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1
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Arya B, Hammoud MS, Toth AJ, Woo J, Campbell M, Patel A, Edwards LA, Freud L, Gandhi R, Krishnan A, Peyvandi S, Pinto N, Ronai C, Tejtel KS, Moon-Grady A, Donofrio MT, Srivastava S, Karamlou T. Impact of COVID-19 on Prenatal Diagnosis and Surgical Outcomes of Congenital Heart Disease: Fetal Heart Society and Society of Thoracic Surgeons Collaborative Study. J Am Heart Assoc 2025; 14:e037079. [PMID: 40314351 DOI: 10.1161/jaha.124.037079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 03/17/2025] [Indexed: 05/03/2025]
Abstract
BACKGROUND Fetal echocardiography is the mainstay of prenatal diagnosis of congenital heart disease. The COVID-19 pandemic led to shifts in triage of prenatal services. Our objective was to evaluate the impact of COVID-19 restrictions on prenatal diagnosis, surgical outcomes, and disparities in neonatal critical congenital heart disease (CCHD) management in the United States during the pandemic's first year. METHODS AND RESULTS A multi-institutional retrospective cohort study compared neonatal CCHD outcomes (requiring surgery within 60 days of birth) 1 year prior (prepandemic era) and during the peak pandemic era, supplemented by a Fetal Heart Society survey assessing regional practice changes. Data on prenatal diagnosis, demographics, outcomes, and 2020 state Area Deprivation Index were analyzed using Wilcoxon rank sum and χ2 tests. The survey, completed by 72 fetal cardiologists from 9 US census regions, showed 75% of institutions implemented restrictions by March 2020, affecting triage, referrals, and number of prenatal cardiology visits. Compared with CCHD neonates born prepandemic (n=4637), those born during the pandemic (n=1806) had a higher proportion of prenatal diagnosis (66% versus 63%, P<0.05). There were no significant differences in complications or mortality, but pandemic-era neonates had longer hospital stays. During the pandemic, CCHD neonates had a more disadvantaged Area Deprivation Index and had surgery at hospitals located in more advantaged regions. CONCLUSIONS Although pandemic-driven care delivery adjustments affected perinatal cardiology referrals and triage, prenatal diagnosis, perioperative outcomes, and survival remained robust. The management of CCHD demonstrates health care resilience, maintaining core prenatal and perioperative care. Regional variations highlight the need for targeted strategies to address disparities during health care crises.
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Affiliation(s)
- Bhawna Arya
- Department of Pediatrics Seattle Children's Hospital and the University of Washington School of Medicine Seattle WA USA
| | - Miza Salim Hammoud
- Division of Pediatric Cardiac Surgery, Heart, Vascular & Thoracic Institute Cleveland Clinic Cleveland OH USA
| | - Andrew J Toth
- Department of Quantitative Health Sciences Cleveland Clinic Cleveland OH USA
| | - Joyce Woo
- Division of Cardiology Ann & Robert H. Lurie Children Hospital of Chicago and Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Matthew Campbell
- Department of Pediatrics Texas Children's Hospital, Baylor College of Medicine Houston TX USA
| | - Angira Patel
- Division of Cardiology Ann & Robert H. Lurie Children Hospital of Chicago and Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Lindsay A Edwards
- Department of Pediatrics, Division of Pediatric Cardiology Duke University School of Medicine Durham NC USA
| | - Lindsay Freud
- Division of Cardiology, The Hospital for Sick Children University of Toronto Toronto Canada
| | - Rupali Gandhi
- Division of Cardiology, Advocate Children's Hospital Oak Lawn IL USA
| | - Anita Krishnan
- Division of Cardiology, Children's National Hospital George Washington University School of Medicine, and Health Sciences Washington DC USA
| | - Shabnam Peyvandi
- Department of Pediatrics University of California San Francisco CA USA
| | - Nelangi Pinto
- Department of Pediatrics Seattle Children's Hospital and the University of Washington School of Medicine Seattle WA USA
| | - Christina Ronai
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics Harvard Medical School Boston MA USA
| | - Kristen Sexson Tejtel
- Department of Pediatrics Texas Children's Hospital, Baylor College of Medicine Houston TX USA
| | - Anita Moon-Grady
- Department of Pediatrics University of California San Francisco CA USA
| | - Mary T Donofrio
- Division of Cardiology, Children's National Hospital George Washington University School of Medicine, and Health Sciences Washington DC USA
| | - Shubhika Srivastava
- Department of Cardiovascular Services Center for Cardiovascular Research and Innovation Nemours Children's Health Wilmington DE USA
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Heart, Vascular & Thoracic Institute Cleveland Clinic Cleveland OH USA
