Pre-operative assessment of pediatric congenital heart disease patients in the COVID-19 era: lessons learned

Abstract

Background: Equal to COVID-19 patients, non-COVID-19 patients are affected by the medical and social drawbacks of the COVID-19 pandemic. A significant reduction in elective life-changing surgeries has been witnessed in almost all affected countries. This study discusses an applicable and effective pre-operative assessment protocol that can be applied during the COVID-19 era. Methods: Our study is a descriptive retrospective observational study that involves pediatric patients with CHD requiring open heart surgeries at our tertiary care center between March and November 2020. We reviewed the charts of eligible patients aged 18 years and below. We identified the total numbers of scheduled, performed, and postponed surgeries, respectively. A thorough description of the clinical and physical presentation of the postponed cases, who tested positive for SARS-CoV-2, is provided. Results: 68 open heart surgeries were scheduled at our center between March and November 2020. Three surgeries (4%) were postponed due to COVID-19. The three patients were asymptomatic COVID-19 cases detected on routine SARS-CoV-2 PCR testing. No symptoms of cough, chest pain, dyspnea, rhinorrhea, diarrhea, abdominal pain, anosmia, and ageusia were reported by our patients. All patients were afebrile and hemodynamically stable. Owing to the pre-operative assessment protocol that was implemented after the first case was detected, only three healthcare workers were at risk of COVID-19 transmission and were imposed to infectious evaluation and home quarantine. Conclusion: Adopting our discussed preoperative COVID-19 assessment protocol for CHD patients is an effective method to detect COVID-19 infections, optimize patient care, and ensure healthcare workers’ safety.

NT-proBNP cardiac value in COVID-19: a focus on the paediatric population

“…[9][10][11][12][13] The clinical applications of NT-proBNP have long been utilised prior to COVID-19, and they not only include determining the severity of heart failure but also the risk stratification in patients with coronary artery disorders. 14 The COVID-19 pandemic was the main source of considerable morbidity and mortality as of December 2019, and as a result, the worldwide community has faced and is still facing significant financial, social, and medical challenges 15 This pandemic is considered the third outbreak caused by the β-coronavirus family, following the Severe Acute Respiratory Syndrome in 2002 and the Middle East Respiratory Syndrome in 2012. 16 Interestingly, evidence linking brain natriuretic peptide and NT-proBNP with the COVID-19 disease has surged, with multiple studies showing that the levels could be indicative of the severity of the disease [17][18][19][20] The relationship between brain natriuretic peptide/NT-proBNP and in-hospital mortality due to COVID-19 has also been tackled, with some studies correlating the high biomarker levels with a higher risk of mortality.…”