COVID-19 and congenital heart disease: a case series of nine children

Memar, Elmira Haji Esmaeil; Pourakbari, Babak; Gorgi, Mojtaba; Sharifzadeh, Mohammad Sharif; Navaeian, Amene; Khodabandeh, Mahmoud; Mahmoudi, Shima; Mamishi, Setareh

doi:10.1007/s12519-020-00397-7

Cited by 24 publications

(28 citation statements)

References 33 publications

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“…According to the previous reports, most cases without underlying diseases experience a mild disease and children with comorbidities might show severe symptoms (40,41). We found 3.6-fold increased risk of the severity of disease in patients with underlying diseases, while no significant association between underlying diseases and in-hospital mortality was found, after adjusting for different factors including age, sex, underlying diseases, and CD4 + /CD8 + T cell ratio.…”

Section: Discussionsupporting

confidence: 49%

Effects of Coronavirus Disease 2019 (COVID-19) on Peripheral Blood Lymphocytes and Their Subsets in Children: Imbalanced CD4+/CD8+ T Cell Ratio and Disease Severity

et al. 2021

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Introduction: While pathogenesis in COVID-19 is not fully known and the effects between SARS-CoV-2 and the immune system are complicated, it is known that lymphopenia, hyper-inflammatory responses, and cytokines play an important role in the pathology of COVID-19. While some hematological abnormalities have been described among the laboratory features of COVID-19, there have not been studies reported on lymphocyte subset analyses in children. The aim of this study was to describe lymphocyte subsets in pediatric patients with mild/moderate or severe COVID-19.Methods: The subjects in the study were children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia confirmed with the real-time RT-PCR. The subjects were admitted to the Children's Medical Center, affiliated with the Tehran University of Medical Sciences, between March 7th and June 10th of 2020. The complete blood counts and lymphocyte subpopulations were analyzed for each patient.Results: The study included 55 hospitalized patients with confirmed SARS-CoV-2 infection (34 patients (62%) with an observed mild/moderate case of the disease and 21 patients (38%) with severedisease). Lymphocyte counts were found to be lower in patients with a severe case (mean ± SD 1.6 ± 0.9 in the severe group vs. 2.3 ± 2.2 in the mild group). Compared to the group with mild/moderate pneumonia, children with severe pneumonia had an increased count of CD8+ T cell and a lower percentage of CD4+ T cell. However, the differences between the groups were negligible. Interestingly, the severe group had a lower CD4+/CD8+ T cell ratio compared to the mild group (1.1 ± 0.47 vs. 1.4 ± 0.8, p-value: 0.063). CD4+/CD8+ T cell ratio <2, 1.5, and 1 was found in 48 (87%), 40 (73%), and 19 cases (35%). All of the seven cases in which the subject passed (13%) had CD4+/CD8+ T cell ratio of <2, 86% had CD4+/CD8+ T cell ratio of <1.5, and 29% had CD4+/CD8+ T cell ratio of <1.Conclusion: The CD4+/CD8+ T cell ratio was lower in patients with severe COVID-19 compared to those with mild/moderate form of disease. However, although a decline in CD4+/CD8+ ratio may serve as a useful metric in analyzing of the derangement in immune responses in patients with severe COVID-19, further study with larger sample sizes is highly recommended.

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Section: Discussionsupporting

confidence: 49%

Effects of Coronavirus Disease 2019 (COVID-19) on Peripheral Blood Lymphocytes and Their Subsets in Children: Imbalanced CD4+/CD8+ T Cell Ratio and Disease Severity

et al. 2021

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“…The reports in children are limited to less than ten patients. [ 11 ] All these series, mostly from the developed nations, reported complication and mortality rates comparable to the general population. [ 8 ] Majority of the patients in these reports were already operated for congenital heart disease (CHD).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, majority of the patients with an CHD contracting a COVID-19 infection in low-and middle-income countries (LMICs) are unoperated for heart disease. [ 11 12 ]…”

