Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.

Concerns for cardiovascular sequelae of coronavirus disease 2019 (COVID-19), including myocardial injury or myocarditis, brought about recommendations for evaluating athletes after infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 Assessments that were based on symptoms, disease severity, and cardiovascular testing were refined to guide decision making and safe return to play in various groups. 2 However, cardiac magnetic resonance (CMR) findings of myocarditis in athletes have ranged from as high as 15% (4 out of 26 athletes in one study) to as low as 1.4% (2 out of 145 athletes in another study), many of whom had no or only mild symptoms, have raised concerns around testing in this population. 3,4 CMR is a recognized tool for diagnosing myocarditis yet is not generally recommended for athletes after COVID-19 without an elevated index of suspicion. 2,5 Given limited data in competitive athletes after infection with SARS-CoV-2, we report our initial experience with an algorithmguided screening of collegiate athletes and intermediate-term follow-up.Collegiate athletes were evaluated in sports cardiology clinic no sooner than 10 days after testing positive for SARS-CoV-2 by reverse transcriptase polymerase chain reaction. A 12-lead ECG, transthoracic echocardiogram, and conventional cardiac troponin I (cTn) level were obtained from all athletes regardless of symptom history or illness severity. Anyone with an abnormal test result or clinical evaluation of concern was referred for CMR. Those with normal evaluations and negative testing results or negative CMR were returned to full participation after a graduated reintroduction of exercise. Clinical follow-up occurred through communication with university athletic staff. The study was approved by the University of Tennessee Institutional Review Board. The data will be made available on reasonable request.We evaluated 137 athletes from July 9, 2020, to October 21, 2020. Athletes were young adults (median, 20 years; range, 18-27 years), majority male (n=93, 68%), and of various racial/ethnic backgrounds (Black, n=66, 48%; White, n=65, 47%; Hispanic, n=10, 7%). Median time to evaluation was 16 days (interquartile range, 12-34). A broad range of athletics was represented: football (n=51, 37%), dance (n=18, 13%), basketball (n=16, 12%), baseball (n=13, 10%), tennis (n=8, 6%), softball (n=7, 5%), soccer (n=7, 5%), cheer (n=6, 4%), track (n=5, 4%), volleyball (n=4, 3%), and golf (n=2, 1%). Students represented 3 universities and competed across National Collegiate Athletic Association Divisions 1 (majority), 2, and 3.Most athletes were symptomatic (n=112, 82%) and experienced only mild (n=75, 67%) or moderate (n=37, 33%) symptoms. The most frequent symptoms were loss of smell/taste (n=65, 58%), fever (<2 days, n=47, 42%), headache (n=46, 41%), and fatigue (n=45, 40%). Less frequently, shortness of breath (n=14, 12%) and chest pain/tightness (n=13, 11%) were reported. Black and Cardiovascular Evaluation After COVID-19 in 137 Collegiat...

Opinion statement Adults with complex congenital heart disease that resulted in a Fontan procedure frequently experience late cardiac failure. Increasingly, liver disease is recognized as an important complication of single-ventricle anatomy and Fontan physiology; however, there is no consensus regarding liver evaluation in this population. Here, we review what is known about liver disease in this unique group and propose screening and prevention measures. We also review controversial treatment areas including assist devices and transplantation, with a review of outcomes in isolated heart and combined heart-liver transplant.

Hematopoietic, mesenchymal, and epithelial progenitors were mobilized into the circulation of patients on ECMO. This may reflect a response to severe cardiopulmonary injury, blood-foreign surface interactions with the ECMO circuit, and/or hemodilution.

Development of gene transfer vectors with regulated, lung-specific expression will be a useful tool for studying lung biology and developing gene therapies. In this study we constructed a series of lentiviral vectors with regulatory elements predicted to produce lung-specific transgene expression: the surfactant protein C promoter (SPC) for alveolar epithelial type II cell (AECII) expression, the Clara cell 10-kD protein (CC10) for Clara cell expression in the airway, and the Jaagskiete sheep retrovirus ( JSRV) promoter for expression in both cell types. Transgene expression from the SPC and CC10 vectors was restricted to AECII and Clara cell lines, respectively, while expression from the JSRV vector was observed in multiple respiratory and nonrespiratory cell types. After intratracheal delivery of lentivector supernatant to mice, transgene expression was observed in AECII from the SPC lentivector, and in Clara cells from the CC10-promoted lentivector. Transgene expression was not detected in nonrespiratory tissues after intravenous delivery of CC10 and SPC lentiviral vectors to murine recipients. In summary, incorporation of genomic regulatory elements from the SPC and CC10 genes resulted in respiratory specific transgene expression in vitro and in vivo. These vectors will provide a useful tool for the study of lung biology and the development of gene therapies for lung disorders.

MethodsAfter approval from the Institutional Review Board, the Pediatric Cardiology and Ahmanson/UCLA Adult Congenital Heart Disease databases were searched for all patients who had undergone prior E-TCPC between 2005 and 2015. Those patients without computed tomography (CT) imaging after the E-TCPC operation were excluded from further study. Patient characteristics including baseline demographics, congenital diagnosis, surgical history, arrhythmia history, and hemodynamic data were recorded.All postoperative CT studies were reviewed in blinded fashion by 1 electrophysiologist and 1 radiologist. Three-dimensional reconstructions of CT examinations were performed using DICOM viewer © 2015 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-Patients with surgically palliated total cavopulmonary connection are at risk for recurrent atrial arrhythmia requiring catheter ablation. Transcatheter procedures for those with extracardiac conduits (extracardiac-total cavopulmonary connection) are perhaps the most challenging because of exclusion of the venous circulation from the arrhythmia substrate. Puncture through the inferior vena cava to the pulmonary venous atrium may be an effective route for access in these patients. Methods and Results-The pediatric and adult congenital surgical databases were explored for patients with extracardiactotal cavopulmonary connection and postoperative computed tomography imaging to assess for the presence of clinically relevant (>3 mm) apposition between the inferior vena cava and pulmonary venous atrium (cavoatrial overlap). The degree of overlap between the structures was measured by 2 blinded reviewers. Patients were stratified by surgical repair in childhood versus adult congenital heart disease. Thirty-seven patients were identified, with cavoatrial overlap observed in 9 (36%) of pediatric and 1 (9%) of adult congenital heart disease-repaired patients. Time elapsed after surgery was associated with cavoatrial overlap in the pediatric cohort (P=0.034) and was identified in all pediatric patients with computed tomography imaging ≥8 years after surgery. Three patients underwent successful transcaval puncture during the study period without complication. Conclusions-Puncture through a region of overlap between the inferior vena cava and pulmonary venous atrium is feasible. Cavoatrial overlap is present in a substantial proportion of patients undergoing extracardiac-total cavopulmonary connection in childhood and is associated with a longer time elapsed since surgery. (Circ Arrhythm Electrophysiol.

The hemodynamic effects of a patent ductus arteriosus (PDA) are well known including systemic hypoperfusion and volume overload on the left ventricle. This article aims to provide a review of the long‐standing effect of a hemodynamically significant PDA on the pulmonary vasculature and the role of cardiac catheterization in preterm infants with a PDA and pulmonary hypertension.

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