Cardiac Follow up of Pediatric Patients Presented with Covid-19 Cardiovascular Affection

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology (post-infectious complication). Our cases of MIS-C have features of shock, with cardiac involvement in form of LV dilatation, impaired EF ,valvuar affection, coronary arteries dilatation , PE. most of our patients also have gastrointestinal symptoms, rash, conjunctivitis, and significantly elevated markers of inflammation, with positive laboratory test results for SARS-CoV-2 e.g. RT-PCR or serology (at least one of them is positive). Recommended treatments for MIS-C include intravenous immunoglobulin, corticosteroids, and inotropic or vasopressor support. For refractory patients, monoclonal antibody to interleukin-6 receptor (tocilizumab), or interleukin-1 receptor antagonist (anakinra) may be recommended. Patients with coronary aneurysms require aspirin or anticoagulant therapy. The prognosis of MIS-C seemed favorable without sequelae in most patients. Distinguishing MIS-C from other severe infectious or inflammatory conditions poses a challenge to clinicians caring for children and adolescents. As the COVID-19 pandemic continues to expand in many jurisdictions, health care provider awareness of MIS-C will facilitate early recognition, early diagnosis, and prompt treatment.