Adults with congenital heart disease and COVID-19

Background

Adults with congenital heart disease (ACHD) are considered at increased risk for complications due to COVID-19, especially in those with cyanosis or heart failure. However, data regarding the rate of infection as well as regarding a myocardial involvement of a COVID-19 infection in ACHD patients are currently lacking.

Purpose

To study the rate of COVID-19 infections in ACHD patients from a tertiary centre as well as the rate of myocardial involvement of a COVID-19 infection.

Methods

All consecutive ACHD patients (over the age of 18 years) who attended the outpatient clinic of a tertiary centre from January 2021 to June 2021 were eligible to participate. Demographic data, as well as medical/surgical data including a history of a COVID-19 infection were collected. All patients had an antibody test for COVID-19. Patients with a positive antibody test were offered cardiovascular magnetic resonance imaging (CMR).

Results

Altogether, 420 patients (44.8% female, mean age 36.4±11.6 years) were included in the study. Congenital heart defect (CHD) complexity according to the Bethesda classification was simple in 96 (22.9%), moderate in 186 (44.3%), complex in 117 (27.9%), and miscellaneous in 21 (5.0%) patients. A positive antibody test for COVID-19 was present in 28 (6.7%) patients (CHD complexity: simple n=5, moderate n=14, severe n=7, miscellaneous n=2). Out of these 28 patients, 14 had no symptoms at all. Those with symptoms had mainly mild symptoms and were all managed in the outpatient setting. While 11 patients (39.3%) were not at all aware of their infection, 17 already knew that they had COVID-19. There was no significant difference between ACHD patients with a positive test vs those with a negative test regarding age, gender, New York Heart Association class, or complexity of CHD. Out of the 28 patients with a positive antibody test, 14 agreed to a CMR. A myocardial involvement, i.e. signs of active or healed myocarditis, was not present in any of these.

Conclusions

In this single-centre study, 6.7% of ACHD patients attending the outpatient clinic had positive antibodies for COVID-19. Out of these, 50% were asymptomatic and 39.3% were not aware of their infection. A myocardial involvement was not found in any of the patients that underwent a CMR. These results indicate a large number of undetected cases of COVID-19 in the ACHD population and offer reassurance that in the vast majority of cases the infection has a mild course.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Bayerisches Staatsministerium für Wissenschaft und Kunst

Increased cancer incidence in children after cardiac catheterization within the first 8 years of life, a single center experience between 1999 and 2013

Background

Children with congenital heart disease are exposed to ionising radiation early in their lives when tissue sensitivity for radiation is highest. This might provoke DNA fractures and cancer development. Our first study with an observation period from 1980–1998 showed a 4.4-fold increased cancer risk for children who had at least one cardiac catheterization in the first year of life.

Objectives

This study aimed to reassess the risk of cancer for children who underwent at least one cardiac catheterization between 1999 and 2013 with a follow-up of seven years.

Methods

This retrospective, single-center study included 2765 children who underwent at least one cardiac catheterization before eight years of age between January 1999 and December 2013. 1688 received their first cardiac catheterization in the first year of life, 1074 between first and eighth year of life. Catheterization and patient data were obtained from our database, and cancer diagnoses up to age 15 were matched with German Childhood Cancer Registry. For each tumor patient and for each of the 60 randomly selected control patients cumulative effective radiation doses were calculated.

Results

37667.16 person-years were evaluated. A total of ten patients developed a malignant tumor, while 5.82 were expected (SIR 1.72; CI 0.82–3.16; p=0.0722). Eight of these ten tumors developed in patients who received their first cardiac catheterization in the first year of life, while 3.99 were expected (SIR 2.0; CI 0.71–3.62; p=0.1095). The cancer group performed an average of 3.7 cardiac catheterizations per patient, with a mean cumulative effective dose of 24,79mSv. In the control group consisting of 60 patients, 2.1 cardiac catheterizations were performed per patient with an average cumulative effective dose of 21.04mSv. Three of the ten tumor patients have chromosomal abnormalities. The cancers observed are two leukemia, two lymphoma, two CNS tumors, one osteosarcoma, two nephroblastoma and one hepatoblastoma.

