Multisystem inflammatory syndrome in children: Salient echocardiogram findings in the acute phase and longitudinal follow-up. (September 2022)

• Record Type: Journal Article
• Authors: Mitchell, Elizabeth C.; Romano, Angela; Capone, Christine A.; Cooper, Rubin; Epstein, Shilpi; Hayes, Denise A.; Parness, Ira A.; Schleien, Charles; Misra, Nilanjana
• Is Part Of: Progress in pediatric cardiology. Volume 66(2022)
• Publication Date: 2022-09
• Subjects: MIS-C -- COVID-19 -- Echocardiogram -- Coronary arteries -- Kawasaki disease -- Vasodilation -- Valve regurgitation; Pediatric cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; Infant; Child; Cardiologie pédiatrique -- Périodiques; 618.9212005
• DOI: 10.1016/j.ppedcard.2022.101492
• Languages: English
• ISSNs: 1058-9813

Abstract

Abstract: Background: Coronary artery (CA) abnormalities and left ventricular (LV) systolic dysfunction have been reported in multisystem inflammatory syndrome in children (MIS-C); however, a thorough review of all findings on transthoracic echocardiogram (TTE) with long term follow-up is lacking. Objectives: Comprehensively describe the findings on TTE during the acute phase of MIS-C and how those findings change on serial follow-up 6 months after diagnosis. Methods: Pediatric patients meeting CDC criteria for MIS-C were included, with data collected from acute phase (T0), outpatient follow-up at 2 weeks (T1), 6–8 weeks (T2), and 6 months (T3), including TTE findings of descending aorta Doppler profile, CA abnormalities, valvar regurgitation, LV systolic function, and pericardial effusion. Results: Fifty patients (52% male) were included; 45 (90%) were SARS-CoV-2 IgG antibody positive, 13 (26%) PCR positive, and 8 (16%) positive for both. Mean age was 8.3 years (range 9 months - 17 years). Holodiastolic flow reversal in descending aorta was seen in 72% at T0, in 6% at T1, with complete resolution in all by T2. CA abnormalities were seen in 52% at T0, 31% at T1, 13% at T2, and none at T3. Mitral regurgitation was present in 84% at T0, 40% at T1, 36% at T2, and 24% by T3. LV systolic dysfunction (ejection fraction <55%) occurred in 52% at T0, with resolution by discharge in 69%, and complete resolution by T2. Trivial to small pericardial effusion was present in 48% at T0, 13% at T1, 3% at T2 and 4% by T3. Conclusion: In addition to CA abnormalities and LV systolic dysfunction, holodiastolic flow reversal in the descending aorta, valvar regurgitation, and pericardial effusion are prominent findings in MIS-C. Longitudinal follow-up shows improvement in all. Highlights: MIS-C TTE findings fit a striking pattern of pancarditis and systemic inflammation. A prominent finding is holodiastolic flow reversal in the descending aorta Doppler profile. Findings of pancarditis include LV dysfunction, valvar regurgitation and pericardial effusion. Coronary artery abnormalities include aneurysms, dilation and lack of tapering. Most findings resolve by early follow-up, with near complete resolution by 6 months.