Congenital heart disease is a form of heart abnormality that has been acquired since the newborn. The clinical course of this disorder varies from mild to severe. In mild forms, there are often no symptoms, and no abnormalities are found on clinical examination. Whereas in severe CHD, symptoms have been visible since birth and require immediate action. With the development of technology, especially echocardiography, many heart abnormalities that previously could not be detected by physical examination and usual support, ECG, radiology using this tool can be detected easily.
Various types of drugs, maternal diseases, exposure to X-rays, are thought to be exogenous causes of congenital heart disease. Rubella disease suffered by the mother in early pregnancy can cause CHD in the baby. In addition to exogenous factors, there are also endogenous factors associated with the incidence of CHD. Various types of genetic diseases and certain syndromes are closely related to the incidence of CHD such as Down syndrome, Turner syndrome, and others. Congenital heart disease (CHD) is the most common and global inborn defect, affects approximately 1% of live births globally. CHD is a term for a range of birth defects that have varying levels of severity depending on the type. Different types of CHDs include coarctation of the aorta (CoA), atrial septal defects (ASDs), and ventricular septal defects (VSDs) (NHS). Studies have suggested that patients with CHD may be at an increased risk of complications, and thus poorer outcomes, if they acquire COVID-19. Generally, the management of congenital heart disease includes non-surgical management and surgical management. Non-surgical management includes medical management and interventional cardiology. Medical management is generally secondary as a result of complications from heart disease itself or due to other accompanying disorders. In this case, the goal of medical therapy is to relieve symptoms and signs in addition to preparing for surgery. The duration and method of administration of drugs depend on the type of disease at hand.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which led to the coronavirus disease 2019 (COVID-19) pandemic, was initially reported in Wuhan, China in December, 2019. Within cardiology, this has led to outpatient appointments and elective surgeries being reduced and/or postponed. COVID-19 appears to have a complicated relationship with cardiovascular system, as studies have suggested cardiovascular diseases increase disease severity and mortality rates in those who are infected. However, the virus has also been shown to cause cardiovascular complications such as acute myocardial injury, heart failure, and arrhythmia.
CHD require continuing care, particularly amongst newborns and infants who often require surgery during a narrow window of time to avoid death and provide for optimal outcomes. Even though COVID-19 infection in childhood is less common and with milder symptoms than when occurring in adult patients, it is not without the risk of cardiac involvement, especially in the patients with a background of congenital heart disease. In newborns and children, previous cardiac surgery is related with the risk of a more severe form of the disease, being admitted to intensive care unit, and needing intubation as well as mechanical ventilation.
Whilst the aetiology of cardiovascular complications due to SARS-Cov-2 infection is not clear, it has been proposed that ACE2 receptors could be used as a mode of entry into myocytes and cause myocardial injury through various mechanisms. 2019-nCoV gains access into the cells by binding to the same receptor, angiotensin-converting enzyme II (ACE2), as SARS-CoV. SARS-CoV-2 downregulates the expression of ACE2 once inside the cells in which ACE2 is responsible for converting angiotensin II to angiotensin 1–7. Angiotensin II has a pro-inflammatory and pro-fibrotic role as well as being a vasoconstrictor, whereas angiotensin 1–7 play an important antiinflammatory and antioxidant role as well as causing mild vasodilation, protecting the heart and lungs from injury. Angiotensin II levels are found to be notably increased in the plasma of those infected with SARS-CoV-2 whilst high ACE2 levels were seen in those less affected by the virus and these levels reportedly decrease with age.
Coronavirus may also cause myocardial injury via the cytokine storm that occurs in response to a possible large immune response during the infection. Cardiac involvement such as right ventricular failure and congestion can either be a result of respiratory distress or direct cardiac injury caused by the virus, as suggested by the raised cardiac troponin I in critical patients compared to non-critical patients.
Author: Nanda Rachmad Putra Gofur
Details of the research can be viewed here:
http://www.jidmr.com/journal/wp-content/uploads/2022/03/57-D22_1707_Nanda_Rachmad_Putra_Gofur2_Indonesia.pdf
Nanda Rachmad Putra Gofur, Aisyah Rachmadani Putri Gofur, Soesilaningtyas, Rizki Nur Rachman Putra Gofur, Mega Kahdina, Hernalia Martadila Putri4, Zamros Yuzadi Bin Mohd Yusof. Management Congenital Heart Disease Surgery during COVID-19 : A Review Article. JIDMR 2022 15(1):344-348. Journal of International Dental and Medical Research ISSN 1309-100X
