Impact Of Covid 19 Infection On Rare Combination Of Subaortic Membrane And Patent Ductus Arteriosus In Adult Female

Abstract

Background Variable presentations manifesting outflow obstruction may lead to non-significant symptoms or produce symptoms linked to the degree of the left ventricular outflow tract obstruction. A patent ductus arteriosus is also an infrequent non-cyanotic congenital heart disease, which usually occurs as an isolated lesion, but in association with subaortic membrane, the prevalence is even lower. This combination affects the presentation, symptoms and management approach. Careful evaluation is important as the management strategy is based on the evaluation. Case presentation This is a case report, discussing a female patient in her middle-ages with subaortic membrane along with patent ductus arteriosus as a rare presentation. The electrocardiogram showed left ventricular hyper- trophy and strain pattern. The chest X-ray revealed cardiac enlargement with enlarged aorta. The echo- cardiography indicated a dilated left ventricle with mild left ventricular systolic dysfunction, a sub-aortic membrane with high gradient and moderate aortic regurgitation. There was also a PDA with a left to right shunt. The coronary angiogram indicated normal coronaries, and a large PDA. The right heart catheter pressure measurements revealed pulmonary hyper-tension. The patient infected with COVID-19 that had resulted in deterioration of her medical status and the planned management. Conclusions The combined lesion presents a challenging clinical presentation and diagnosis. Cardiac catheterization might be helpful. Management strategy might need modification. Exposure to COVID 19 infection compose a risk to such patient and influence the management strategy.

References

1. 1.Choi J.Y., Sullivan I.D. Fixed subaortic stenosis:anatomicalspectrumandnatureof progression, Br Heart J, 1991; 65: 280-286
2. 2.Glower DD, Bashore TM, Spritzer CE. Congenital aortic stenosis and patent ductus arteriosus in the adult. Ann Thorac Surg. 1992; 54: 368-370.
3. 3.Moafa H, Alnasef M, Diraneyya OM, Alhabshan F. Subaortic Membrane and Patent Ductus Arteriosus in Rare Association-Case Series. Journal of the Saudi Heart Association. 2020; 32:410
4. 4.Basnet N, Singh A, Pradhan R, Sunny SA, Adhikary AB. Subaortic membrane with patent ductus arteriosus. Bangabandhu Sheikh Mujib Med Univ J. 2017; 10: 243-245.
5. 5.Cassidy HD, Cassidy LA, Blackshear JL. Incidental discovery of a patent ductus arteriosus in adults. JAm Board Fam Med. 2009; 22: 214–218.
6. 6.Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N, et al. ESC guidelines for the management of grown-up congenital heart disease (new version 2010) The Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC). Eur Heart J. 2010; 31:2915– 2957.
7. 7.Diller GP, Gatzoulis MA, Broberg CS, Aboulhosn J, Brida M, Schwerzmann M, et al. Coronavirus disease 2019 in adults with congenital heart disease: a position paperfromtheESCworkinggroupofadult congenital heart disease, and the International Society for Adult Congenital Heart Disease. Eur Heart J. 2020; 12: ehaa960.
8. 8.Lewis MJ, Anderson BR, Fremed M, Argenio M, Krishnan U, Weller R, et al. CUIMC Pediatric/Adult Congenital Heart Research Collaborative ‡. Impact of Coronavirus Disease 2019 (COVID-19) on Patients with Congenital Heart Disease Across the Lifespan: The Experience of an Academic Congenital Heart Disease Center in New York City. J Am Heart Assoc. 2020;9: e017580. Majmaah Journal of Health Sciences ,Vol. 9, Issue 3, July - 2021, Dhu al-Qi’dah - 1442 143 Impact Of Covid 19 Infection On Rare Combination Of Subaortic MembraneAnd Patent DuctusArteriosus InAdult Female
9. 9.Abushaban L, Uthaman B, Selvan JP, Al Qbandi M, Sharma PN, Mariappa TV. Long-term follow-up and outcomes of discrete subaortic stenosis resection in children. Ann Pediatr Cardiol. 2019;12:212-
10. 10.Moustafa S, Patton DJ, Balon Y, Connelly MS, Alvarez N. Patent ductus arteriosus with Eisenmenger syndrome. Heart Lung Circ. 2013; 22: 968–969.
11. 11.Brauner R, Laks H, Drinkwater DC Jr, Shvarts O, Eghbali K, GalindoA. Benefits of early surgical repair in fixed subaortic stenosis. J Am Coll Cardiol. 1997; 30: 1835-1842
12. 12.Ogunjimi M, Haiduc AA, Harky A. Congenital heart disease and incremental risks of COVID-19. J Card Surg. 2021;36:433-435.