Emergency Pediatric Cardiac Surgery In An 11-year-old Child Complicated By Covid-19 & Myocarditis
James M. Meza, MD, MSc, Alison Brown, MD, Warwick Ames, MBBS, Veerajalandhar Allareddy, MBBS, Nicholas Andersen, MD, Joseph Turek, MD, PhD.
Duke University Medical Center, Durham, NC, USA.
Objective(s): COVID-19 and its sequelae continue to threaten public health worldwide. Its seemingly distinct manifestations in children, including multi-system inflammatory syndrome, are becoming better understood as well. Emergency surgery has been rarely reported in pediatric patients infected with SARS-CoV-2 and no cases of cardiac surgery in a child with active COVID-19 infection have yet been reported.
Methods: We here describe the course of an 11-year-old girl who underwent emergency atrial septal defect (ASD) closure and device retrieval following embolization of a percutaneous-placed ASD closure device, whose recovery was complicated by severe COVID-19 infection.
Results: The child underwent an uneventful ASD closure with a pericardial patch and retrieval of the percutaneous device, which had been lodged in the chordal apparatus of the anterior leaflet of the mitral valve. Despite a negative pre-operative test, the patient rapidly developed acute, severe COVID-19 infection following surgery. The child’s recovery was complicated by hypoxemia, myocarditis resulting in ventricular dysfunction, coagulopathy, and systemic inflammation. A multi-disciplinary management strategy was employed, as she required treatment with supplemental oxygen, antiviral medication, IVIG, and anticoagulation. The child made a full recovery following an 11 day hospitalization and is in her normal state of health 9 months post-operatively.
Conclusions: We believe this represents the first documented pediatric cardiac operation in a patient with acute COVID-19 and multiple sequelae including myocardial dysfunction and multi-system inflammation. This experience is relevant as children worldwide return to school, travel more widely, and develop acute COVID-19, as some will undoubtedly require emergency surgery.
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