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Gupta D, Vuong T, Wang S, Korst LM, Pruetz JD. Update on Prenatal Detection Rate of Critical Congenital Heart Disease Before and During the COVID-19 Pandemic. Pediatr Cardiol 2024; 45:1015-1022. [PMID: 38565667 PMCID: PMC11056324 DOI: 10.1007/s00246-024-03487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
Prenatal diagnosis of critical congenital heart disease (CCHD) has improved over time, and previous studies have identified CCHD subtype and socioeconomic status as factors influencing rates of prenatal diagnosis. Our objective of this single-center study was to compare prenatal diagnosis rates of newborns with CCHD admitted for cardiac intervention from the COVID-19 pandemic period (March 2020 to March 2021) to the pre-pandemic period and identify factors associated with the lack of CCHD prenatal diagnosis. The overall rate of CCHD and rates of the various CCHD diagnoses were calculated and compared with historical data collection periods (2009-2012 and 2013-2016). Compared with the 2009-2012 pre-pandemic period, patients had 2.17 times higher odds of having a prenatal diagnosis of CCHD during the pandemic period controlling for lesion type (aOR = 2.17, 95% CI 1.36-3.48, p = 0.001). Single ventricle lesions (aOR 6.74 [4.64-9.80], p < 0.001) and outflow tract anomalies (aOR 2.20 [1.56-3.12], p < 0.001) had the highest odds of prenatal diagnosis compared with the remaining lesions. Patients with outflow tract anomalies had higher odds for prenatal detection in the pandemic period compared with during the 2009-2012 pre-pandemic period (aOR 2.01 [1.06-3.78], p = 0.031). In conclusion, prenatal detection of CCHD among newborns presenting for cardiac intervention appeared to have improved during the pandemic period.
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Affiliation(s)
- Deepak Gupta
- Children's Hospital Los Angeles, Department of Pediatrics, Los Angeles, California, USA
| | - Tiffany Vuong
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Shuo Wang
- Children's Hospital Los Angeles, Division of Cardiology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Lisa M Korst
- Childbirth Research Associates, LLC, North Hollywood, Los Angeles, California, USA
| | - Jay D Pruetz
- Children's Hospital Los Angeles, Division of Cardiology, Fetal Cardiology Program, Keck School of Medicine of USC, 4650 Sunset Blvd, Los Angeles, California, 90027, USA.
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3
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Scott MW, Metcalf C, Bhadury S, Feygin Y, Neal AE. Impact of COVID-19 pandemic healthcare restrictions on utilisation and diagnostic yield of outpatient transthoracic echocardiograms. Cardiol Young 2023; 33:1936-1941. [PMID: 36380489 DOI: 10.1017/s1047951122003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, Kentucky prohibited elective medical procedures from 3/18/2020-4/27/2020. We sought to determine if cessation of elective procedures in Kentucky during the COVID-19 pandemic resulted in a decrease in the proportion of rarely appropriate outpatient transthoracic echocardiograms interpreted at the open echocardiography lab at Norton Children's Hospital. METHODS A retrospective chart review was conducted comparing proportions of rarely appropriate outpatient paediatric transthoracic echocardiograms performed pre-COVID (3/21/2019-4/28/2019) and during COVID (3/19/2020-4/27/2020). Transthoracic echocardiogram indication was determined by chart review and echocardiogram reports. Indication appropriateness was evaluated using paediatric appropriate use criteria for initial outpatient transthoracic echocardiogram or CHD follow-up as applicable. RESULTS Of transthoracic echocardiograms pre-COVID, 100 (37.7%) were rarely appropriate versus 18 (20.2%) during COVID. Pre-COVID, paediatric cardiologists tended to order fewer rarely appropriate transthoracic echocardiograms than paediatricians (35.9% versus 46.4%), although this difference was not statistically significant. Cardiologists ordered the majority of outpatient transthoracic echocardiograms during COVID (77/89, 86.5%), limiting the ability to compare transthoracic echocardiogram indications by provider type. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms with (13.0%) abnormal studies pre-COVID versus 7 (15.5%) during COVID. CONCLUSION While elective procedures were prohibited in Kentucky during the COVID-19 pandemic, a decrease in the proportion of rarely appropriate outpatient paediatric transthoracic echocardiograms was observed. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms between time periods, suggesting that clinically significant echocardiogram findings were still detected despite more prudent utilisation of echocardiography during this time.
