Abnormalities of the Coronary Arteries in Children: Looking beyond the Origins

Abstract

Coronary arterial abnormalities are uncommon findings in children that have profound clinical implications. Although anomalies of the coronary origins are well described, there are many other disease processes that affect the coronary arteries. Immune system-mediated diseases (eg, Kawasaki disease, polyarteritis nodosa, and other vasculiditides) can result in coronary arterial aneurysms, strictures, and abnormal tapering of the vessels. Because findings at imaging are an important component of diagnosis in these diseases, the radiologist's understanding of them is essential. Congenital anomalies may present at varying ages, and findings in hemodynamically significant anomalies, such as fistulas, are key for both diagnosis and preoperative planning. Pediatric heart surgery can result in wide-ranging postoperative imaging appearances of the coronary arteries and also predisposes patients to a multitude of complications affecting the heart and coronary arteries. In addition, although rare, accidental trauma can lead to injury of the coronary arteries, and awareness and detection of these conditions are important for diagnosis in the acute setting. Patients with coronary arterial conditions at presentation may range from being asymptomatic to having findings of myocardial infarction. Recognition of the imaging findings is essential to direct appropriate treatment. RSNA, 2017.

A Case of Multisystem Inflammatory Syndrome in a Three-Year-Old Boy

“…Our patient had a three-day fever, which is common in all the available reported cases. Abdominal pain, diarrhea, and vomiting have been recorded in 60-100% of MIS-C patients, and only diarrhea was seen in our case as well [21][22][23].…”

“…In our case, laboratory results showed elevation in liver enzymes and LDH as well, but cardiac enzymes were within the normal range. Moreover, 688 MIS-C patients were recognized as having brain natriuretic peptide (BNP) raised in a published systematic study, and it was present in 86% of them, as for our case it was normal [23]. Additionally, one of the complications that are associated with MIS-C is coagulopathy (prolonged PT or PTT, elevated DD), which our case presented with high INR, prolonged PT, PPT, and elevated DD [25].…”

An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

“…Cardiogenic shock was present in 53.20% (48.70–57.80%), pro-BNP increased was present in 86.80% (83.60–89.40%), and ECG abnormalities were present in 27.6% (23.9–31.6%). The incidence of myocardial dysfunction was 52.20% (48.40–56.00%), coronary artery ectasia/aneurysm was 15.40% (12.40–17.80%), and 53.4% of patients required PICU (Pediatric Intensive Care Unit) care [ 31 ]. There have been a number of cohort studies and meta-analyses that reached similar conclusions [ 12 , 32 , 33 , 35 ].…”

“…Nonetheless, the pathophysiology of cardiac lesions caused by MIS-C in children has not been fully described. Various theories suggest that SARS-CoV-2 spike proteins, infecting cardiomyocytes through the angiotensin converting enzyme 2 (ACE2) receptor, caused myocardial damage and deregulated immune function, and the subsequent cytokine storm leads to multiorgan failure and severe cardiotoxicity [ 31 ]. Further, due to prolonged hypoxia and ischemia, microvascular thrombosis, coronary artery disease, right heart strain, and stress cardiomyopathy, a consequence of oxygen demand and supply imbalance, all contribute to cardiac muscle damage [ 29 ].…”

“…Further, due to prolonged hypoxia and ischemia, microvascular thrombosis, coronary artery disease, right heart strain, and stress cardiomyopathy, a consequence of oxygen demand and supply imbalance, all contribute to cardiac muscle damage [ 29 ]. Medications like lopinavir/ritonavir, hydroxychloroquine, and tocilizumab, whose safety margins are less clear, could worsen cardiac dysfunction in pediatric patients with COVID-19 infection [ 31 ]. As reported by biopsy, a COVID-19 viral particle localized in the myocardium [ 39 ] leads to severe necrotizing myocarditis [ 40 ].…”