Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Table 8 Classification of Congenital heart diseases regarding the risk of severe coronavirus disease-2019 based on their anatomical and physiological characteristics

High risk of poor outcomes with COVID-19		Low risk1 of poor outcomes with COVID-19
Physiological stage B	Physiological stage A	Physiological stage A	NYHA FC I symptoms
	Mild hemodynamic squeal		No hemodynamic or anatomic squeal
	Mild valvular disease		No arrhythmias
	Trivial or small shunt		Normal exercise capacity
	Arrhythmia not requiring treatment		Normal renal/hepatic/pulmonary function
	Abnormal objective cardiac limitation to exercise
Physiological stage C	NYHA FC III symptoms
	Significant valvular disease moderate or greater ventricular dysfunction
	Moderate aortic enlargement
	Venous or arterial stenosis.
	Mild-moderate hypoxemia/cyanosis
	Hemodynamically significant shunt
	Arrhythmias controlled with treatment
	Mild-Moderate Pulmonary hypertension
	End-organ dysfunction that is responsive to therapy.
Physiological stage D	NYHA FC IV symptoms
	Severe aortic enlarge
	Arrhythmias refractory to treatment
	Severe hypoxemia (associated with cyanosis)
	Severe pulmonary hypertension
	Eisenmenger syndrome
	Refractory end-organ dysfunction

COVID-19: Coronavirus disease-2019.

¹Patients with congenital heart diseases and complex anatomy are always at high-risk for poor outcomes independent of the physiological stage: Double-outlet ventricle, truncus arteriosus, transposition of the great arteries, pulmonary atresia, mitral atresia, interrupted aortic arch, fontan procedure, single ventricle, other abnormalities of atrioventricular and ventriculoarterial connection (crisscross heart, isomerism…), cyanotic heart defects (excluding fully repaired defects).