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Affiliation(s)
- Michael W Scott
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Christina Metcalf
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Sagnik Bhadury
- Department of Biostatistics, University of Louisville, Louisville, KY, USA
| | - Yana Feygin
- Norton Children's Research Institute Affiliated with University of Louisville School of Medicine, Louisville, KY, USA
| | - Ashley E Neal
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
- Norton Children's, Louisville, KY, USA
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4
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Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, Michelfelder E, Morris SA, Peyvandi S, Pinto NM, Pruetz J, Sethi N, Simpson J, Srivastava S, Tian Z. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:679-723. [PMID: 37227365 DOI: 10.1016/j.echo.2023.04.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Joe Kreeger
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wesley Lee
- Baylor College of Medicine, Houston, Texas
| | | | - Shaine A Morris
- Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas
| | - Shabnam Peyvandi
- University of California, San Francisco, San Francisco, California
| | | | - Jay Pruetz
- Children's Hospital of Los Angeles, Los Angeles, California
| | | | - John Simpson
- Evelina London Children's Hospital, London, United Kingdom
| | | | - Zhiyun Tian
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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5
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Liu K, Zhu M, Dong SZ. Prenatal diagnosis of fetal ectopia cordis by fetal cardiovascular magnetic resonance imaging. Prenat Diagn 2022; 42:1636-1642. [PMID: 36307940 DOI: 10.1002/pd.6254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/22/2022] [Accepted: 10/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to report our cases of fetal ectopia cordis (EC) and to evaluate the utility of fetal cardiovascular magnetic resonance imaging (MRI) for the diagnosis of this rare anomaly. METHOD This retrospective study included 11 fetuses with EC. The multiplane steady-state free precession (SSFP) sequence, single-shot turbo spin-echo sequence and non-gated SSFP cine cardiovascular magnetic resonance were used to evaluate the fetal heart and abdomen. RESULTS The 11 fetal cases with EC were examined by fetal cardiovascular MRI and confirmed by postnatal or post-mortem findings. Of these 11 cases, two were isolated thoracic EC, six had pentalogy of Cantrell, and three had an omphalocele and EC. Among all 11 fetuses, nine were associated with congenital heart defects. In four cases, fetal MRI added additional information compared to fetal ultrasound, however, in two cases, fetal MRI missed the diagnosis of a ventricular septal defect noted by echocardiography. CONCLUSION Fetal MRI combined with prenatal echocardiography can improve the accuracy of the prenatal diagnosis of EC.
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Affiliation(s)
- Ke Liu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Su-Zhen Dong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T, on behalf of the Japanese Circulation Society Joint Working Group. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Impact of the COVID pandemic on quality measures in a pediatric echocardiography lab. PROGRESS IN PEDIATRIC CARDIOLOGY 2022; 67:101549. [PMID: 35813038 PMCID: PMC9250899 DOI: 10.1016/j.ppedcard.2022.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022]
Abstract
Background The COVID pandemic necessitated an altered approach to transthoracic echocardiography, especially in COVID cases. Whether this has effected echocardiography lab quality is unknown. Objectives We sought to determine whether echocardiography lab quality measures during the COVID pandemic were different from those prior to the pandemic and whether quality and comprehensiveness of echocardiograms performed during the pandemic was different between COVID and non-COVID patients. Methods The four quality measures (diagnostic errors, appropriateness of echocardiogram, American College of Cardiology Image Quality metric and Comprehensive Exam metric in structurally normal hearts) reported quarterly in our lab were compared between two quarters during COVID (2020) and pre-COVID (2019). Each component of these metrics was also assessed in randomly selected echocardiograms in COVID patients and compared to non-COVID echocardiograms. Results For non-COVID echocardiograms, the image quality metric did not change between 2019 and 2020 and the comprehensive exam metric improved. Diagnostic error rate did not change, and appropriateness of echocardiogram indications improved. When COVID and non-COVID echocardiograms were compared, the image quality metric and comprehensiveness exam metric were lower for COVID cases (image quality mean 21.3/23 for non-COVID, 18.6/23 for COVID, p < 0.001 and comprehensive exam mean 29.5/30 for non-COVID, 27.7/39 for COVID, p < 0.001). In particular, systemic and pulmonary veins, pulmonary arteries and aortic arch were not adequately imaged in COVID patients. For studies in which a follow-up echocardiogram was available, no new pathology was found. Conclusions At our center, though diagnostic error rate did not change during the pandemic and the proportion of echocardiograms ordered for appropriate indications increased, imaging quality in COVID patients was compromised, especially for systemic and pulmonary veins, pulmonary arteries and arch. Though no new pathology was noted on the small number of patients who had follow-up studies, we are paying careful attention to these structures to avoid diagnostic errors going forward.
