Categories: Coronavirus

COVID-19 and Congenital Heart Disease

  • My child has been diagnosed with Congenital Heart Disease. How does the COVID-19 pandemic affect my child?

Patients with underlying Congenital Heart Defects are more vulnerable to get critically ill if they are infected with the Coronavirus. Specifically, these groups of patients may be at increased risk for COVID-19:

  1. Single ventricle patients after Fontan operation
  2. Those with cyanosis and decreased ventricular function
  3. Patients with severe pulmonary hypertension
  4. Immune-compromised patients (including those who have undergone heart transplantation)
  5. Infants with unrepaired significant congenital heart disease

So, all precautions should be taken by the family members to minimize the risk of infection for the child.

  • Then should we avoid going for treatment of the child’s heart defect to the hospital to avoid the risk of Coronavirus exposure to my family?

There are various types of Congenital Heart Defects that need treatment at different ages and the timing of surgery or intervention also depends on the child’s symptoms.

Broadly, let us divide the time-frame in which treatment should be sought for heart defects into three categories: Emergency/urgent, early/semi-elective, and elective.

Category 1: Emergency/urgent –

These defects need to be treated by surgery or intervention within hours to days after birth or soon after diagnosis. You cannot delay the treatment for fear of exposure to Coronavirus, as any delay can be life-threatening for the baby. Examples of conditions in this category include Pulmonary Atresia, Critical Coarctation, Critical Aortic Stenosis, Transposition of Great Arteries, and Obstructed TAPVC.

Category 2: Early/semi-elective –

These defects need to be treated by surgery or intervention within a few months. For example, large VSD with severe PAH needs to be treated by 4-6 months of age. Tetralogy of Fallot needs to be operated by 6 months to 1-year age if the child is stable, and even earlier if the baby has cyanotic spells and excessive bluish discoloration. In this category of patients, the timing of surgery depends on the symptoms of the baby in addition to the type of defect. So, if the baby is not gaining weight or is getting admitted with pneumonia to a hospital, then surgery needs to be planned early. In this category of patients, we can delay surgery by a few weeks. But it is risky to delay surgery indefinitely or by more than a month later than the timing of intervention advised by the Pediatric Cardiologist after assessing the patient.

Category 3: Elective –

These defects need to be treated by surgery or intervention in a few months. Delay of a few months in treating these defects will usually not adversely affect the health of the patient. Examples of defects in this category include Secundum ASD, Moderate Restrictive PDA without Heart Failure, Pulmonary Stenosis without RV dysfunction, Moderate Restrictive VSD without Heart Failure.

  • How should we decide which category of defect my child has?

The best people to decide which category of defect your child has, and how urgently the treatment is indicated, are the Pediatric Cardiologists, once they have seen and assessed the patient. If a direct physical consultation is not immediately possible with the Pediatric Cardiologist, even a video consultation can be extremely helpful to assess the child’s symptoms, especially if the child’s complete diagnosis is known with a previous echocardiography report.

  • If I want to bring my child for a pediatric cardiac check-up, what is the procedure like?

At SRCC Children’s Hospital, we are running routine pediatric cardiac OPDs with precautions to prevent cross-infection with COVID-19. These are the precautions and steps of the OPD consultation.

1. Avoid coming to the hospital for a cardiac check-up if the baby or the parents have cough and fever, and if any of the close contacts have recently been diagnosed with COVID-19. This precaution is to prevent cross-infection between hospital patients. Additionally, if the child has cough and fever, treatment of the respiratory infection by the general pediatrician becomes the priority. Once the respiratory infection is treated, we would then assess the child for the cardiac condition.

2. Only one attendant is allowed to enter the hospital with the patient. This is to minimize the number of people in the OPD waiting area and to enable adequate social distancing.

3. Preferably, we would encourage you to take a prior appointment before coming to the hospital, rather than coming as a direct walk-in patient. This would minimize the waiting time in the OPD and shorten the total duration of your hospital visit, as the child would be seen faster, instead of having to wait in line in a busy OPD.

