Table.
Characteristics, clinical management, and outcomes of children with COVID-19 and congenital heart disease
| Case nos. | Age | Cardiac history | Presenting signs and symptoms | Key CXR findings | Key echocardiography findings | BNP, pg/mL | Troponin, ng/mL | Maximum CRP, mg/dL | Maximum respiratory support | Milrinone, yes/no | ECMO | COVID-19 treatment | Days in ICU | Days on ward | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Case 1 | 3 mo | CAVC | Fever, irritability, hypoxemia, tachypnea, tachycardia | Hyperinflated lungs with scattered atelectasis; no focal consolidation | Not performed | 77 | Not performed | 2 | 8 L HFNC FiO2 21% | No | None | None | 4 | 2 | Recovery, discharged home. Readmitted for complete surgical repair, discharged home |
| Case 2 | 3 mo | CAVC | Increased work of breathing, decreased oral intake, hypoxemia | Diffuse interstitial densities and increased pulmonary vascularity with superimposed linear areas of airspace opacity at the bilateral lung bases and in the upper lobes, cardiomegaly | Moderate-to-severe regurgitation from left AV-valve component on common AV- valve; trivial regurgitation from right component. Mild-to-moderately hypertrophied and dilated right ventricle. | 530 | Not performed | 7.7 | MV PRVC mode, rate 37 bpm, TV 27 mL, PEEP 7 cmH2O, PS +10 cmH2O, PIPs in the 20s cmH2O, FiO2 60% | Yes | None | Remdesivir, convalescent plasma | 100 | 9, ongoing | Improved after complete surgical repair, remains inpatient |
| Case 3 | 6 mo | ALCAPA | Fever, increased work of breathing, decreased oral intake, hypoxemia | Cardiomegaly with ground-glass opacities consistent with pneumonia, and mild increased pulmonary vascularity | Severe LV dysfunction with ejection fraction 20% (unchanged from baseline), moderate RV dysfunction (worse from baseline), moderate-to-severe PH with tricuspid regurgitation jet predicting ¾ systemic RV pressure, and moderate tricuspid and mitral valve regurgitation. | NT-pro-BNP 74160 | 0.21 | 10.1 | MV PRVC mode, rate 40 bpm, TV 60 mL, PEEP 12 cmH2O, PS +10 cmH2O, PIP in the 30s cmH2O, FiO2 100% | Yes | None | Tocilizumab, remdesivir (incomplete) | 35 | N/A | Recovery, discharged home |
| Case 4 | 6 mo | LV non-compaction/ DCM with depressed biventricular function | Fever, increased work of breathing, decreased oral intake, diarrhea, cough, emesis, nasal congestion | Stable enlargement of the cardiothymic silhouette. Mild stable perihilar opacities. | Mildly dilated left ventricle with mildly depressed LV systolic function (EF 51%), mildly impaired LV diastolic function. | NT-proBNP 353 | Not performed | Not performed | N/A | No | None | None | 0 | 4 | Recovery, discharged home. Readmitted 2 wk later for fever, diarrhea, fever. Discharged home. |
| Case 5 | 9 mo | ToF, right dominant CAVC, parachute left AV valve | Fever, increased work of breathing, hypoxemia, cough | Increased opacification with a new right pleural effusion | No echocardiogram acquired during admission | NT-pro-BNP 777 | 0.3 | 1.6 | 10 L HFNC FiO2 50% | No | None | None | 5 | 3 | Recovery, discharged home. Readmitted 1 mo later with hypoxemia, discharged home. Death from unknown causes 2.5 mo after initial admission. |
| Case 6 | 18 y | HCM | Fever, increased work of breathing | Diffuse bilateral airspace opacities | LV hypertrophy with severe LV dysfunction | 572 | 2.7 | Not performed | MV VDR mode 50/18 cmH20, rate 20 bpm, FiO2 100%, 40 PPM iNO | Yes | VV, VA ECMO | Hydroxychloroquine, azithromycin, tocilizumab, IVIG, convalescent plasma | 31 | N/A | Death due to recurrence of VT |
| Case 7 | 19 y | DILV with Fontan palliation followed by heart transplant 8 years ago |
Poor oral intake, diarrhea, loss of taste, decreased appetite | No CXR acquired during admission | Normal echocardiogram after orthotopic heart transplant | NT-pro-BNP 1171 | 0.3 | Not performed | None | No | None | None | 0 | 9 | Recovery, discharged home. |
ALCAPA, anomalous left coronary artery from the pulmonary artery; DCM, dilated cardiomyopathy; DILV, double-inlet left ventricle; EF, ejection fraction; FiO2, fraction of inspired oxygen; HCM, hypertrophic cardiomyopathy; HFNC, high-flow nasal cannula; ICU, intensive care unit; iNO, inhaled nitrous oxide; IVIG, intravenous immunoglobulin; LV, left ventricular; MV, mechanical ventilation; N/A, not available; NT pro-BNP, N-terminal-pro-hormone BNP; PEEP, peak end-expiratory pressure; PH, pulmonary hypertension; PIP, peak inspiratory pressure; PPM, parts per million; PRVC, pressure-regulated volume control; PS, pressure support; RV, right ventricular; ToF, tetralogy of Fallot; TV, tidal volume; VA, venoarterial; VDR, volumetric diffusive respirator; VT, ventricular tachycardia; VV, venovenous.