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8
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Chowdhury D, Fremed MA, Dean P, Glickstein JS, Robinson J, Rellosa N, Thacker D, Soma D, Briskin SM, Asplund C, Johnson J, Snyder C. Return to Activity After SARS-CoV-2 Infection: Cardiac Clearance for Children and Adolescents. Sports Health 2022; 14:460-465. [PMID: 34427496 PMCID: PMC9214892 DOI: 10.1177/19417381211039746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
CONTEXT Sedentary behavior and inability to participate in organized physical activity has negatively affected the physical and mental health of children and adolescents; however, cardiac injury and associated risk for sudden cardiac death with return to activity remains a major concern. Guidelines have been proposed for return to activities; however, these fail to address the needs of younger children and those participating in more casual activities. Guidance is needed for primary care providers to facilitate safe return to everyday activity and sports and to help direct appropriate laboratory, electrocardiographic, and anatomical assessment. EVIDENCE ACQUISITION Review of computerized databases of available literature on SARS-CoV-2 infection in children and postinfection sequelae, risk factors for sudden cardiac death, and previous return to play recommendations. STUDY DESIGN Clinical guidelines based on available evidence and expert consensus. LEVEL OF EVIDENCE Level 4. RESULTS In this report, we review the literature on return to activity after SARS-CoV-2 infection and propose recommendations for cardiac clearance for children and adolescents. Though severe disease and cardiac injury is less common in children than in adults, it can occur. Several diagnostic modalities such as electrocardiography, echocardiography, cardiac magnetic resonance imaging, and serologic testing may be useful in the cardiac evaluation of children after SARS-CoV-2 infection. CONCLUSION Gradual return to activity is possible in most children and adolescents after SARS-CoV-2 infection and many of these patients can be cleared by their primary care providers. Providing education on surveillance for cardiopulmonary symptoms with return to sports can avoid unnecessary testing and delays in clearance.
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Affiliation(s)
- Devyani Chowdhury
- Devyani Chowdhury, MD, Cardiology Care for Children, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1834 Oregon Pike 20, Lancaster, PA 17601 ()
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9
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Evaluation of the frequency and types of structural heart disease in fetuses of pregnant women according to risk groups by fetal echocardiography. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.1014181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Fremed MA, Niaz T, Hope KD, Altman CA, Levy VY, Glickstein JS, Johnson JN. Adaptations of paediatric cardiology practice during the COVID-19 pandemic. Cardiol Young 2021; 32:1-5. [PMID: 34657645 PMCID: PMC8545844 DOI: 10.1017/s1047951121004364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/10/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, paediatric heart centres were forced to rapidly alter the way patient care was provided to minimise interruption to patient care as well as exposure to the virus. In this survey-based descriptive study, we characterise changes that occurred within paediatric cardiology practices across the United States and described provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardising responses to future public health crises.
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Affiliation(s)
- Michael A. Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle D. Hope
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carolyn A. Altman
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Victor Y. Levy
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Julie S. Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Jonathan N. Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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11
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Silva ACSSD, Góes FGB, Silva LFD, Silva LJD, Bonifácio MCS, Coelho YCCB. Children with congenital heart disease in COVID-19 pandemic times: an integrative review. Rev Bras Enferm 2021; 75:e20201033. [PMID: 34614074 DOI: 10.1590/0034-7167-2020-1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/27/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify the scientific production in health about children with congenital heart disease in COVID-19 pandemic times. METHOD this is an integrative review, carried out in June 2020 in the information resources Latin American and Caribbean Literature in Health Sciences (LILACS), National Library of Medicine, National Institutes of Health (PubMed), Scientific Electronic Library Online Journal Portal (SciELO) and Brazilian Institute of Information Science and Technology (Oasis Ibict). RESULTS 14 studies composed this review. Most studies pointed to tests, interventional procedures and surgery for children with heart disease in pandemic times; others discussed possible complications of COVID-19 among children with congenital heart disease. CONCLUSION the incipient production of studies and the weak level of evidence denote an important knowledge gap so far, highlighting the need for studies with strong scientific evidence for the formulation of care guidelines aimed at children with heart disease.
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12
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Srivastava S, Parra DA. 2021 Refocus - The Revolution of Imaging in Pediatric and Congenital Heart Disease. J Am Soc Echocardiogr 2021; 34:A13-A14. [PMID: 33958101 DOI: 10.1016/j.echo.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Altman CA, Donofrio MT, Arya B, Wasserman M, Ensing GJ, Cohen MS, Lewin MB, Swaminathan M, Barker PCA. ASE Statement on Adapting Pediatric, Fetal, and Congenital Heart Disease Echocardiographic Services to the Evolving COVID-19 Pandemic. J Am Soc Echocardiogr 2021; 34:553-561. [PMID: 33516940 PMCID: PMC7842196 DOI: 10.1016/j.echo.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/23/2022]
Abstract
Over the 12 months since the start of the coronavirus disease 2019 pandemic, an explosion of investigation and an increase in experience have led to vast improvement in our knowledge about this disease. However, coronavirus disease 2019 remains a huge public health threat.
