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Impact of coronavirus disease 2019 in a child who underwent ventricular septal defect device closure: a case report
Saud A Bahaidarah1, Ahmed M Dohain1, Gaser Abdelmohsen1
1Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah 21589, Saudi Arabia.
Insights
This case study reports the first known mortality in a child with congenital heart disease (CHD) who contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19. The child experienced respiratory failure and multi-organ dysfunction, highlighting risks for vulnerable pediatric populations.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Limited data exist on COVID-19's impact on children with congenital heart disease (CHD).
- Studies show lower incidence and severity of COVID-19 in children compared to adults.
- This study addresses the knowledge gap regarding COVID-19 outcomes in pediatric CHD patients.
Observation:
- A 16-month-old boy with a history of ventricular septal defect (VSD) closure presented with severe respiratory distress, fever, and cough.
- The patient tested positive for SARS-CoV-2 and required mechanical ventilation due to rapid respiratory failure.
- He had pre-existing risk factors including malnutrition and persistent pulmonary hypertension (PH) post-VSD closure.
Findings:
- The child exhibited ventricular systolic dysfunction, elevated troponin, and a new trifascicular block, indicating myocardial injury.
- COVID-19 exacerbated his pre-existing pulmonary hypertension and led to acute respiratory failure.
- Elevated inflammatory markers and multi-organ dysfunction suggested a potential multisystem inflammatory syndrome in children (MIS-C).
Implications:
- This case highlights the potential for severe outcomes, including mortality, in children with CHD infected with SARS-CoV-2.
- It underscores the importance of considering COVID-19 in pediatric patients with complex cardiac conditions presenting with respiratory symptoms.
- Early recognition and management of COVID-19 complications, such as myocardial injury and multi-organ dysfunction, are critical in this vulnerable population.
Background:
Studies about the incidence and severity of coronavirus disease 2019 (COVID-19) in children are still significantly lower than those in adults. Moreover, data on the effect of COVID-19 in children with congenital heart disease (CHD) are limited. To the best of our knowledge, this study first reported mortality in a child with CHD who acquired COVID-19.
Case Summary:
A 16-month-old boy presented to the emergency department due to shortness of breath, fever, cough, and poor oral intake. He tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He required mechanical ventilation for rapidly progressing respiratory failure. The patient had a large mid-muscular ventricular septal defect (VSD) that was closed percutaneously at the age of 13 months. Moreover, we followed his hospital sequelae from admission to death.
Discussion:
This child had multiple risk factors, including malnutrition and persistent pulmonary hypertension (PH) after late closure of the VSD. The pre-existing PH could have been aggravated by the lung condition associated with COVID-19 and the respiratory failure triggered by SARS-CoV-2 infection. The patient presented with ventricular systolic dysfunction, elevated troponin serum levels and newly developed trifascicular block, which were indicative of myocardial injury. The elevated inflammatory markers and multi-organ dysfunction seem to corroborate multisystem inflammatory syndrome in children, which was described recently among paediatric patients with COVID-19.
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