Case Report: Mitral Valve Involvement and First-Degree Atrial-Ventricular Block in Two Patients With Multisystem Inflammatory Syndrome in Children

Filippo, Paola Di; Raso, Massimiliano; Cacciatore, Marta; Patacchiola, Roberta; Renda, Giulia; Rossi, Nadia; Chiarelli, Francesco

doi:10.3389/fped.2021.676934

Cited by 3 publications

(3 citation statements)

References 30 publications

(38 reference statements)

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“…MIS-C is significantly associated with cardiac manifestations, including ventricular dysfunction and valvular regurgitation (22). In the present study, the echocardiography performed on the first day of admission of patients demonstrated that 21% had LV dysfunction upon arrival at the hospital, though only 6% of them had LV dysfunction at the time of discharge.…”

Section: Discussionsupporting

confidence: 45%

Clinical and Laboratory Characteristics of the Multisystem Inflammatory Syndrome in Children: A Case Series of 75 Patients

Ghotbabadi

Mollaie

Hamzavi

et al. 2022

Arch Pediatr Infect Dis

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Background: SARS-CoV-2 has been characterized since December 2019 as the etiology of severe pneumonia throughout the world. However, the majority of children and adolescents with the respective infection have mild COVID-19. In April 2020, a warning was issued by the National Health Service (NHS), based on which a multisystem inflammatory syndrome in children (MIS-C) could be associated with COVID-19, presenting with cardiovascular shock, fever, and hyperinflammation. The syndrome presents with fever and organ involvement but with no pathognomonic findings or diagnostic tests, while some of the manifestations are almost the same as those of Kawasaki disease. Objectives: Knowledge of clinical course, demographic data, treatment, and prognosis can contribute to the more efficient management of the patients and, consequently, a decrease in morbidity and mortality. Methods: Seventy-five patients < 18 years from September 22, 2020, to March 10, 2021, in Namazi hospital, Shiraz, Iran, with a diagnosis as per MIS-C defined criteria, were recruited. Results: Median age of the patients was 6.2 years, and 58.6% were male. Of the patients, 46% had positive SARS-CoV-2 RT-PCR, antibody, or both. Thirty percent of the total patients reported contact with proven COVID-19 cases. The abdominal free fluid in 17 patients, hepatitis in one patient, and stasis in both kidneys of one patient were detected. Upon echocardiography on the first day, 77%, 48%, 21%, and one patient were with tricuspid regurgitation, mitral regurgitation, abnormal LV function, and myocarditis, respectively; however, after 5 - 7 days, the repeated echocardiography revealed 44% of patients with tricuspid regurgitation, 30% with mitral regurgitation, and 6% with abnormal LV function. For the treatment, 18% of the patients received inotropes, 60% ASA, 32% IVIG, 84% glucocorticoids, and 25.3% received furosemide. All of the patients received antibiotics as well. Finally, 97% of the patients were discharged alive, while two cases died. Conclusions: The results of this study suggest the importance of cardiac consultation along with early hospital care during the course of MIS-C in order to prevent the associated short-term and long-term complications.

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Section: Discussionsupporting

confidence: 45%

Clinical and Laboratory Characteristics of the Multisystem Inflammatory Syndrome in Children: A Case Series of 75 Patients

Ghotbabadi

Mollaie

Hamzavi

et al. 2022

Arch Pediatr Infect Dis

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“…The most frequently described ECG anomalies were non-specific anomalies of ventricular repolarization, prolongation of the QT interval and premature atrial or ventricular beats (14). First and second degree atrioventricular (AV) blocks and atrial fibrillation were also reported (8,30). In literature, less information were reported findings in patients without MIS-C ranged from fever (66.7% of patients), tachypnea (50.0%), cough (41.7%), diarrhea and weight loss (8.3%), headache (8.3%) and tachycardia (8.3%).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of MIS-C is not clear, but some estimates showed that MIS-C occurs in 5.1 out of 1,000,000 personmonths in individuals under the age of 21 years (7). Cardiac involvement was frequently described in children with MIS-C, with myo-pericardial inflammation, coronary dilatation or aneurysm and arrhythmias (8). The mechanism of myocardial dysfunction in MIS-C is still unclear, but possible causes include acute myocarditis, post-viral immunological reaction, and systemic inflammatory response syndrome (2).…”

Section: Introductionmentioning

confidence: 99%

Case report: Increased troponin level in 125 children during COVID-19

Filippo

David²,

Attanasi³

et al. 2023

Front. Pediatr.