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Affiliation(s)
- Carolyn A Altman
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
| | - Mary T Donofrio
- Division of Pediatric Cardiology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia
| | - Bhawna Arya
- Division of Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Melissa Wasserman
- University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory J Ensing
- University of Michigan/C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Meryl S Cohen
- University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark B Lewin
- Division of Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
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14
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Beck ALDS, Barberato SH, de Almeida ALC, Grau CRPDC, Lopes MMU, Lima RDSL, Cerci RJ, Albricker ACL, Barros FS, Oliveira AJ, de Lira EB, Miglioranza MH, Vieira MLC, Pena JLB, Strabelli TMV, Bihan DCDSL, Tsutsui JM, Rochitte CE. Position Statement on Indications and the Safe Reintroduction of Cardiovascular Imaging Methods in the COVID-19 Scenario - 2021. Arq Bras Cardiol 2021; 116:659-678. [PMID: 33909785 PMCID: PMC8159553 DOI: 10.36660/abc.20210133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Adenalva Lima de Souza Beck
- Universitária de CardiologiaInstituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal - Fundação Universitária de Cardiologia, Brasília, DF – Brasil,Hospital Sírio-LibanêsBrasíliaDFBrasilHospital Sírio-Libanês, Brasília, DF – Brasil
| | - Silvio Henrique Barberato
- CardioEco - Centro de DiagnósticoCuritibaPRBrasilCardioEco - Centro de Diagnóstico Cardiovascular, Curitiba, PR – Brasil,Quanta Diagnóstico e TerapiaCuritibaPRBrasilQuanta Diagnóstico e Terapia, Curitiba, PR – Brasil
| | - André Luiz Cerqueira de Almeida
- Santa Casa de Misericórdia de Feira de SantanaFeira de SantanaBABrasilSanta Casa de Misericórdia de Feira de Santana, Feira de Santana, BA – Brasil
| | - Claudia R. Pinheiro de Castro Grau
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Grupo FleurySão PauloSPBrasilGrupo Fleury, São Paulo, SP – Brasil
| | - Marly Maria Uellendahl Lopes
- Universidade Estadual PaulistaSão PauloSPBrasilUniversidade Estadual Paulista (Unesp), São Paulo, SP – Brasil,Diagnósticos da AméricaSão PauloSPBrasilDiagnósticos da América SA (Dasa), São Paulo, SP – Brasil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil
| | - Rodrigo Júlio Cerci
- Quanta Diagnóstico e TerapiaCuritibaPRBrasilQuanta Diagnóstico e Terapia, Curitiba, PR – Brasil
| | - Ana Cristina Lopes Albricker
- Instituto Mineiro de UltrassonografiaBelo HorizonteMGBrasilInstituto Mineiro de Ultrassonografia (IMEDE), Belo Horizonte, MG – Brasil
| | | | - Alessandra Joslin Oliveira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Edgar Bezerra de Lira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Marcelo Haertel Miglioranza
- Hospital Mãe de DeusPorto AlegreRSBrasilPrevencor – Hospital Mãe de Deus, Porto Alegre, RS – Brasil,Fundação Universitária de CardiologiaInstituto de Cardiologia do Rio Grande do SulPorto AlegreRSBrasilInstituto de Cardiologia do Rio Grande do Sul – Fundação Universitária de Cardiologia, Porto Alegre, RS – Brasil
| | - Marcelo Luiz Campos Vieira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas GeraisBelo HorizonteMGBrasilFaculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG – Brasil,Hospital Felício RochoBelo HorizonteMGBrasilHospital Felício Rocho, Belo Horizonte, MG – Brasil
| | - Tânia Mara Varejão Strabelli
- Hospital Sírio-LibanêsBrasíliaDFBrasilHospital Sírio-Libanês, Brasília, DF – Brasil,Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - David Costa de Souza Le Bihan
- Diagnósticos da AméricaSão PauloSPBrasilDiagnósticos da América SA (Dasa), São Paulo, SP – Brasil,Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | - Jeane Mike Tsutsui
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto do Coração (InCor)São PauloSPBrasilInstituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil,Hospital do CoraçãoSão PauloSPBrasilHospital do Coração (HCor), São Paulo, SP – Brasil,Hospital Pró-CardíacoRio de JaneiroRJBrasilHospital Pró-Cardíaco, Rio de Janeiro, RJ – Brasil
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15
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Lichtenauer M, Prinz E, Granitz C, Wernly B, Kopp K, Daburger A, Hoppe UC. Overview of Current International Recommendations for Echocardiography Exams During the Covid-19 Pandemic and Its Local Implementation in Austria. Front Cardiovasc Med 2021; 8:623076. [PMID: 33644131 PMCID: PMC7902516 DOI: 10.3389/fcvm.2021.623076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Since its first appearance in December 2019, the novel Coronavirus SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) has spread throughout the world at rapid pace causing the coronavirus disease 2019 (Covid-19). Originating in the Chinese province Hubei, more than 91.8 million people globally have now been infected with the coronavirus and more than 1.966.000 patients have died thus far from Covid-19 (as of January 13th 2021). The virus spreads primarily by droplet infection as well as via aerosols during close physical contact. Particularly in medical examinations with close physical contact between examiner and patient, like echocardiography, the risk of contracting the virus is increased. Therefore, the use of personal protective equipment is recommended for the protection of patients and medical personnel alike. In this article, the current recommendations of international professional associations on the use of personal protective equipment and their local implementation are presented.
