Clinical course of congenital heart disease cases with COVID-19
This was a 14-year-old male patient with aortic stenosis who presented with pressure-like chest pain along with respiratory distress and cough. Chest high-resolution-computed-tomography (HRCT) scan showed diffuse ground-glass opacification in both lungs and moderate bilateral pleural effusion. Blood culture was positive for Staphylococcus aureus. The patient was treated with azithromycin, hydroxychloroquine (HCQ), oseltamivir, ceftriaxone, and levofloxacin. The patient’s general conditions worsened, and trimethoprim/sulfamethoxazole, meropenem, and vancomycin were initiated. However, the patient passed away due to acute respiratory distress syndrome (ARDS), even after treatment with lopinavir/ritonavir and methylprednisolone.
This was a 10-month-old male infant with hypoplastic left heart syndrome (HLHS) and patent ductus arteriosus (PDA) admitted due to cyanosis, lethargy, and decreased oxygen saturation. A chest HRCT scan showed deformed interlobular septal thickening and mosaic attenuation along with subpleural alveolar consolidation in both upper and lower lobes. Nasopharyngeal RT-PCR was positive for SARS-CoV-2, and Pseudomonas aeruginosa was isolated from blood culture. The patient was treated with azithromycin, HCQ, cefotaxime, and clindamycin. Unfortunately, the infant passed away due to respiratory failure.
This was a 5-year-old boy with truncus arteriosus (TA) who was admitted due to respiratory distress, facial and limb edema, and decreased oxygen saturation. On examination, the patient had generalized edema and hepatomegaly. The chest HRCT scan showed a bilateral diffuse alveolar ground-glass pattern. Blood culture was positive for Enterobacter spp.. The patient was treated with azithromycin, HCQ, and cefotaxime.
Cases 4 and 5
These included two infants, an 18-month-old male and a 6-month-old female, who were diagnosed with ventricular septal defect (VSD) and situs ambiguous. These patients were admitted for emergent surgery. A nasopharyngeal RT-PCR for SARS-CoV-2, which was ordered for preoperational assessment, tested positive in both patients; subsequently, they were treated with azithromycin and survived from the surgery and the COVID-19.
This was an 18-day-old female neonate with PDA who presented with respiratory distress at birth. The patient was intubated and referred to our center. The blood culture was positive for P. aeruginosa, and the urine culture was positive for Candida spp.. The patient was treated with cefotaxime and vancomycin. Nasopharyngeal RT-PCR for SARS-CoV-2 was positive, and azithromycin was added to the therapeutic regimen.
This was a 2-year-old female child with tetralogy of fallot (TOF) who presented with nausea and vomiting, diarrhea, generalized rash, and shortness of breath. Nasopharyngeal RT-PCR for SARS-CoV-2 was positive, and the patient was treated with azithromycin and cefotaxime.
This was a 5-month-old boy with VSD/total anomalous pulmonary venous connection (TAPVC) who was admitted due to failure to thrive and reconstructive surgery. The patient became febrile during hospitalization, and ceftazidime and vancomycin were initiated for the patient. Nasopharyngeal RT-PCR for SARS-CoV-2 was positive, and the patient was treated with azithromycin and HCQ. The patient had impaired renal function, and hemodialysis was conducted. In addition, blood culture of the patient was positive for Acinetobacter baumannii, so the patient was treated with ampicillin/sulbactam.
This was a 4-month-old girl with pulmonary atresia-intraventricular septum-status post (PA-IVS-S/P) PDA stenting who presented with lip cyanosis after routine vaccination. The patient was admitted due to low ejection fraction and blood hemoglobin. Blood culture was positive for P. aeruginosa, and nasopharyngeal RT-PCR was positive for SARS-CoV-2. The patient was treated with cefotaxime.
Comparison of cases with and without mortality
The participants were categorized based on mortality. Among the nine patients, whose ages ranged from 18 days to 14 years [median 10 months (interquartile range 5 months–3.5 years)], two died. Both deaths were boys: one was 14 years old, and the other was ten months old. The surviving patients included 3 boys and 4 girls. The age range of this group was 18 days–5 years.
As shown in Table 1, the two patients who died had aortic valve stenosis (AVS) and HLHS plus PDA, whereas the other seven had other types of CHD (four had a VSD with or without other CHDs, one had PDA, one had TOF, and one had PA-IVS-S/P PDA stenting). None of the participants had headache, abdominal pain, lymphadenitis, myositis, or rash. Both of the deceased patients had tachypnea, respiratory distress, and chest pain; one had cough and the other had fever. Among the surviving patients, three had no symptoms, one had only rhinorrhea, and one other had rhinorrhea and diarrhea. Fever, like cough, was only observed in one patient in this group.
Azithromycin was prescribed to all patients in both groups (deceased or survived). Chloroquine was administered to both children that died and to only one of the surviving children.
Table 1 demonstrates the length of hospital stay, clinical signs/symptoms, the administered drugs, echocardiographic findings, and HRCT findings for each patient. Tachypnea, chest pain, and respiratory distress were the most common signs in the deceased group. Furthermore, the deceased group received a wider range of drugs compared to the surviving group. The results of each patient’s ABG and other laboratory findings are shown in Table 2.