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Adult congenital heart disease and the COVID-19 pandemic

Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease preven...

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Autores principales: Radke, Robert M, Frenzel, Tim, Baumgartner, Helmut, Diller, Gerhard-Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299644/
https://www.ncbi.nlm.nih.gov/pubmed/32522822
http://dx.doi.org/10.1136/heartjnl-2020-317258
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author Radke, Robert M
Frenzel, Tim
Baumgartner, Helmut
Diller, Gerhard-Paul
author_facet Radke, Robert M
Frenzel, Tim
Baumgartner, Helmut
Diller, Gerhard-Paul
author_sort Radke, Robert M
collection PubMed
description Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures.
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spelling pubmed-72996442020-06-23 Adult congenital heart disease and the COVID-19 pandemic Radke, Robert M Frenzel, Tim Baumgartner, Helmut Diller, Gerhard-Paul Heart Review Adults with congenital heart disease (ACHD) may be at high risk in the case of COVID-19. Due to the heterogeneity of ACHD and secondary complications, risk profiles are, however, not uniform. This document aims to give an overview of relevant data and outline our pragmatic approach to disease prevention and management. Based on anatomy and additional physiological factors including symptoms, exercise capacity, heart failure, pulmonary hypertension and cyanosis, we propose a pragmatic approach to categorising patients into low-risk, intermediate-risk and high-risk groups. We regard especially patients with complex cyanotic conditions, those with palliated univentricular hearts, heart failure, severe valvular disease or pulmonary hypertension as high-risk patients. To avoid infection, we recommend self-isolation and exemption from work for these cohorts. Infected ACHD patients with low or moderate risk and without signs of deterioration may be remotely followed and cared for at home while in self isolation. High-risk patients or those with signs of respiratory or cardiovascular impairment require admission ideally at a tertiary ACHD centre. Especially patients with complex, cyanotic disease, heart failure and arrhythmias require particular attention. Treatment in patients with cyanotic heart disease should be guided by the relative degree of desaturation compared with baseline and lactate levels rather than absolute oxygen saturation levels. Patients with right heart dilatation or dysfunction are potentially at increased risk of right heart failure as mechanical ventilation and acute respiratory distress syndrome can lead to increase in pulmonary arterial pressures. BMJ Publishing Group 2020-09 2020-06-10 /pmc/articles/PMC7299644/ /pubmed/32522822 http://dx.doi.org/10.1136/heartjnl-2020-317258 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Review
Radke, Robert M
Frenzel, Tim
Baumgartner, Helmut
Diller, Gerhard-Paul
Adult congenital heart disease and the COVID-19 pandemic
title Adult congenital heart disease and the COVID-19 pandemic
title_full Adult congenital heart disease and the COVID-19 pandemic
title_fullStr Adult congenital heart disease and the COVID-19 pandemic
title_full_unstemmed Adult congenital heart disease and the COVID-19 pandemic
title_short Adult congenital heart disease and the COVID-19 pandemic
title_sort adult congenital heart disease and the covid-19 pandemic
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299644/
https://www.ncbi.nlm.nih.gov/pubmed/32522822
http://dx.doi.org/10.1136/heartjnl-2020-317258
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