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Affiliation(s)
- Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Erika Prinz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christina Granitz
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Kristen Kopp
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Apollonia Daburger
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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16
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Schwartz BN, Klein JH, Barbosa MB, Hamersley SL, Hickey KW, Ahmadzia HK, Broth RE, Pinckert TL, Sable CA, Donofrio MT, Krishnan A. Expanding Access to Fetal Telecardiology During the COVID-19 Pandemic. Telemed J E Health 2021; 27:1235-1240. [PMID: 33513044 DOI: 10.1089/tmj.2020.0508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: This study aims to describe one center's experience in expanding a fetal telecardiology program through collaborative work with maternal fetal medicine (MFM) clinics with the goal of safely reaching mothers during the COVID-19 pandemic. We sought to define the extent of fetal telehealth conversion at a large fetal cardiac care center and evaluate the diagnostic accuracy for studies performed. Methods: At our center, fetal telemedicine expanded from one MFM site before the pandemic to four additional sites by May 2020. A retrospective review of fetal telecardiology visits between March 15 and July 15, 2020, was performed. The chart was reviewed for confirmation of diagnosis postnatally. Results: With pandemic onset, there was a large increase in the number of telemedicine visits with a total of 122 mothers seen between five MFM clinics. Fourteen mothers (11.5%) had abnormal fetal echocardiograms requiring additional follow-up, and seven mothers (5.8%) had a fetal echocardiogram suspicious for a critical congenital heart disease (CCHD). All the fetal echocardiograms suspicious for CCHD were confirmed on postnatal echocardiogram. To our knowledge, none of the normal fetal echocardiograms were found to have congenital heart disease postnatally. Conclusions: In response to the COVID-19 pandemic, we rapidly transitioned to fetal telecardiology using a variety of formats. This has reduced potential infectious exposure for pregnant mothers and minimized contact between physicians without compromising diagnostic accuracy. In our experience, the expansion of a telemedicine program requires strong initial infrastructure, prior relationships with MFM providers, and appropriate training among obstetric sonographers.
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Affiliation(s)
- Bryanna N Schwartz
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Jennifer H Klein
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Megan B Barbosa
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Sheri L Hamersley
- Maternal-Fetal Medicine Associates of Maryland, Rockville, Maryland, USA.,Department of Obstetrics and Gynecology, The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kimberly W Hickey
- Maternal-Fetal Medicine Associates of Maryland, Rockville, Maryland, USA.,The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University, Washington, District of Columbia, USA
| | - Richard E Broth
- TLC Perinatal PA, Silver Spring, Germantown and Hagerstown, Maryland, USA
| | - Thomas L Pinckert
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine, Washington, District of Columbia, USA.,Greater Washington Maternal Fetal Medicine and Genetics, Washington, District of Columbia, USA
| | - Craig A Sable
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Mary T Donofrio
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Anita Krishnan
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
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17
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Niaz T, Hope K, Fremed M, Misra N, Altman C, Glickstein J, Sanchez-de-Toledo J, Fraisse A, Miller J, Snyder C, Johnson JN, Chowdhury D. Role of a Pediatric Cardiologist in the COVID-19 Pandemic. Pediatr Cardiol 2021; 42:19-35. [PMID: 33015722 PMCID: PMC7533115 DOI: 10.1007/s00246-020-02476-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has affected patients across all age groups, with a wide range of illness severity from asymptomatic carriers to severe multi-organ dysfunction and death. Although early reports have shown that younger age groups experience less severe disease than older adults, our understanding of this phenomenon is in continuous evolution. Recently, a severe multisystem inflammatory syndrome in children (MIS-C), with active or recent COVID-19 infection, has been increasingly reported. Children with MIS-C may demonstrate signs and symptoms of Kawasaki disease, but also have some distinct differences. These children have more frequent and severe gastrointestinal symptoms and are more likely to present with a shock-like presentation. Moreover, they often present with cardiovascular involvement including myocardial dysfunction, valvulitis, and coronary artery dilation or aneurysms. Here, we present a review of the literature and summary of our current understanding of cardiovascular involvement in children with COVID-19 or MIS-C and identifying the role of a pediatric cardiologist in caring for these patients.
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Affiliation(s)
- Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle Hope
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Michael Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, New York, USA
| | - Nilanjana Misra
- Pediatric Cardiology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Carrie Altman
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Julie Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, New York, USA
| | | | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton and Harefield Hospitals Trust, National Heart and Lung Institute, Imperial College, London, UK
| | - Jacob Miller
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA
| | - Christopher Snyder
- Pediatric Cardiology, Rainbow Babies and Children's Hospital, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Devyani Chowdhury
- Cardiology Care for Children, 1834 Oregon Pike, Ste 20, Lancaster, PA, 17601, USA.
