Recommendations for risk stratified use of cardiac computed tomography for congenital heart disease during the COVID-19 pandemic

Abstract

The impact of the coronavirus disease (COVID-19) pandemic in the United States and around the world has required significant changes to medical practice. Amidst the rapidly evolving public health emergency, hospital centers have been required to postpone elective procedures, preserve personal protective equipment (PPE), practice social distancing and limit staff exposures. Patients with congenital heart disease (CHD) often need urgent evaluation, most commonly for preprocedural evaluation. We have stratified the most common indications for cardiac computed tomography (CCT) imaging in patients with CHD to help guide care for these patients during the COVID-19 pandemic including considerations for reopening.

Children with congenital heart disease in COVID-19 pandemic times: an integrative review

“…The 14 selected studies (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) were published in 2020. The results of this review revealed that all selected articles were published in international journals in English, totaling four countries, in which the vast majority, 10 articles, was produced in the United States of America (USA), followed by two publications in Italy, one in Europe and another in Australia.…”

“…Level VII S3 (18) Recommendations for risk stratified use of cardiac computed tomography for congenital heart disease during the COVID-…”

“…In this unit, nine studies (16)(17)(18)(19)(20)(21)(22)(23)(24) reported guidelines/recommendations based on consensus among experts for performing imaging tests, intervention procedures and surgery in children with CHD in COVID-19 pandemic times. S1 (16) highlights that, in regions considered epicenters of CO-VID-19, interventionist practice patterns have changed due to the risk of transmission through direct contact with children and their families, in addition to the limited availability of personal protective equipment (PPE) in many US hospitals, as well as ventilators, making it essential to only perform tests considered to be emergency or very urgent.…”

“…According to S3 (18) , MR is rarely considered a mandatory test, however, it is highlighted that it may be necessary in view of the development of complications caused by COVID-19, such as myocarditis. In these cases, the exam must be performed considering risk/benefit according to the hemodynamic status of the patients and the therapeutic impact of the exam.…”

Healthcare Deprived Centers Attempting Congenital Heart Surgery: what is Desirable versus what is Attainable in this Covid Era?

“…The Yellow fever virus’s ability at 40-50nm in width through with filtered human serum is worrying for our future use of blood products; Covid’s size ranges from 50-200nm. Use of blood products obtained by donation may therefore have uncertain deleterious consequences [ 1 , 3 ] .…”