COVID-19 pneumonia in an infant with a hemodynamically significant ventricular septal defect

Abstract

Reports thus far suggest a mild course for acute COVID-19 infection in children; however, its effects in vulnerable paediatric populations, including children with haemodynamically significant congenital heart disease, have rarely been reported. We therefore report on a 4-month-old Hispanic male with a moderate sized conoventricular ventricular septal defect and pulmonary overcirculation who presented with COVID-19-associated pneumonia.

Keywords: COVID-19; cardiomegaly; pneumonia; pulmonary overcirculation; ventricular septal defect.

Figure 1.

The chest radiograph shows levocardia, cardiomegaly, increased pulmonary vascularity, left-sided aortic arch, normal visceral situs, and a left-sided retrocardiac opacity suggesting pneumonia.

Figure 2.

The echocardiogram shows moderate left atrial and left ventricular dilation (Panels a, b, and c). The moderate-sized conoventricular ventricular septal defect is profiled in apical 4-chamber, parasternal long, and parasternal short axis views (red arrows, Panels b, c, and d). Interrogation with Colour Doppler reveals the shunt across the ventricular septal defect to be left-to-right. Continuous wave Doppler interrogation of the pulmonary valve (Panel e) reveals an increase in flow velocity (peak velocity 3.2 m/second, peak gradient 41 mmHg) across a normal-sized pulmonary valve annulus (1.0 cm, Z score = 0.29). An increase in flow velocity (Peak E wave velocity = 1.54 m/second, mean gradient = 3.3 mmHg) is also noted across a normal-sized mitral valve annulus (1.9 cm, Z score = 1.7) upon continuous wave Doppler interrogation suggesting functional mitral stenosis (Panel f).