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18
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Rodriguez-Gonzalez M, Castellano-Martinez A, Cascales-Poyatos HM, Perez-Reviriego AA. Cardiovascular impact of COVID-19 with a focus on children: A systematic review. World J Clin Cases 2020; 8:5250-5283. [PMID: 33269260 PMCID: PMC7674714 DOI: 10.12998/wjcc.v8.i21.5250] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Since the beginning of the pandemic, coronavirus disease-2019 (COVID-19) in children has shown milder cases and a better prognosis than adults. Although the respiratory tract is the primary target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cardiovascular involvement is emerging as one of the most significant and life-threatening complications of SARS-CoV-2 infection in adults. AIM To summarize the current knowledge about the potential cardiovascular involvement in pediatric COVID-19 in order to give a perspective on how to take care of them during the current pandemic emergency. METHODS Multiple searches in MEDLINE, PubMed were performed using the search terms "COVID-19" or "SARS-CoV-2" were used in combination with "myocardial injury" or "arrhythmia" or "cardiovascular involvement" or "heart disease" or "congenital heart disease" or "pulmonary hypertension" or "long QT" or "cardiomyopathies" or "channelopathies" or "Multisystem inflammatory system" or "PMIS" or "MIS-C" or "Pediatric multisystem inflammatory syndrome" or "myocarditis" or "thromboembolism to identify articles published in English language from January 1st, 2020 until July 31st, 2020. The websites of World Health Organization, Centers for Disease control and Prevention, and the Johns Hopkins Coronavirus Resource Center were reviewed to provide up to date numbers and infection control recommendations. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts concerning the subject were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. For Pediatric multisystemic inflammatory syndrome temporally associated with COVID-19 (PMIS), multiple meta-analyses were conducted to summarize the pooled mean proportion of different cardiovascular variables in this population in pseudo-cohorts of observed patients. RESULTS A total of 193 articles were included. Most publications used in this review were single case reports, small case series, and observational small-sized studies or literature reviews. The meta-analysis of 16 studies with size > 10 patients and with complete data about cardiovascular involvement in children with PMIS showed that PMIS affects mostly previously healthy school-aged children and adolescents presenting with Kawasaki disease-like features and multiple organ failure with a focus on the heart, accounting for most cases of pediatric COVID-19 mortality. They frequently presented cardiogenic shock (53%), ECG alterations (27%), myocardial dysfunction (52%), and coronary artery dilation (15%). Most cases required PICU admission (75%) and inotropic support (57%), with the rare need for extracorporeal membrane oxygenation (4%). Almost all of these children wholly recovered in a few days, although rare deaths have been reported (2%). Out of PMIS cases we identified 10 articles reporting sporadic cases of myocarditis, pulmonary hypertension and cardiac arrythmias in previously healthy children. We also found another 10 studies reporting patients with pre-existing heart diseases. Most cases consisted in children with severe COVID-19 infection with full recovery after intensive care support, but cases of death were also identified. The management of different cardiac conditions are provided based on current guidelines and expert panel recommendations. CONCLUSION There is still scarce data about the role of cardiovascular involvement in COVID-19 in children. Based on our review, children (previously healthy or with pre-existing heart disease) with acute COVID-19 requiring hospital admission should undergo a cardiac workup and close cardiovascular monitoring to identify and treat timely life-threatening cardiac complications.
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Affiliation(s)
- Moises Rodriguez-Gonzalez
- Pediatric Cardiology Division, Puerta del Mar University Hospital, Cadiz 11009, Spain
- Biomedical Research and Innovation Institute of Cadiz, Puerta del Mar University Hospital, Cadiz 11009, Spain
| | - Ana Castellano-Martinez
- Pediatric Nephrology Division, Puerta del Mar University Hospital, Cadiz 11009, Spain
- Biomedical Research and Innovation Institute of Cadiz, Puerta del Mar University Hospital, Cadiz 11009, Spain
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19
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Maintaining paediatric cardiac services during the COVID-19 pandemic in a developing country in sub-Saharan Africa: guidelines for a "scale up" in the face of a global "scale down". Cardiol Young 2020; 30:1588-1594. [PMID: 33140715 DOI: 10.1017/s1047951120003650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care.There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.
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20
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21
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Review of the efforts of the Japanese Society of Echocardiography for coronavirus disease 2019 (COVID-19) during the initial outbreak in Japan. J Echocardiogr 2020; 18:226-233. [PMID: 32892279 PMCID: PMC7474571 DOI: 10.1007/s12574-020-00487-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/07/2022]
Abstract
Under the coronavirus disease 2019 (COVID-19) pandemic, the Japanese Society of Echocardiography (JSE) has been working to protect medical staff involved in echocardiographic examinations and to prevent secondary infections caused by the examinations since mid-March 2020. This review aims to describe the footprint of the JSE's responses, focusing on the 3 months in which the initial outbreak of COVID-19 pandemic occurred in Japan. We summarized the six parts as follows: (1) the initial actions for COVID-19 of JSE, (2) JSE’s actions for infection control-associated echocardiographic examinations, (3) statements from the American Society of Echocardiography during the COVID-19 pandemic and their Japanese translation by JSE, (4) making videos for explaining the practice of echocardiography during the COVID-19 pandemic, (5) attempts with the JSE members’ opinions by the communication platform and surveys, and (6) efforts of final statement during the initial spread of COVID-19. We look forward that this review will help daily practices associated with echocardiography under the COVID-19 pandemic and in the future event of an unknown infectious disease pandemic.
