COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease.

BACKGROUND Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications. OBJECTIVES The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients. METHODS COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2 g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression. RESULTS Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12 TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; P < 0.0001) and were in more advanced physiological stage (P = 0.032) and NYHA functional class (P = 0.01), had lower baseline oxygen saturation (P = 0.0001), and more frequently had a history of atrial arrhythmia (P < 0.0001), previous hospitalization for heart failure (P < 0.0007), and were more likely hospitalized for COVID-19 (P < 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95% CI: 2-11.76; P = 0.0003), cardiac injury (OR: 5.34; 95% CI: 1.98-14.76; P = 0.0009), and severe COVID-19 (OR: 17.39; 95% CI: 6.67-45.32; P < 0.0001) were independently associated with increased risk of TE/bleeding complications. CONCLUSIONS ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants

Four successful pregnancies in a patient with Fontan palliation and congenital heart disease: a case report

Abstract Background Fontan is a palliative procedure in patients with single ventricle. Single ventricle supports systemic cardiac output and pulmonary blood flow is passively directed to the right pulmonary artery. Women with Fontan palliation are reported to have increased maternal risk during pregnancy. There are few reports of successful pregnancies in such cases. However data on these pregnancies is lacking, we consider this to be the first reported from kingdom of Saudi Arabia. Case presentation We present a 35-year-old woman from the Kingdom of Saudi Arabia who had Fontan surgery and who had four successful pregnancies and multiple miscarriages. She delivered live, low birth weight neonates. Conclusion This report provides an anecdotal evidence that pregnancy can be tolerated in an adequate Fontan patient with successful outcomes

80. Atrioventricular septal defect and tetralogy of Fallot: A 16-year experience

The choice between primary and staged repair of atrioventricular septal defect with tetralogy of Fallot (AVSD/TOF) is still controversial. We report our surgical experience with this lesion. Methods: Twenty-four patients with AVSD/TOF were repaired between 1997 and 2013. Ten, group 1 (40%), underwent primary repair at a mean age of 29.4 months. Fourteen, group 2 (60%), underwent staged repair at a mean-age of 65.2 months. Mean interval between shunt and repair was 26.5 months. Out of 24 patients, 8 (33%) were repaired by transannular patch, 15 (62%) by pulmonary valve preservation and 1 by pulmonary valve replacement. Results: There was one hospital death in group 2. Mean follow-up period was 70 months. In group 1, 8 patients were alive while 2 were lost to follow-up. Three were re-operated, one for mitral valve repair and left diaphragmatic plication, one for thoracic duct ligation and one for pulmonary valve replacement. In group 2, 10 patients were alive while 3 were lost to follow-up. One developed biventricular outflow obstruction and is awaiting surgery. One had ventricular septal defect device closure. There were 3 reoperations, one for left atrioventricular valve and pulmonary valve replacement, one for pulmonary valve replacement alone and one for relief of biventricular outflow obstruction. All transannular patch patients had dilated right ventricle with moderate to severe tricuspid valve regurgitation. Conclusion: Shunt procedure is a reasonable initial option for many of patients with AVSD/TOF but primary repair can be performed in selected patients with low operative mortality and reasonable morbidity

Pulmonary arterial hypertension in Saudi Arabia: Patients′ clinical and physiological characteristics and hemodynamic parameters. A single center experience

Aims: The main objective of this study is to describe patients′ clinical characteristics and physiological and hemodynamic parameters at the time of diagnosis in a pulmonary hypertension center in Saudi Arabia. Materials and Methods: This study reports the results from a single pulmonary hypertension specialized center in Riyadh, Saudi Arabia, namely Prince Sultan Medical Military City/Cardiac Center (PSMMC & CC). Both newly diagnosed (incidence) and referred (prevalence) cases of pulmonary arterial hypertension are included. All characteristics, including clinical, physiological, and hemodynamic parameters at the time of diagnosis are described. Results: A total of 107 patients were identified as having pulmonary arterial hypertension as diagnosed by right heart catheterization. The mean age at diagnosis was 36 (± 9) years, and there was a female preponderance of 62.6%. The mean duration between symptom onset and diagnosis was 27.8 (± 9.0) months. At the time of enrollment, 56.1% of patients were in functional class III and 16.8% were in functional class IV. Fifty five patients (51.4%) were diagnosed as idiopathic pulmonary arterial hypertension, 29 patients (27.1%) as congenital heart disease associated with pulmonary arterial hypertension, 16 patients (15.0%) as connective tissue diseases associated with pulmonary arterial hypertension, 4 patients (3.7%) as heritable pulmonary arterial hypertension, and 3 patients (2.8%) as portopulmonary hypertension. Conclusion: This data highlights the current situation of pulmonary arterial hypertension in Saudi Arabia. Our patients are much younger than patients described in other international registries but still detected as late in the course of the disease. A majority of patients displays severe functional and hemodynamic compromise