Sen Supratim, Joshi Vinay, Majhi Lopamudra, Pradhan Priya M, Jain Sneha, Dhabe Vaibhav, Trivedi Dipesh, Kaushik Pradeep K
Department of Pediatric Cardiology, NH SRCC Children's Hospital, Mumbai, Maharashtra, India.
Department of Pediatric Intensive Care, NH SRCC Children's Hospital, Mumbai, Maharashtra, India.
Ann Pediatr Cardiol. 2022 Jan-Feb;15(1):27-33. doi: 10.4103/apc.apc_162_21. Epub 2022 Jun 14.
We evaluated our early experience of cardiac procedures in children with congenital heart defects (CHD) after asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, to understand whether recent reverse transcription-polymerase chain reaction (RT-PCR) positivity had a negative impact on their postprocedural recovery and outcomes.
In this retrospective observational study, all patients with CHD who underwent cardiac surgery or transcatheter intervention at our institution between March 2020 and June 2021 who were detected to have asymptomatic SARS-CoV-2 infection on routine RT-PCR were included. Details of the cardiac procedure and postprocedural recovery were reviewed and compared with RT-PCR-negative patients who concurrently underwent similar cardiac surgeries or interventions at our center.
Thirteen patients underwent cardiac surgery after recent SARS-CoV-2 positivity after a mean interval of 25.4 ± 12.9 days. One patient expired with multiorgan dysfunction and systemic inflammatory response with elevated D-dimer, serum Ferritin, C-reactive protein, and significant ground-glass opacities on chest radiograph. Another patient developed spontaneous thrombosis of the infrarenal abdominal aorta, bilateral iliac arteries, and bilateral femoral veins, requiring low-molecular weight heparin postoperatively. This patient's postoperative recovery was also prolonged due to lung changes delaying extubation. All other patients had uneventful postprocedural recovery with intensive care unit and hospital stays comparable to non-SARS-CoV-2-infected patients.
From our early experience, we can surmise that an interval of 2-3 weeks after asymptomatic SARS-CoV-2 infection is adequate to undertake elective or semi-elective pediatric cardiac surgeries. For patients requiring emergent cardiac surgery prior to this interval, there is potentially increased risk of inflammatory and/or thrombotic complications.
我们评估了先天性心脏病（CHD）患儿在无症状严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染后进行心脏手术的早期经验，以了解近期逆转录聚合酶链反应（RT-PCR）阳性是否会对其术后恢复和结局产生负面影响。
在这项回顾性观察研究中，纳入了2020年3月至2021年6月期间在我们机构接受心脏手术或经导管介入治疗且在常规RT-PCR检测中被发现无症状SARS-CoV-2感染的所有CHD患者。回顾了心脏手术的细节和术后恢复情况，并与同期在我们中心接受类似心脏手术或介入治疗的RT-PCR阴性患者进行了比较。
13例患者在近期SARS-CoV-2阳性后平均间隔25.4±12.9天接受了心脏手术。1例患者因多器官功能障碍和全身炎症反应死亡，D-二聚体、血清铁蛋白、C反应蛋白升高，胸部X线片显示明显的磨玻璃影。另1例患者发生肾下腹主动脉、双侧髂动脉和双侧股静脉自发性血栓形成，术后需要使用低分子量肝素。由于肺部改变延迟拔管，该患者的术后恢复也延长。所有其他患者术后恢复顺利，重症监护病房和住院时间与未感染SARS-CoV-2的患者相当。
根据我们的早期经验，我们可以推测，无症状SARS-CoV-2感染后2至3周的间隔时间足以进行择期或半择期小儿心脏手术。对于在此间隔时间之前需要紧急心脏手术的患者，炎症和/或血栓形成并发症的风险可能会增加。
