Impact of coronavirus disease 2019 in a child who underwent ventricular septal defect device closure: a case report

Abstract

Background Studies about the incidence and severity of coronavirus disease 2019 (COVID-19) in children are still significantly lower than those in adults. Moreover, data on the effect of COVID-19 in children with congenital heart disease (CHD) are limited. To the best of our knowledge, this study first reported mortality in a child with CHD who acquired COVID-19. Case summary A 16-month-old boy presented to the emergency department due to shortness of breath, fever, cough, and poor oral intake. He tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He required mechanical ventilation for rapidly progressing respiratory failure. The patient had a large mid-muscular ventricular septal defect (VSD) that was closed percutaneously at the age of 13 months. Moreover, we followed his hospital sequelae from admission to death. Discussion This child had multiple risk factors, including malnutrition and persistent pulmonary hypertension (PH) after late closure of the VSD. The pre-existing PH could have been aggravated by the lung condition associated with COVID-19 and the respiratory failure triggered by SARS-CoV-2 infection. The patient presented with ventricular systolic dysfunction, elevated troponin serum levels and newly developed trifascicular block, which were indicative of myocardial injury. The elevated inflammatory markers and multi-organ dysfunction seem to corroborate multisystem inflammatory syndrome in children, which was described recently among paediatric patients with COVID-19.

Heart Block in the Patients with COVID-19

“…The reported mortality rate in our study was 22.45% (n=11) during hospitalization. We noted that 45.45% (n=5) of the patients who died had complete heart block [11][12][13][14][15][16][17] . The other types of heart block reported in the other patients who died include Mobitz type 1 heart block with RBBB 11 , sinus pauses and sinus arrest, sinus tachycardia with an incomplete right bundle branch block (RBBB) 18 , trifascicular block 17 , RBBB and left anterior fascicular block (LAFB), RBBB, left posterior fascicular block (LPFB) and incomplete trifascicular block 13 .…”

“…We noted that 45.45% (n=5) of the patients who died had complete heart block [11][12][13][14][15][16][17] . The other types of heart block reported in the other patients who died include Mobitz type 1 heart block with RBBB 11 , sinus pauses and sinus arrest, sinus tachycardia with an incomplete right bundle branch block (RBBB) 18 , trifascicular block 17 , RBBB and left anterior fascicular block (LAFB), RBBB, left posterior fascicular block (LPFB) and incomplete trifascicular block 13 .…”