Echocardiographic findings in infants with presumed congenital Zika syndrome: Retrospective case series study

Abstract

ObjectiveTo report the echocardiographic evaluation of 103 infants with presumed congenital Zika syndrome.MethodsAn observational retrospective study was performed at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil. 103 infants with presumed congenital Zika syndrome. All infants had microcephaly and head computed tomography findings compatible with congenital Zika syndrome. Zika IgM antibody was detected in cerebrospinal fluid samples of 23 infants. In 80 infants, the test was not performed because it was not available at that time. All infants had negative serology for HIV, syphilis, rubella, cytomegalovirus and toxoplasmosis. A complete transthoracic two-dimensional, M-mode, continuous wave and pulsed wave Doppler and color Doppler echocardiographic (PHILIPS HD11XE or HD15) examination was performed on all infants.Results14/103 (13.5%) echocardiograms were compatible with congenital heart disease: 5 with an ostium secundum atrial septal defect, 8 had a hemodynamically insignificant small apical muscular ventricular septal defect and one infant with dyspnea had a large membranous ventricular septal defect. The echocardiograms considered normal included 45 infants with a persistent foramen ovale and 16 with a minimum patent ductus arteriosus.ConclusionsPreliminarily this study suggests that congenital Zika syndrome may be associated with an increase prevalence of congenital heart disease. However the types of defects noted were septal defects, a proportion of which would not be hemodynamically significant.

In Reply—Electrocardiographic Finding in Zika Virus Infection

“…In the present report from an endemic area in tropical Asia, there is no problem of cardiac arrhythmia among the infected cases. 3 Focusing on the present report by Villamil-Gómez et al, the ECG problem is reversible, which might imply that there might be a reversible cardiac abnormality due to Zika virus infection. The exact underlying pathophysiology of abnormal ECG changes in the reported cases is unknown and might not relate to the Zika viruseinduced cellular pathology, which is generally not reversible.…”

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“…In a cohort reported by Brasil et al [5], a case with congenital Zika syndrome and congenital heart disease was present but details on the degree or type of heart disease were not provided. A recent study has found an increased prevalence of congenital heart disease in the form of atrial or ventricular septal defect in infants with presumed congenital Zika syndrome [17]. Arboviruses other than Zika are known to cause myocarditis and pericarditis [18,19], and viral antigen detection has been confirmed in myocardium and endothelial cells, so it is plausible that ZIKV infection could also cause heart disease.…”

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“…A recent study demonstrated that 13% of 103 intrauterine cases with ZIKV infection had cardiac anomalies such as ostium secundum atrial septal defect (in 5 of 14 cases), small apical ventricular septal defect (in 8 cases), and large ventricular septal defect (in 1 case) [56].…”