Conclusion

There is still an increased risk of cancer development for children with congenital heart disease exposed to ionizing radiation early in life. However, due to technical development and increased sensitivity to this fact, we observed a decrease in cancer disease compared to our previous study with catherization between 1980 and 1998.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Stiftung Kinderherz

Are there correlations between lung volume and exercise capacity in children and adolescents with native Ebstein's anomaly?

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with Ebstein’s Anomaly (EA) represent a wide clinical range with patients needing surgery in infancy and others needing no surgery throughout life. Exercise capacity in EA is often impaired. However, lung function is rarely investigated.

Purpose

This study examines lung volumes in native EA and their correlation with exercise capacity.

Methods

This retrospective study investigated 35 children with native EA (14 ± 4 years, 17 female), who underwent a cardiopulmonary exercise test (CPET) including spirometry to examine peak oxygen uptake (peakV’O2), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and its ratio (FEV/FVC). Percentage in peakV’O2 <80% represents a reduced exercise capacity, and values <60% are defined as impaired. Z-scores below -1.64 categorize restrictive (FVC) or obstructive (FEV1/FVC) patterns. To analyse correlations between CPET and lung volumes Spearman’s rank test was performed.

Results

Reduced exercise capacity was found in 17 children (47%), and further seven (20%) children showed impaired exercise capacity. Seven patients (20%) had a restrictive lung volume pattern and three patients (9%) showed obstructive patterns. One patient showed both. Eleven (92%) patients with an impaired lung function had at least a reduced exercise capacity with a median of 64 [53;73] %predicted. Lung volumes correlate significantly with %peakV’O2 (z-FVC: r=0.500, p=0.002 and z-FEV1: r=0.443, p=0.008).

Conclusions

Most young patients with native EA have impaired results in exercise capacity and a third has reduced lung volumes. Low lung volumes correlate with worse exercise capacity. Thus, the lung function should also be taken into consideration when looking at the performance of these and medical aftercare.

What does a genetic syndrome associated CHD in comparison with CHD patients mean for clinical practice? A cross-sectional study by the German National Register for Congenital Heart defects

Introduction

About 20% of all patients with congenital heart disease (CHD) showing other malformations and abnormalities. They have an increased likelihood for a genetic disorder which is either hereditary or firstly occurred spontaneously. Especially the influence of a genetic syndrome for clinical practice in CHD patients is of particular importance.

Purpose

This cross-sectional registry study focusses patients with CHD in comparison with patients having the most frequent genetic syndrome associated CHD, registered with the National Register for Congenital Heart Defects (NRCHD), to identify whether they are at higher risk for secondary diagnoses (SD), more surgeries and interventional treatments or not.

Methods

By using the NRCHD medical database at the date of 12 Feb 2020, out of a total of 55687 registered CHD patients, 34004 patients with CHD up to thirty years were identified. 28478 (female 48.1%; 16.1±7.0 years) CHD patients without any hereditary fetal or neonatal secondary diagnosis (HFN) representing the control group (CG) and 5526 (female 51.8%; 13.7±6.6 years) CHD patients with HFN were included in the statistical analyses. SD were defined and classified by using the International Paediatric and Congenital Cardiac Code (IPCCC). The CHD severity classification of Warnes at al. was used. Statistical analyses were conducted using a multinomial logistic regression model.

Results

Out of the 5526 CHD patients with HFN, the most frequent genetic syndromes associated with CHD were Trisomy 21 (1645 (4.8%); simple 300 moderate 974 complex 371), Catch 22-syndrome (306 (0.9%); simple 11 moderate 132 complex 163), Noonan syndrome (93 (0.3%); simple 13 moderate 71 complex 9) and Williams-Beuren syndrome (88 (0.3%); simple 2 moderate 82 complex 4). Regarding Trisomy 21 they have a significantly reduced risk of 26.8% for having a number of interventional treatments as high as the CG (OR:0.73 95% CI:0.60–0.89; p=0.002). In Catch 22-syndrome patients a higher risk for acquired secondary diagnosis of 17.6% (OR:1.17 95% CI:1.05–1.31; p=0.004) as well as for interventional treatments of 6.9% (OR:1.06 95% CI:1.01–1.14; p=0.033) was found. A 28.6% higher risk for an increased number of extracardiac secondary diagnoses was shown in Noonan syndrome patients (OR:1.29 95% CI:1.06–1.56; p=0.010). Patients with Williams-Beuren syndrome are at 52.1% decreased risk for having a number of surgeries as high as the CG (OR:0.48 96%CI:0.28–0.83; p=0.008) but a higher risk for a higher number of interventional treatments of 20.5% (OR:1.21 95% CI:1.06–1.37; p=0.004).

