COVID-19 in children with congenital heart disease in Asia: clinical features and recommendations for management


  • Samaa Akhtar Department of Research, Paediatric Cardiology, Pakistan Children's Heart Foundation, Lahore, Pakistan
  • Assma Asif Department of Biomedical Sciences, Chelsea and Westminster Hospitals, London, United Kingdom



CHD, Pediatric cardiology, COVID-19, Asia, Pediatrics, Coronavirus


Globally, around 1.35 million children are born with a congenital heart disease’s every year. Making CHDs one of the world's most common congenital anomaly and, thus, a significant global health issue. The CHD prevalence rate is highest in Asia (9.3 per 1000 live births) which is followed by Europe (8.2 per 1000 live births) and lowest in Africa (1.9 per 1000 live births). The existing high CHD burden on pediatric health infrastructures around the world has been worsened due to the global coronavirus (COVID-19) pandemic. Approximately, a total of 22.9 million children and adolescent cases of COVID-19 have been recorded. The highest infectivity rate has been in children under 3 years of age.3 90% of reported pediatric cases have been categorized as mild or moderate disease, 5.2% as severe and 0.6% as critical.4 Over 12,300 children and adolescents have died due to COVID-19. Of these deaths, 58% have occurred in the 10-19 age group and 42% in the 0-9 age group. Which can prove to be exceedingly detrimental in Low to Middle Income regions, such as Asia, where the medical infrastructure is less robust and usually poorly accessible. According to a systematic review on the association of COVID-19 and pediatric co-morbidities, around 5.1% of severely ill children have had an underlying comorbidity, such as CHD. However, at present, the data from Asia is very limited. There are only a handful of large, observational cohort studies. These have been conducted primarily in China, Iran, and India.


Van Der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am College Cardiol. 2011;58(21):2241-7.

UNICEF. COVID-19 confirmed cases and deaths. UNICEF DATA. 2021. Available at: Accessed on 25 January, 2022.

Zheng F, Liao C, Fan QH, Chen HB, Zhao XG, Xie ZG et al. Clinical characteristics of children with coronavirus disease 2019 in Hubei, China. Curr Med Sci. 2020;40(2):275-80.

Sachdeva S, Ramakrishnan S, Choubey M, Koneti NR, Mani K, Bakhru S. Pcsi-COVID-19 Study Group. Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease: A multicentric study from India. Ann Ped Cardiol. 2021;14(3):269.

Tsang KW, File Jr TM. Respiratory infections unique to Asia. Respirology. 2008;13(7):937-49.

Tsankov BK, Allaire JM, Irvine MA, Lopez AA, Sauvé LJ, Vallance BA et al. Severe COVID-19 infection and pediatric comorbidities: a systematic review and meta-analysis. Int J Infect Dis. 2021;103:246-56.

Tsabouri S, Makis A, Kosmeri C, Siomou E. Risk factors for severity in children with coronavirus disease 2019: a comprehensive literature review. Pediatric Clin. 2021;68(1):321-38.

Wong JJM, Abbas Q, Chuah SL, Malisie RF, Pon KM, Katsuta T. PACCOVRA Investigators of the PACCMAN Research Group. Comparative analysis of pediatric COVID-19 infection in Southeast Asia, south Asia, Japan, and China. Am J Trop Med Hygiene. 2021;105(2):413.

Du W, Yu J, Wang H, Zhang X, Zhang S, Li Q, Zhang Z. Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China. Infect. 2020;48(3):445-52.

Esmaeeli H, Ghaderian M, Zanjani KS, Ghalibafan SF, Mahdizadeh M, Aelami MH. COVID-19 in Children with Congenital Heart Diseases: A Multicenter Case Series from Iran. Case Rep Pediatrics. 2021; 2021:6690695.

Latif A. Pakistani children face 14% mortality risk after catching COVID: Study. Anadolu Ajansı. 2021. Available at: Accessed on 26, January 2022.

Madani S, Shahin S, Yoosefi M, Ahmadi N, Ghasemi E, Koolaji S et al. Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran. BMC Pediatr. 2021;21(1):1-9.

Dong Y, Mo XI, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatr. 2020;145(6):e20200702.

Bertoncelli D, Guidarini M, Della Greca A, Ratti C, Falcinella F, Iovane B et al. COVID19: potential cardiovascular issues in pediatric patients. Acta Bio Medica: Atenei Parmensis. 2020;91(2):177.

Ali MI, Alkhuzaie HF, Alhashim SA, Hassan HA, Tawhari AH, Al Aqili MA. Effect of COVID-19 on congenital heart disease children: A literature review. Int J Community Med Public Health. 2021;8(2):900.

Soleimani A, Soleimani Z. Presentation and Outcome of Congenital Heart Disease During COVID-19 Pandemic: A Review. Current Problems in Cardiol. 2021;100905.

Alsaied T, Tremoulet AH, Burns JC, Saidi A, Dionne A, Lang SM et al. Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation. 2021;143(1):78-88.

Gottlieb M, Bridwell R, Ravera J, Long B. Multisystem inflammatory syndrome in children with COVID-19. The Am J Emergency Med. 2021;49:148-52.

Memar EHE, Pourakbari B, Gorgi M, Ekbatani MS, Navaeian A, Khodabandeh M et al. COVID-19 and congenital heart disease: a case series of nine children. World J Pediatr. 2021;17(1):71-8.

Kache S, Chisti MJ, Gumbo F, Mupere E, Zhi X, Nallasamy K et al. COVID-19 PICU guidelines: for high-and limited-resource settings. Pediatr Res. 2021;88(5):705-16.

Haiduc A, Ogunjimi M, Shammus R, Mahmood S, Kutty R, Lotto A et al. COVID-19 and congenital heart disease: An insight of pathophysiology and associated risks. Cardiology in Young. 2021;31(2):233-40.

Matters H. Congenital heart disease and coronavirus: What you need to know. Congenital heart disease and coronavirus-Heart Matters Magazine. 2021. Available at: Accessed on 14 January, 2022.

Marrian Z, Francesca R, Li G. 2021. Omicron in Asia: A wake-up call for COVID policymaking. Nikkei Asia. Available at: Accessed on 14 January, 2022.