Effect of acute lower respiratory tract infection on pulmonary artery pressure in children with post-tricuspid left-to-right shunt

Abstract

We sought to examine the influence of clinically severe lower respiratory tract infection on pulmonary artery pressure in children having CHD with post-tricuspid left-to-right shunt, as it may have physiological and clinical implications. In a prospective single-centre observational study, 45 children with post-tricuspid left-to-right shunt and clinically severe lower respiratory tract infection were evaluated during the illness and 2 weeks after its resolution. Pulmonary artery systolic pressure was estimated non-invasively using shunt gradient by echocardiography and systolic blood pressure measured non-invasively. Median pulmonary artery systolic pressure during lower respiratory tract infection was only mildly (although statistically significantly) elevated during lower respiratory tract infection [60 (42–74) versus 53 (40–73) mmHg, (p < 0.0001)]. However, clinically significant change in pulmonary artery systolic pressure defined as the increase of >10 mmHg was present in only 9 (20%) patients. In the absence of hypoxia or acidosis, only a small minority (9%, n = 4) showed significant pulmonary artery systolic pressure rise >10 mmHg. In the absence of hypoxia or acidosis, severe lower respiratory tract infection in patients with acyanotic CHD results in only mild elevation of pulmonary artery systolic pressure in most of the patients.

Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease: A multicentric study from India

“…Pneumonia is the most common noncardiac cause of death in children with CHD, who are known to have poorer outcomes with influenza and other common respiratory viral and bacterial infections. [ 23 24 ] In addition, COVID-19 pneumonia in a child with CHD may lead to progressive hypoxia, worsening V/Q mismatch, embolic events, worsening pulmonary hypertension, and hypercapnic vasoconstriction. The combined effect is likely to be more pronounced in children with cyanotic CHD, leading to worsening of tissue oxygenation and perfusion.…”

COVID-19 in Cyanotic Congenital Heart Disease

“…31 patients had acyanotic CHD, and 39 patients were cyanotic, with >80% of the patients being unoperated. Based on the occurrence of cyanotic episodes, refractory heart failure, persistent shock, or the need for ventilatory support, the degree of sickness upon presentation was divided into severe and nonsevere illness [ 36 ]. Children with CHD are known to have poorer prognosis with common respiratory viral and bacterial infections, and pneumonia are the most prevalent noncardiac cause of mortality in these children [ 36 , 37 ].…”

“…Based on the occurrence of cyanotic episodes, refractory heart failure, persistent shock, or the need for ventilatory support, the degree of sickness upon presentation was divided into severe and nonsevere illness [36]. Children with CHD are known to have poorer prognosis with common respiratory viral and bacterial infections, and pneumonia are the most prevalent noncardiac cause of mortality in these children [36,37]. Furthermore, COVID-19 pneumonia in a child with CHD can result in hypercapnic vasoconstriction, worsening V/Q mismatch, embolic events, worsening pulmonary Patients with Down syndrome are at higher risk for pulmonary infections and Acute Respiratory Distress Syndrome.…”