Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
COVID-19 infections in adults with congenital heart disease
N. Langes1, S. J. Maurer2, C. Meierhofer1, N. Nagdyman1, F. Bourier3, S. Holdenrieder4, P. Ewert1, O. Tutarel5
1Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, München; 2Elektrophysiologie, Deutsches Herzzentrum München, München; 3Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München; 4Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, München; 5Deutsches Herzzentrum München/Technische Universität München, München;

Background

Adults with congenital heart disease (ACHD) are considered to have an increased risk for complications due to COVID-19, especially in those patients with cyanosis or heart failure symptoms. However, data regarding the rate of infection in this emerging patient population as well as data 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

In this single-centre study, 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 history 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, 17 patients already knew that they had COVID-19, while 11 patients (39.3%) were not aware of their infection. Out of the 28 patients with a positive antibody test, 14 had no symptoms at all. Patients with symptoms had mainly mild symptom and were all managed in the outpatient setting. 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. In none of them, a myocardial involvement, i.e. signs of active or healed myocarditis, were present.

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. 
https://dgk.org/kongress_programme/jt2022/aV319.html