Patients with complicated COVID-19 course
| Age (years) | Sex | Main diagnosis | Clinical background and disease course | Main cause of fatal outcome/relation to congenital heart defect |
| Fatal outcomes | ||||
| 40–50 | Male | Repaired tetralogy of Fallot | Pre-existing severe biventricular dysfunction and progressive heart failure (had implanted CRT-D), cardiac-related liver cirrhosis and right lung hypoplasia due to an occluded right pulmonary artery; decision regarding cardiac and liver transplant was pending. Admitted with ARDS; due to comorbidities, the patient was not considered a candidate for extensive cardiorespiratory support; patient died at day 3 after hospital admission. | Death due to SARS-CoV-2 infection (ARDS related to COVID-19) Comorbidities: three (heart failure, liver and lung disease) |
| >60 | Male | Repaired pulmonary valve stenosis | Mild pulmonary regurgitation, acquired cardiovascular disease (coronary artery disease, previous ischaemic stroke, abdominal aneurysm, atrial fibrillation) and COPD; NYHA class II prior to COVID-19. Admitted with bilateral pneumonia leading to ARDS requiring intubation on the day of admission; renal failure occurred 3 days after presentation; patient died on day 11 after admission with multiorgan failure. | Death due to SARS-CoV-2 infection (ARDS related to COVID-19) Comorbidities: three (previous stroke, coronary artery disease and lung disease) |
| 40–50 | Female | Bicuspid aortic valve with severe aortic stenosis | Presentation with decompensated heart failure due to severe aortic stenosis, requiring urgent surgical aortic valve replacement; at admission, COVID-19 was not suspected; complicated postoperative course with cardiogenic shock requiring venoarterial ECMO. Developed ARDS on first postoperative day and tested positive for SARS-CoV-2; patient died 7 days after surgery. | Death with SARS-CoV-2 infection (postoperative death due to heart failure) Comorbidities: one (heart failure) |
| 50–60 | Female | Eisenmenger syndrome with unrepaired complete AVSD | Severe pulmonary hypertension, heart failure and moderate leucopenia; presentation at the emergency department with bilateral pneumonia and ARDS. Due to the patient’s functional status (NYHA class III) prior to COVID-19 and personal preferences, she was transferred to a palliative care centre; she died on day 32 after initial hospital admission. | Death due to SARS-CoV-2 infection (ARDS related to COVID-19) Comorbidities: two (heart failure and pulmonary hypertension) |
| 40–50 | Female | Eisenmenger syndrome with unrepaired complete AVSD | Severe pulmonary hypertension, heart failure and severely reduce renal function; presentation at the emergency department with ARDS. Due to the patient’s functional status (NYHA class IV) prior to COVID-19 and personal preferences, she was discharged home; patient died at home 22 days after initial hospital presentation. | Death due to SARS-CoV-2 infection (ARDS related to COVID-19) Comorbidities: three (heart failure, pulmonary hypertension and kidney failure) |
| Patient with complicated disease course, ongoing cases | ||||
| 20–30 | Male | Unrepaired atrial secundum septal defect Down syndrome | History of bronchial asthma, NYHA class I prior to COVID-19. Admitted with bilateral pneumonia and ARDS, requiring non-invasive ventilation; pulmonary thromboembolism occurred on day 4 after hospital admission; case still ongoing. | Admission due to SARS-CoV-2 infection Comorbidities: two (respiratory disease and genetic syndrome) |
| 50–60 | Male | Partial anomalous pulmonary venous connection, PFO with severe right-to-left shunt | History of type 2 diabetes mellitus and oesophageal cancer; incidental diagnosis of partial anomalous partial anomalous pulmonary venous connection during the diagnostic cancer workup; normal right ventricular dimensions, no evidence of pulmonary hypertension. Hospital admission for elective oesophagectomy; at admission, COVID-19 not suspected; recurrent postoperative hypoxaemia requiring reintubation. Diagnosed with COVID-19 on postoperative day 4; subsequently severe ARDS with haemodynamic instability, severe pulmonary hypertension and multiple secondary infectious complications; diagnosis of a PFO with severe right-to-left shunting on postoperative day 23; emergent venoarterial ECMO on postoperative day 26 and percutaneous PFO closure on postoperative day 27; weaning from ECMO 7 days after PFO closure; case is still ongoing, slow recovery. | Admission for non-cardiac surgery PFO was a contributor to complicated disease course; partial anomalous pulmonary venous return likely not substantially contributing to disease course Comorbidities: two (diabetes and cancer) |
| 30–40 | Female | Eisenmenger syndrome with persistent ductus arteriosus and atrial septal defect | Obesity grade I (BMI 33 kg/m2). NYHA class III prior to COVID-19. ARDS secondary to bilateral pneumonia and bacterial superinfection; venoarterial ECMO since day 1 of hospitalisation; a thromboembolic event occurred during hospitalisation; case still ongoing. | Admission due to SARS-CoV-2 infection Comorbidity: one (pulmonary hypertension) |
| Recovered patients with complicated disease course | ||||
| 30–40 | Female | Fontan palliation for tricuspid atresia | NYHA class II prior to COVID-19. Admitted with bilateral pneumonia leading to ARDS, requiring intubation the day after of admission. The patient fully recovered 28 days after hospital admission. | Admission due to SARS-CoV-2 infection Comorbidity: zero |
| 30–40 | Male | Repaired ALCAPA | NYHA class I prior to COVID-19 Admitted with cardiogenic shock requiring inotropic support for 4 days. Diagnosis of COVID-19-related myocarditis; the patient fully recovered 27 days after hospital admission. | Admission due to SARS-CoV-2 infection Comorbidity: zero |
| >60 | Male | Unrepaired CCTGA with VSD and residual severe pulmonary stenosis Persistent right-to-left shunt through VSD with baseline oxygen saturation at 85% | History of atrial flutter; NYHA class II prior to COVID-19 Admitted with bilateral pneumonia requiring transfer to the ICU for non-invasive ventilation at day 2 of hospitalisation; the patient experienced recurrent flutter during his hospitalisation and remained short of breath at last follow-up (NYHA III). | Admission due to SARS-CoV-2 infection Comorbidity: zero |
| 50–60 | Male | Repaired aortic coarctation Mechanical aortic valve replacement for severe aortic stenosis | History of diabetes, stroke, heart failure with preserved ejection fraction and atrial fibrillation; NYHA class II prior to COVID-19. Admitted to the hospital with bilateral pneumonia requiring ICU transfer for non-invasive ventilation 2 days after admission; patient recovered 22 days after hospital admission, but impaired renal function persisted after hospital discharge. | Admission due to SARS-CoV-2 infection Comorbidities: three (diabetes, stroke and heart failure) |
| 50–60 | Male | Bentall procedure for bicuspid valvulopathy and aortopathy | History of diabetes and hypertension; NYHA class II previous to COVID-19. Admitted with bilateral pneumonia requiring non-invasive ventilation; patient fully recovered 16 days after hospital admission. | Admission due to SARS-CoV-2 infection Comorbidities: two (diabetes and arterial hypertension) |
ALCAPA, This footnote is not necessary - no such abbreviation is used in table 4; ARDS, acute respiratory distress syndrome; AVSD, atrioventricular septal defect; BMI, Body Mass Index; CCTGA, congenitally corrected transposition of the great arteries; COPD, chronic obstructive pulmonary disease; CRT-D, cardiac resynchronisation therapy defibrillator; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; NYHA, New York Heart Association; ; PFO, persistent foramen ovale; VSD, ventricular septal defect.