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IntroductionIncrease in cardiac biomarkers during Coronavirus disease 2019 (COVID-19) was frequent regardless of the presence of myocarditis and multisystem inflammatory syndrome in children (MIS-C). Several studies described MIS-C, but few papers evaluated cardiac manifestations in children with SARS-CoV-2 infection without MIS-C and investigated the role of troponin in absence of electrocardiogram (ECG) and echocardiographic alterations. The aim of this case series is to describe the cardiac manifestations during COVID-19 in children, trying to explain the meaning of laboratory findings during COVID-19, especially of increased troponin.Materials and methodsWe conducted a retrospective case series of children aged <18 years admitted at the Department of Pediatrics, University of Chieti, for SARS-CoV-2 infection between 1st March 2020 and 31th July 2022. All patients with documented SARS-CoV-2 infection underwent a laboratory evaluation at admission. Children with increased troponin I and/or BNP underwent electrocardiographic and echocardiographic exams.Results125 children were admitted for SARS-CoV-2 infection to our Department of Pediatrics, of whom 17 (13.6% of cases) with different patterns of cardiac involvement. Specifically, 5 subjects (4.0% of admitted children) were diagnosed as MIS-C and 12 children (9.6%) manifested a cardiac involvement in terms of increased troponin with or without ECG and echocardiography anomalies. Troponin, C-reactive protein, procalcitonin and BNP values resulted higher in patients with MIS-C compared to patients without MIS-C. Furthermore, patients with MIS-C had higher neutrophils and lower lymphocytes compared to patients without MIS-C. ECG abnormalities were found in 4/5 patients with MIS-C and in 2/12 patients without MIS-C. Echocardiographic anomalies were found in all patients with MIS-C, especially in terms of valve regurgitation and ejection fraction reduction and in 2/12 patients without MIS-C, especially in terms of pericardial effusion. Despite high troponin levels, children presented a favorable clinical evolution.ConclusionThe increase in troponin level in children with COVID-19 could also be due to respiratory causes or a massive inflammatory state. In our case series, patients with increased troponin associated to COVID-19 presented a favorable clinical course with clinical and laboratory remission almost always within 7 days.

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Arrhythmia and COVID-19 in children

Song¹,

Kwon²

2023

Clin Exp Pediatr

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection caused worldwide health problems, and coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. Cardiovascular complications of COVID-19 are not uncommon; among them, arrhythmia is considered a significant risk factor for poor health outcomes in adults. However, data are scarce on the arrhythmia of pediatric patients with SARS-CoV-2 infection, possibly due to their mild symptoms and low incidence of cardiovascular involvement. Multisystem inflammatory syndrome in children reportedly features increas ed cardiovascular involvement, but arrhythmic complications remain unidentified. Thus, here we review the epidemiology, manifestations, and outcomes of pediatric arrhythmia associated with COVID-19.

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Case Report: Mitral Valve Involvement and First-Degree Atrial-Ventricular Block in Two Patients With Multisystem Inflammatory Syndrome in Children

Cited by 3 publications

References 30 publications

Clinical and Laboratory Characteristics of the Multisystem Inflammatory Syndrome in Children: A Case Series of 75 Patients

Clinical and Laboratory Characteristics of the Multisystem Inflammatory Syndrome in Children: A Case Series of 75 Patients

Case report: Increased troponin level in 125 children during COVID-19

Arrhythmia and COVID-19 in children

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