 5% compared with published mortalities of 50% to 62% in adults admitted to the ICU. These conclusions were drawn from 48 critically ill children with COVID-19 of whom more than 80% had significant comorbidities including congenital heart diseases. [1] Data from China suggest the same tendency towards better survival and outcomes from critical illness in infants and children than reported for adult patients. [2,3]

The British Congenital Cardiac Association has published recommendations for precautions for some groups with CHD based on existing knowledge from other infectious diseases which have been extrapolated to the COVID-19 situation. According to the BCCA recommendations the following groups should be particularly strict in following the social distancing measures:

  • Single ventricle patients.
  • Infants under 1 year with unrepaired congenital heart disease requiring surgery or catheter intervention.
  • Patients with chronic cyanosis (oxygen saturations <85% persistently)
  • Patients with severe cardiomyopathies
  • Patients with CHD on medication for heart failure
  • Patients with pulmonary hypertension
  • Patients after heart transplantation
  • Patients with CHD and significant comorbidities e.g. chronic kidney disease, chronic lung disease. [4]

COVID-19 infection may occur in patients with channelopathies e.g. congenital LQTS, Brugada syndrome (BS), catecholaminergic polymorphic ventricular tachycardia (CPVT) and short QT syndrome, with a risk of pro-arrhythmia. [5,6]

In the setting of LQTS with COVID-19 the QT should be monitored closely, because the combination of antiviral drugs (hydroxychloroquine and azithromycin) and stress factors (electrolyte disturbances and kidney dysfunction) may further prolong QT. [6]

Fever-triggered malignant ventricular arrhythmia is the major concern in BS with COVID-19 infection, therefore, fever should be aggressively treated with paracetamol. [7]

In patients with CPVT and COVID-19 infection, beta-blockers and flecainide should be continued with monitoring of drug interactions with antiviral drugs. [6]

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