ABSTRACT
BACKGROUND: Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. OBJECTIVES: This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. METHODS: Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. RESULTS: From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. CONCLUSIONS: COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
Subject(s)
COVID-19 , Cardiac Surgical Procedures , Cyanosis , Heart Defects, Congenital , Hypertension, Pulmonary , Adult , COVID-19/mortality , COVID-19/therapy , COVID-19 Testing/methods , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Causality , Comorbidity , Cyanosis/diagnosis , Cyanosis/etiology , Cyanosis/mortality , Female , Global Health/statistics & numerical data , Heart Defects, Congenital/classification , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/therapy , Hospitalization/statistics & numerical data , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/mortality , Male , Mortality , Patient Acuity , Risk Factors , SARS-CoV-2/isolation & purification , Symptom AssessmentABSTRACT
La constricción del conducto arterioso en la etapa fetal es un fenómeno fisiopatológico anormal que altera la estabilidad hemodinámica y la función cardiaca del feto. Conduce a dilatación e hipertrofia del ventrículo derecho, al igual que desarrollo de hidrops fetal, que, de no ser corregidos a tiempo, causan cierre total del conducto arterioso y muerte in utero. La constricción del conducto arterioso es más frecuente después de la semana 31 de gestación. Como causante se ha involucrado el consumo de antiinflamatorios no esteroideos que interfieren con la síntesis de prostaglandinas, indispensables para mantenerlo permeable. Así mismo se han reportado casos con el consumo de acetaminofén o paracetamol, y de esteroides sistémicos y tópicos, además de la ingestión de alimentos ricos en polifenoles y flavonoides. Se presenta el caso de una primigestante de 27 años de edad y 32 semanas de gestación, a quien se le realizó ecocardiografía fetal a causa de arritmia fetal. Dos semanas previas al estudio había consumido 1 g de acetaminofén por vía oral cada 6 horas. Mediante estudio ecocardiográfico fetal se constató conducto arterioso restrictivo, con anormalidades sobre el ventrículo derecho y el arco ductal, las cuales se revirtieron en un lapso de una semana posterior a la supresión del medicamento.
The constriction of the ductus arteriosus in the fetal stage is abnormal pathophysiological phenomenon that alters the hemodynamic stability and fetal cardiac function. It leads to the dilatation and hypertrophy of the right ventricle, development of hydrops fetalis, and if not corrected in time there is complete closure of the ductus arteriosus and in utero death. The constriction of the ductus arteriosus is more common after 31 weeks gestation. Is involved in causing consumption nonsteroidal anti-inflammatory drugs that interfere with the synthesis of prostaglandins, which are indispensable to keep open. Also cases have been reported with the use of acetaminophen or paracetamol, and systemic and topical steroids, in addition to the consumption of foods rich in polyphenols and flavonoids. We present the case of a 27-year-old at 32 weeks gestation of her first pregnancy. A fetal echocardiography was performed due to the presence of fetal arrhythmia. Two weeks before the study she was consuming 1 g of acetaminophen orally every 6 hours. The fetal echocardiographic study concluded the presence of restrictive ductus arteriosus, with abnormalities of the right ventricle and ductal arch. Everything reversed within 1 week after the removal of the drug.