Section: Introductionmentioning

confidence: 99%

Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease

Sachdeva

Ramakrishnan

Choubey

et al. 2021

Annals of Pediatric Cardiology

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Background : Outcome data of children with heart disease who acquired COVID-19 infection are limited. Aims : We sought to analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with congenital heart disease (GUCH) who had a laboratory-confirmed COVID-19 infection. Settings and Design : This is a retrospective, multicentric, observational study. Materials and Methods : The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group. Results : From 24 pediatric cardiac centers across India, we included 94 patients with a median age of 12.5 (interquartile range 3–96) months and 49 (52.1%) patients were males. Majority (83 patients, 88.3%) were children. One-third of the patients (n = 31, 33.0%) had acyanotic congenital heart disease, and 41.5% (n = 39) were cyanotic, with > 80% of the patients being unoperated. Only 30 (31.9%) patients were symptomatic for COVID-19 infection, while the rest were incidentally detected positive on screening. A total of 13 patients died (case fatality rate: 13.8%). The in-hospital mortality rate among hospitalized patients was significantly higher among COVID-19-positive cases (13 of 48; 27.1%) as compared to COVID-negative admissions (9.2%) during the study period (P < 0.001). On multivariate analysis, the independent predictors of mortality among COVID-19-positive cases were severity of illness at admission (odds ratio [OR]: 535.7, 95% confidence interval [CI]: 6.9–41,605, P = 0.005) and lower socioeconomic class (OR: 29.5, 95% CI: 1.1–814.7, P = 0.046). Conclusions : Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes.

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“…One was a 14 years old girl with significant aortic stenosis (AS) and the other was a complex form of CHD, hypoplastic left heart syndrome (HLHS) and patent ductus arteriosus (PDA), in a 10-month-old male. Laboratory measures of C-reactive protein (CRP) and partial thromboplastin time (PTT) were higher in these patients ( 33 ).…”

Section: Methodsmentioning

confidence: 99%

Presentation and Outcome of Congenital Heart Disease During Covid-19 Pandemic: A Review

Soleimani

2022

Current Problems in Cardiology

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Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-COV 2 ) infection is a rapid evolving pandemic with multiple peaks of outbreak and substantial mortality worldwide. It has been proposed that infants are more vulnerable to SARS-COV-2 infection. On the other hand, children with COVID-19 have generally milder disease compared to infected adults and more often presented with gastrointestinal symptoms compared to respiratory ones. Multisystem inflammatory syndrome in children (MIS-c) is an ominous demonstration of COVID-19 with cardiac involvement and mortality rate <2%. From cardiovascular point of view, wide spectrum of manifestations including subclinical myocardial injury, myocarditis, stress cardiomyopathies, cardiac arrhythmias, pulmonary thromboembolism and thrombus formation in cardiac chambers and vascular bed has been reported in COVID-19 disease . Congenital heart disease (CHD), assumed as the most prevalent form of congenital disease. Advances in medical and surgical treatments for CHD have led to more alive patients with underlying heart disease secondary to congenital defects. These group of pediatric patients are prone to heart failure, arrhythmia and embolic events. In this narrative review, we intended to evaluate the cardiovascular and pediatric presentations of COVID-19 as well as the manifestation and outcomes of SARS-CoV-2 infection on pediatric patients with CHD.

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COVID-19 and congenital heart disease: a case series of nine children

Cited by 24 publications

References 33 publications

Effects of Coronavirus Disease 2019 (COVID-19) on Peripheral Blood Lymphocytes and Their Subsets in Children: Imbalanced CD4+/CD8+ T Cell Ratio and Disease Severity

Effects of Coronavirus Disease 2019 (COVID-19) on Peripheral Blood Lymphocytes and Their Subsets in Children: Imbalanced CD4+/CD8+ T Cell Ratio and Disease Severity

Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease

Presentation and Outcome of Congenital Heart Disease During Covid-19 Pandemic: A Review

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