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      COVID-19 in a Child With Transposition of the Great Arteries S/P Fontan Palliation: A Case Report and Literature Review

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          Abstract

          Background

          Although adult patients with cardiovascular disease are at higher risk of adverse outcomes such as death or severe infection, limited data exist regarding pediatric patients with congenital heart disease. We would like to report our experience with COVID-19 in a pediatric patient with Fontan circulation. Furthermore, we present a review of patients with Fontan palliation and COVID-19 previously reported in the literature to summarize the clinical characteristics of this population.

          Case Presentation

          A 9-year-old boy with dextro-transposition of the great arteries, ventricular septal defect, pulmonary stenosis, patent foramen ovale, and borderline left ventricle post bidirectional Glenn shunt and Fontan palliation presented with paroxysmal cough in the context of COVID-19. The coagulation profile was beyond the normal limits, and the patient began to receive anticoagulant aspirin. On the 5th day, the patient presented with fever, sore throat, and fatigue. The oxygen saturations dropped to 93%, and he received nasal catheter oxygen inhalation. On the 7th day, computed tomography of the chest revealed little emerging flaky exudation in the posterior basal segment of the left lower lobe. Nasal cannula was removed on the 12th day, and the coagulation profile returned to normal on the 16th day. After two consecutively negative SARS-CoV-2 viral RNA tests (on the 18th and 19th days, interval ≥ 24 h), he was discharged from the hospital on the 21st day. Literature review indicated that COVID-19 with Fontan palliation seemed to be more common in male adults. Disease presentation varied from mild upper respiratory tract infection to severe pneumonia. Complications were not uncommon in this population. The treatments varied depending on the specific factors. Fortunately, most patients reported a favorable prognosis.

          Conclusion

          Although patients with COVID-19 and Fontan circulation might have the risk of adverse outcomes due to multiple mechanisms, most patients have a favorable prognosis.

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          Most cited references14

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          Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China

          To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China.
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            Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper

            Summary The coronavirus disease 2019 (COVID-19) pandemic poses an enormous challenge to healthcare systems in affected communities. Older patients and those with pre-existing medical conditions have been identified as populations at risk of a severe disease course. It remains unclear at this point to what extent chronic liver diseases should be considered as risk factors, due to a shortage of appropriate studies. However, patients with advanced liver disease and those after liver transplantation represent vulnerable patient cohorts with an increased risk of infection and/or a severe course of COVID-19. In addition, the current pandemic requires unusual allocation of healthcare resources which may negatively impact the care of patients with chronic liver disease that continue to require medical attention. Thus, the challenge hepatologists are facing is to promote telemedicine in the outpatient setting, prioritise outpatient contacts, avoid nosocomial dissemination of the virus to patients and healthcare providers, and at the same time maintain standard care for patients who require immediate medical attention.
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              Coronavirus Disease 2019 (COVID‐19) Pandemic Implications in Pediatric and Adult Congenital Heart Disease

              Abstract The corona virus disease ‐2019 (COVID‐19) is a recently described infectious disease caused by the severe acute respiratory syndrome corona virus 2 with significant cardiovascular implications. Given the increased risk for severe COVID‐19 observed in adults with underlying cardiac involvement, there is concern that patients with pediatric and congenital heart disease (CHD) may likewise be at increased risk for severe infection. The cardiac manifestations of COVID‐19 include myocarditis, arrhythmia and myocardial infarction. Importantly, the pandemic has stretched health care systems and many care team members are at risk for contracting and possibly transmitting the disease which may further impact the care of patients with cardiovascular disease. In this review, we describe the effects of COVID‐19 in the pediatric and young adult population and review the cardiovascular involvement in COVID‐19 focusing on implications for patients with congenital heart disease in particular.
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                Author and article information

                Contributors
                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                06 July 2022
                2022
                06 July 2022
                : 9
                : 937111
                Affiliations
                [1] 1Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
                [2] 2Department of Pediatrics, The First Affiliated Hospital of Xiamen University , Xiamen, China
                [3] 3Pediatric Key Laboratory of Xiamen , Xiamen, China
                [4] 4Institute of Pediatrics, School of Medicine, Xiamen University , Xiamen, China
                [5] 5The School of Clinical Medicine, Fujian Medical University , Fuzhou, China
                [6] 6The Third Clinical Medical College, Fujian Medical University , Fuzhou, China
                Author notes

                Edited by: Hongfang Jin, Peking University, China

                Reviewed by: Yanqiu Ou, Guangdong Academy of Medical Sciences, China; Tianli Zhao, Central South University, China; Atsuhito Takeda, Hokkaido University Hospital, Japan

                *Correspondence: Gangxi Lin lingangxi@ 123456qq.com

                This article was submitted to Pediatric Cardiology, a section of the journal Frontiers in Cardiovascular Medicine

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fcvm.2022.937111
                9297369
                94157de6-a525-4e94-865d-3d6129455538
                Copyright © 2022 Wen, Shi, Liu, Zhang, Lin and Chen.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 05 May 2022
                : 10 June 2022
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 14, Pages: 6, Words: 3685
                Funding
                Funded by: National Natural Science Foundation of China, doi 10.13039/501100001809;
                Award ID: 81801777
                Award ID: 81970267
                Award ID: 82170307
                Funded by: School of Medicine, Shanghai Jiao Tong University, doi 10.13039/501100008233;
                Award ID: YG2022QN094
                Funded by: Science and Technology Commission of Shanghai Municipality, doi 10.13039/501100003399;
                Award ID: 19411964000
                Award ID: 20025800300
                Categories
                Cardiovascular Medicine
                Case Report

                congenital heart disease,covid-19,fontan procedure,sars-cov-2,case report

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