SARS-CoV-2 in a Neonate with Truncus Arteriosus: Management and Surgical Correction Timing

Abstract

Children seem to be less affected by SARS-CoV-2 infection. High risk categories should include patients with Congenital Heart Disease (CHD), both children and adults. We describe the case of a newborn with a postnatal diagnosis of Truncus Arteriosus (TA) type A1 without 22.q.11 deletion syndrome. Soon after birth, SARS-CoV-2 infection was transmitted by the father. Due to the onset of heart failure symptoms, diuretic therapy has been set up. For worsening of clinical conditions, inotropic support with milrinone was added. A progressive reduction of N-terminal-pro hormone BNP over the days has been observed. Fourteen days after the negativization of the nasopharyngeal swab, the patient underwent surgical repair with Cardiopulmonary Bypass (CPB). Postoperative course was not complicated and the patient was discharged in good clinical conditions. There is very little evidence suggesting the optimal timing for surgery in SARS-CoV-2 positive patients. With a lack of specific guidelines, current strategy suggests a symptom-based or a polymerase chain reaction (PCR) test-based approach. In our case it was challenging to determine COVID-19 impact on heart failure symptoms. Our case is the first describing the surgical correction of CHD in a 40 days year old patient, performed in CPB after 14 days from SARS-CoV-2 infection negativization.

Keywords: Congenital heart disease; Management; Neonate; SARS-CoV-2; Surgical correction.

Fig. 1

Chest X-rays showing cardiomegaly, hilar congestion and peribronchovascular thickening on preoperative on the 4th day of life (A) and on the 20th day of life (B)

Fig. 2

Preoperative NT-proBNB trend

Fig. 3

The CT scan highlighted disventilative streaks in the middle Lobe; faint subpleural interstitial thickening in the posterior area of haemodynamic significance; diffuse ectasia of the pulmonary vessels, due to overflow