COVID-19 sequelae on transthoracic echocardiography findings in pediatric patients with septal congenital heart disease: A retrospective comparative analysis

Objective:The COVID-19 pandemic has raised concerns about its impact on patients with congenital heart disease (CHD) with left-to-right shunting.We hypothesized that the pandemic, particularly its long-term sequelae known as Post-Acute Sequelae of SARS-CoV-2 infection (PACS) or long COVID syndrome, may influence cardiac chamber size and functional echocardiographic parameters in this population.Methods: We conducted a retrospective comparative analysis of echocardiographic reports in pediatric CHD patients with left-to-right shunting lesions before (pre-pandemic) and after (post-pandemic) the COVID-19 pandemic.These lesions included atrial (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA).Patients were assessed by following age categories; under one year (infants) and older than one year (older children).Results: Most of the ASDs presented by secundum type, whereas the majority of VSDs consist of perimembranous type of defects in both groups of age categories.Comparison of echocardiographic parameters revealed a significant increase in left atrial size in the post-pandemic group compared to the pre-pandemic group in both older age and infant categories ((21.0(5.0)mm vs 18.9 (3.7), p=0.01; 14.6 (2.1) vs 11.8 (2.6), p=0.003, respectively)).Although the frequency of ASDs did not differ between groups, there was a trend towards a higher prevalence of VSDs in the postpandemic group of older children without statistical significance. Conclusion:Our study provides preliminary evidence of altered cardiac chamber size in CHD patients with left-toright shunting lesions during the post-COVID-19 period.These findings underscore the need for continued surveillance and multidisciplinary management of CHD patients in the context of the pandemic, highlighting the potential impact of COVID-19 on cardiovascular outcomes in this vulnerable population.