Post-COVID-19 cardiovascular complications in children. Description of clinical cases

Abstract

Background. Cardiovascular complications in children can occur in the remote period after coronavirus disease 2019 (COVID-19). The most frequent clinical variants of damage to the cardiovascular system in children after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are multisystem inflammatory syndrome, myocarditis, heart rhythm disorders, hydropericardium. Signs of heart damage can be masked by manifestations of damage to other organs, since the clinical symptoms are often multi-organ. The purpose was to analyze cases of cardiovascular lesions in children who suffered SARS-CoV-2 infection. Materials and methods. Three clinical cases of post-COVID-19 cardiovascular complications in children aged 8, 9 and 1 are presented. The patients developed life-threatening conditions caused by hydropericardium with cardiac tamponade (case 1), complete atrioventricular block (case 2), bacterial endocarditis with mitral valve damage and heart failure (case 3). Results. All patients showed high levels of pro-inflammatory markers (C-reactive protein, procalcitonin, erythrocyte sedimentation rate, interleukin-6, fibrinogen), markers of myocardial damage (N-terminal prohormone of brain natriuretic peptide (NT-pro-BNP), troponin I), hypercoagulation (D-dimer, fibrinogen, activated partial thromboplastin time), high titers of immunoglobulin G (IgG) to COVID-19. In presented clinical cases, there were symptoms of damage to other organs, but cardiovascular disorders dominated and determined the severity of children’s condition. Conclusions. Given the risk of developing life-threatening conditions, all pediatric patients admitted to the hospital with a history of COVID-19 and a high level of IgG to SARS-CoV-2 should be screened for cardiac complications. In case of the complexity of the diagnosis, as well as with an extensive clinical picture, the determination of NT-pro-BNP, troponin I can become a decisive argument in establishing the diagnosis.

Keywords

• sars-cov-2
• post-covid
• children
• complications
• inflammatory markers
• cardiovascular lesions
• markers of myocardial damage
• hypercoagulation