Conclusions

Patients with genetic syndrome associated CHD could be assumed being at higher risk for secondary diagnosis, however, this holds true for Noonan syndrome and Catch 22-syndrome patients but not for patients with Trisomy 21 or Williams-Beuren syndrome. It would be necessary to monitor the genetic syndrome associated with CHD patients whether these findings change when they reaching older ages.

Funding Acknowledgement

Type of funding source: None

[Medical care of adults with congenital heart diseases : Present and future]

Congenital heart diseases (CHD) are the most common types of congenital organ defects. Thanks to medical progress in congenital cardiology and heart surgery, most children with CHD reach adulthood. Despite primarily successful treatment residual and subsequent conditions as well as (non)cardiac comorbidities can influence the chronic course of the disease and lead to a higher morbidity and mortality. Adults with congenital heart disease (ACHD) in Germany are not tied to the healthcare structure despite the great need for aftercare. According to the results of the medical care of ACHD (MC-ACHD) study, ACHD centers and specialists in Germany are insufficiently perceived despite increased complication rates and the great need for specialist guidance. General practitioners and patients are not adequately informed about existing ACHD facilities. A better awareness of the ACHD problem should be created at the level of primary medical supply in order to optimize care and to reduce morbidity and mortality. Improved future-oriented patient care includes lifelong regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD.

P1824Aortic wall shear stress in bicuspid aortic valve disease - 10-year follow-up

Introduction

Bicuspid aortic valve (BAV) disease leads to deviant complex helical flow patterns in the aorta - especially in the mid-ascending (AoA) part. In association with congenital BAV, aortic wall alterations such as aortic dilatation and dissection may occur. Among others, wall shear stress (WSS) could be one parameter to contribute to the prediction of the long-term outcome of patients with BAV. 4D-flow in cardiovascular magnetic resonance has been established as a valid method to estimate WSS.

Purpose

The aim of this study is to reevaluate WSS and comparing it to values generated in the same patient cohort with bicuspid aortic valve disease in 2008. No one of the above had aortic dilation in 2008 but proven helical flow pattern. The long term follow-up study might show changes in WSS over the period of ten years.

Methods

Ten complete 4D flow datasets of patients (age at follow-up: median 34.5 years; range 19–41 years) with bicuspid aortic valve disease without enlargement of the aorta were obtained in 2008 and reevaluated in 2018/2019 in the same patient collective. Mean WSS values were calculated with identical specific software tools. All data were analyzed by two experienced investigators.

Results

Aortic diameters at the level of the mid AoA did not change significantly in the 10-year period. The WSS values were lower in 2018 at all levels of the ascending aorta (Table 1). Indexed aortic diameters at the level of the mid ascending aorta did not change, median difference 0.06 cm/m2 (range −0.1 cm/m2 to 0.2 cm/m2; p=0.28), absolute values of indexed AoA diameters in 2018/2019 ranged from 1.27 cm/m2 to 2.2 cm/m2 (median 1.76 cm/m2).

Table 1 WSS magnitudinal [N/m2] 2008 (n=10) 2018 (n=10) Median difference p-value median range median range Level aortic bulb 0.95 0.80–1.46 0.42 0.34–0.82 −0.53 <0.01 Level mid ascending aorta 0.72 0.40–0.98 0.39 0.34–0.59 −0.33 <0.01 Level brachiocephalic trunc (BCT) 0.71 0.38–1.03 0.40 0.37–0.61 −0.31 <0.01

Conclusions

Indexed AoA diameters in BAV disease did not change significantly over a 10-year period. WSS of AoA was less compared to values generated in 2008. This might be explained by a slight alteration in hemodynamic flow patterns by the aging aorta, but not by changes of the aortic diameters. Possibly a drop of WSS in BAV could serve as a marker for a benign long term course.