Image

Babies will be born regardless of the current state of “lockdown” due to the COVID-19 pandemic. Approximately 1% of these children will have congenital heart disease (CHD) and as many as 1 in 4 will require evaluation for possible surgical intervention in the first year of life. In addition, adults make up a majority of patients living with CHD. Thus, adequate care for the CHD patient spans from neonates to adults.  

As the focus of the medical community has shifted toward patients suffering from COVID-19, taking care of our CHD patients has become extremely challenging. This includes enforcing social distancing with our younger patients and postponing procedures when the majority of our cases require emergent or urgent surgery. 

However, there are options to mitigate risks while providing you and/or your child with the necessary care. You must continue to be the strongest advocate for yourself or your child, reaching out to the respective medical teams for support and guidance. This will help hospitals to triage the appropriate resources for patients, such as ventilators, intensive care unit beds, blood products, operating room availability, and medical staff.  

So far, in many parts of the country, hospital responses include:

• Postponing elective surgeries and procedures
• Replacing in-person office visits with telemedicine 
• Requiring temperature and symptom screenings for visitors and employees 
• Implementing universal masking for everyone
• Preoperatively testing patients for COVID-19 
• Using personal protective equipment (PPE)
• Minimizing the number of personnel 
• Practicing social distancing as much as possible in the hospital environment
• Requiring additional hygiene procedures to protect patients and health care employees

Due to limitations in hospital resources, increased COVID cases, and travel restrictions, the possibility of transferring care to a different institution other than the one originally planned also must be considered. 

Here are some additional ways that patients/families and physicians can continue to provide care for CHD patients during these difficult times.

Prenatal Care

• After an initial in-person fetal echocardiogram, if possible, request that additional visits be performed via telemedicine with a pediatric cardiologist
• Discuss with the pediatric cardiologist the possibility of extending time between recommended fetal echocardiograms
• Utilize telemedicine to undergo consultation with a congenital heart surgeon

Labor and Delivery

• Prepare for restricted hospital visitor policies both in Labor and Delivery and the Neonatal Intensive Care Unit (NICU)

NICU/PICU/Hospital stay

• Plan accordingly as many hospitals have changed visitor policies to allow only one parent with the child every 24 hours
• Undergo temperature and symptom screenings at hospital entrances prior to any visits
• Discuss discharge planning earlier so your family can be ready to provide care for your loved one as soon as he/she is medically stable for discharge

Outpatient Care

• Be sure to review ahead of time any medical equipment and supplies for home, such as weighing scale, pulse oximeter, Holter monitor, feeding tubes, medication pumps, and/or special formulas
• Utilize telemedicine visits to stay under the care of the pediatric cardiologist and to ensure that timely decisions can be made regarding necessary tests or procedures 

Caring for CHD patients is a shared responsibility and requires a great deal of coordination. The importance of communication between you and the physicians is paramount so that we avoid unnecessary delays in providing appropriate medical or surgical therapy for you or your child. 

While CHD patients are inherently a higher risk population, we must weigh the risks of failing to address a cardiac abnormality with that of exposure to COVID-19. This patient population tends to be younger than the average patient suffering from acquired heart disease, so the risk of complications from the COVID-19 respiratory illness is presumed to be lower, but certainly not zero. Technologies such as telemedicine visits, email access to your physicians and various specialists, and home monitoring systems are critical to help bridge the current gap between patients and hospitals due to the COVID-19 pandemic.

The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.