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.