4. Masks need to be worn by the attendants at all times while in the hospital premises, and also should be worn by the patient if they are above the age of 5-6 years.

5. The doctors and nurses who will be seeing the patient including the Pediatric Cardiologist will be wearing an appropriate Personal Protective Equipment (PPE) while seeing the patient. This is to minimize the risk of cross-infection from asymptomatic COVID-19 patients.

  • If we need to admit our child for Surgery or Intervention, what is the procedure like?

Once the Pediatric Cardiac team has decided that the child needs to be admitted for surgery or intervention, the child along with one attendant (usually the mother) is admitted. We would send a COVID-19 swab for the child and the attendant, as per the BMC guidelines (this process can get updated in the future if there is a change in the BMC guidelines). Once the COVID swab comes negative, we would shift the child to the pre-surgical cardiac ward, and the surgery or intervention is planned the next day. While the COVID test results are pending, if an emergency surgery or procedure is needed due to the critical nature of the heart disease, the patient would be treated with the doctors and nurses wearing full PPE and taking all precautions to prevent cross-infections.

It is important to note that studies have shown that risks of surgery and interventions are higher in COVID positive patients. It is important for parents to understand this fact. This does not mean that Emergency Cardiac procedures should not be done in critically ill patients who are COVID positive, as not treating a critical cardiac defect will also be life-threatening. But this means that we must accept a higher risk of the cardiac procedure when we treat these COVID positive patients with critical congenital heart defects.

  • Now that the lockdown is gradually getting relaxed, are routine pediatric cardiac procedures being done at SRCC Children’s hospital?

Yes, we are doing all routine pediatric cardiac procedures now at SRCC Children’s Hospital. However, due to a large backlog of emergency cases, and the need for ICU bed availability due to the COVID-19 pandemic, there may be a longer waiting time for admission for routine cardiac procedures.

Patients coming from out of Mumbai for their treatment would need to arrange for an e-pass along with a local doctor’s prescription and referral letter so they are not stopped at the interstate and inter-district checkpoints when they are coming to our hospital for a surgery or intervention.

  • Are there any special precautions we need to take in patients after cardiac surgery or intervention due to the COVID pandemic?

We should take standard precautions like frequent hand-washing, social distancing, wearing masks when travelling outside, avoiding crowds, and avoiding contact with people with cough and fever. Even after a cardiac procedure, especially after open-heart surgery, although the cardiac defect has been corrected, the patient’s immune response may not be optimal. So, we should minimize any chance of the patient catching a Coronavirus infection. The patient should preferably be at home for the 2-3 weeks immediately after discharge following the procedure to minimize possible contact with asymptomatic COVID-19 patients.

  • I have read that some medicines are risky if the patient gets a Coronavirus infection. Should I stop my child’s cardiac medications?

The present recommendation is that all cardiac medications, including Aspirin, Anticoagulants, ACE inhibitors, Angiotensin Receptor Blockers, Beta-blockers, Diuretics, and Antiarrhythmic medications should be continued during COVID-19 illness. These guidelines may be updated once more scientific evidence becomes available.

  • How long is the pandemic expected to last? Can we just wait it out and seek treatment for my child’s heart condition after the COVID-19 pandemic is over?

The present scientific evidence is suggesting that the pandemic will last for months to years, or at least an effective the vaccine is developed and widely administered. We might have a decrease in cases once people get used to following standard precautions, but we must continue our hospital precautions and safety measures to minimize the risk of infection to the patients during their hospital stay.

As this pandemic is not going away anytime soon, it would not be wise to delay seeking medical attention for other treatable medical conditions such as Congenital Heart Disease. After all, the fear of Coronavirus should not lead us to avoid all medical treatment. Most medical ailments have excellent treatment options available with excellent long-term results if timely diagnosis and treatment is sought. So, in short, we must learn to live with Coronavirus and carry on with our lives, of course with all standard precautions.

Dr. Supratim Sen | Senior Consultant – Paediatric Cardiology | NH SRCC Children’s Hospital, Mumbai

Narayana Health

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