COVID-19 and congenital heart disease: an insight of pathophysiology and associated risks

Abstract

Objective: We aimed to examine the literature to determine if both paediatric and adult patients diagnosed with congenital heart disease (CHD) are at a higher risk of poor outcomes if they have the coronavirus disease 2019 (COVID-19), compared to those without CHD. Methods: A systematic review was executed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. To identify articles related to COVID-19 and CHD, an extensive literature search was performed on EMBASE, Medline, Scopus, and Global Health databases using keywords and MeSH terms. Results: A total of 12 articles met the inclusion criteria and were included for analysis in this systematic review. Two themes were identified for data extraction: evidence supporting higher risks in CHD patients and evidence against higher risks in CHD patients. After combining the data, there were 99 patients with CHDs out of which 12 required admissions to ICU. Conclusion: This systematic review suggests that CHD may increase the risk of poor outcomes for those with COVID-19, but also highlights the necessity for more research with larger sample sizes in order to make a more justified conclusion, as the majority of papers that were analysed were case series and case reports. Future research should aim to quantify the risks if possible whilst accounting for various confounding factors such as age and treatment history.

Effect of COVID-19 on congenital heart disease children: a literature review

“…18 In the same context, a systematic review by Haiduc et al has included concluded that CHD increases the risks of bad outcomes for patients infected with COVID-19. 15 On the contrary, an Italian multi-centre, observational cohort study that included 76 CHD patients that acquired COVID-19 infection has observed a mild clinical course of COVID-19 symptoms in CHD patients. 19 Another study included six neonates with CHD that were born to mothers diagnosed with w SARS-CoV-2 during their pregnancy showed that all six neonates were not infected or suffer from any adverse effect.…”

“…12 For that, the management of CHD patients and the impact of COVID-19 on them makes a challenge for the health care system. [13][14][15] Bertoncelli et al outlined that the outcome of COVID-19 infection can vary according to the type of CHD. He also categorized the high-risk patients which include large ventricular septal defect (VSD), tricuspid atresia, and hypoplastic left heart syndrome.…”

“…16 Several studies showed cardiovascular (CV) complications as a result of COVID-19 infection in most patients; however, others reported that 88% of the included patients were not admitted to the intensive care unit (ICU). 15 In the same context, a study by Xia et al included two patients diagnosed with atrial septal defect (ASD) who had not any CV complications and was not admitted. Both were discharged after complete resolution.…”

The spectrum of COVID-19 in complex adult congenital heart disease: A case series

“…There is limited amount of data as to which factors related to ACHD are prognostic for COVID-19 increased severity and is hard to predict clinical outcomes 7 . However, amidst the pandemic, the need for intensive follow-up of ACHD patients, no matter if their clinical condition is deemed stable, persists 8 .…”

Reply to Letter: factors affecting COVID-19 outcomes in patients with congenital heart disease

“…In our systematic review of current published literature, we have reported outcomes on 12 papers; five of them were cases reports, four case series and three cross-sectional studies totalling 143 patients, of which 99 patients had congenital heart disease (CHD) [1]. Based on the available evidence from these studies, we concluded that CHD may increase the risk of poor outcomes for those who are contracting ; and yet due to limited cohort size and available data, there is a necessity for more research with larger sample sizes in order to have a more justified conclusion.…”