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22
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Augoustides JG. Perioperative Echocardiography During the Coronavirus Crisis: Considerations in Pediatrics and Congenital Heart Disease. J Cardiothorac Vasc Anesth 2020; 34:2303-2306. [PMID: 32387016 PMCID: PMC7165086 DOI: 10.1053/j.jvca.2020.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/22/2022]
Affiliation(s)
- John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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23
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Faraoni D, Caplan LA, DiNardo JA, Guzzetta NA, Miller-Hance WC, Latham G, Momeni M, Nicolson SC, Spaeth JP, Taylor K, Twite M, Vener DF, Zabala L, Nasr VG. Considerations for Pediatric Heart Programs During COVID-19: Recommendations From the Congenital Cardiac Anesthesia Society. Anesth Analg 2020; 131:403-409. [PMID: 32459667 PMCID: PMC7273948 DOI: 10.1213/ane.0000000000005015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 12/15/2022]
MESH Headings
- Betacoronavirus/pathogenicity
- COVID-19
- COVID-19 Testing
- Cardiology/standards
- Clinical Laboratory Techniques/standards
- Consensus
- Coronavirus Infections/diagnosis
- Coronavirus Infections/therapy
- Coronavirus Infections/transmission
- Coronavirus Infections/virology
- Delivery of Health Care, Integrated/standards
- Health Services Accessibility/standards
- Health Services Needs and Demand/standards
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Host-Pathogen Interactions
- Humans
- Infant, Newborn
- Infection Control/standards
- Infectious Disease Transmission, Patient-to-Professional/prevention & control
- Infectious Disease Transmission, Vertical/prevention & control
- Needs Assessment/standards
- Pandemics
- Pediatrics/standards
- Personal Protective Equipment/standards
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/therapy
- Pneumonia, Viral/transmission
- Pneumonia, Viral/virology
- Risk Assessment
- Risk Factors
- SARS-CoV-2
- Time-to-Treatment/standards
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Affiliation(s)
- David Faraoni
- From the Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lisa A. Caplan
- Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - James A. DiNardo
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nina A. Guzzetta
- Department of Anesthesiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Wanda C. Miller-Hance
- Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Gregory Latham
- Division of Pediatric Cardiac Anesthesia, Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Mona Momeni
- Division of Cardiac Anesthesia, Department of Acute Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Brussels, Belgium
| | - Susan C. Nicolson
- Division of Cardiothoracic Anesthesia, The Cardiac Center at The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - James P. Spaeth
- Division of Cardiac Anesthesia, Department of Anesthesia, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Katherine Taylor
- From the Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mark Twite
- Section of Pediatric Anesthesiology, Department of Anesthesiology, Children’s Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - David F. Vener
- Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Luis Zabala
- Division of Pediatric Cardiac Anesthesia, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children’s Health, Dallas, Texas
| | - Viviane G. Nasr
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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24
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Abstract
Coronavirus disease 2019 (COVID-19), caused by a novel betacoronavirus (SARS-CoV-2), has led to an unexpected outbreak affecting people of all ages. The first data showed that COVID-19 could cause severe pulmonary disease, cardiac injury, and death in adults, especially the elderly and those with concomitant diseases. Currently, it was demonstrated that severe COVID-19 may also develop in neonatal age, although rarely. Newborns with CHD are known to be at high risk for increased morbidity from viral lower respiratory tract infections because of underlying anatomical cardiac lesions. There are limited data on the implications of COVID-19 on patients with cardiovascular disease, especially for those with CHD. Herein, we aimed to summarise the COVID-19-specific perioperative management issues for newborns with CHD by combining available data from the perspectives of neonatology and paediatric cardiovascular surgery.
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Hung J, Abraham TP, Cohen MS, Main ML, Mitchell C, Rigolin VH, Swaminathan M. ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic. J Am Soc Echocardiogr 2020; 33:1034-1039. [PMID: 32762917 PMCID: PMC7237908 DOI: 10.1016/j.echo.2020.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022]
Abstract
Echocardiography services have been interrupted by the COVID pandemic. Services are being gradually reintroduced as healthcare facilities reopen. Operational, workflow and prioritization considerations are suggested.
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Affiliation(s)
- Judy Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael L Main
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Carol Mitchell
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Vera H Rigolin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Telehealth for Pediatric Cardiology Practitioners in the Time of COVID-19. Pediatr Cardiol 2020; 41:1081-1091. [PMID: 32656626 PMCID: PMC7354365 DOI: 10.1007/s00246-020-02411-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 01/18/2023]
Abstract
Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.
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