key: cord-0890700-wkp70b6x authors: Fusco, Flavia; Scognamiglio, Giancarlo; Merola, Assunta; Palma, Michela; Correra, Anna; Borrelli, Nunzia; Barracano, Rosaria; Grimaldi, Nicola; Colonna, Diego; Romeo, Emanuele; Sarubbi, Berardo title: Coronavirus disease 2019 in patients with Fontan circulation date: 2021-03-31 journal: International journal of cardiology. Congenital heart disease DOI: 10.1016/j.ijcchd.2021.100126 sha: f97a4b2fa0241659772377d5892d95c5dcbddbe6 doc_id: 890700 cord_uid: wkp70b6x nan Dear Editor, early data during the current pandemic demonstrated worse outcome in patients with pre-existing heart disease 1 . Consequently, adults with congenital heart disease (ACHD) have been deemed at high risk of adverse outcome from Covid-19, particularly those with complex anatomy 2 . We would like to report our experience with Coronavirus disease 2019(Covid-19) among patients with Fontan circulation at our ACHD tertiary centre. We retrospectively included all Fontan patients who were infected from the beginning of the To the best of our knowledge, this is the first European report of Covid-19 in Fontan circulation. Surprisingly, in our cohort no one presented severe manifestations from Covid-19. Our data are in line with the positive outcome described in 10 Fontan patients in a single-centre US study 6 . These results may be partially explained with the observation that, despite the above-described multiple implications of Covid-19, patients with single-ventricle might be protected by younger age, patients' education to self-isolation and chronic treatment with anticoagulants/antiplatelets, which were showed to improve the outcome 7, 8 . Interestingly, according to the 2018 ACC/AHA ACHD guidelines 9 , 6 out of 7 patients in our study had an advanced physiological stage, which was reported as a risk factor of adverse outcome in ACHD patients 5 . Patients with failing Fontan or unstable haemodynamics may be at higher risk of complications from Covid-19. In our cohort, patient 7 was recently admitted for acute heart failure and had undergone abdominal surgery for hemoperitoneum following ovarian cyst rupture, which was complicated by acute kidney injury requiring dialysis shortly before contracting Covid-19. After 1-year of observation, we found a relatively low rate of infection among our Fontan patients. The effects of our stringent preventive policy, which has already described elsewhere 10 , might have protected ACHD patients from exposure. However, due to the small number of cases, the real F igure L egend Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavius-Infected Pneumonia in Wuhan, China Coronavirus disease 2019 in adults with congenital heart disease: a position paper from the ESC working group of adult congenital heart disease, and the International Society for Adult Congenital Heart Disease CT Imaging Features of 2019 Novel Coronavirus COVID-19 and the liver: little cause for concern COVID-19 risk, disparities and outcomes in patients with chronic liver disease in the United States. EClinicalMedicine COVID-19) on Patients With Congenital Heart Disease Across the Lifespan: The Experience of an Academic Congenital Heart Disease Center Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy Effects of antiplatelet therapy on the mortality rate of patients with sepsis: A meta-analysis AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Caring for adults with CHD in the era of coronavirus disease 2019 pandemic: early experience in an Italian tertiary centre