Cardiovascular System Damage in Children With Covid-19

Coronavirus infection poses a particular danger in relation to decompensation of existing chronic diseases and specific damage to the cardiovascular system (CVS) both during an acute infection and during convalescence. Objective of the study: to summarize current knowledge about the potential involvement of CVS in the development and progression of acute COVID-19 infection and multisystem inflammatory syndrome (MIS) in children and to form an sense of the predictive value, diagnostic tactics and treatment of cardiac anomalies during the coronavirus pandemic. A search was performed in MEDLINE, PubMed, e-library using the search terms «cardiovascular disease in COVID-19/MIS in children», «congenital heart disease/pulmonary hypertension/prolonged QT interval and COVID-19 in children» to identify articles published from April 1, 2020 to May 1, 2021. A literature review indicates that cardiac disorders associated with the new coronavirus infection in children, in the vast majority of cases, developed during MIS, which manifests itself in the form of febrile fever, external signs of Kawasaki disease, hyperinflammatory state and multi-organ damage with an emphasis on CVS. Cardiovascular symptoms occur in the vast majority of children with MIS, and in more than half of the patients – by the type of myocardial dysfunction and/or shock, somewhat less often – in the form of ECG changes, pericardial effusion, сoronary artery ectasia. Against the background of treatment with steroids, intravenous human immunoglobulin (IVIG) and biologic drugs in combination with inotropic support in almost all children, the morphofunctional characteristics of CVS are restored to normal or subnormal levels in a few days. The need for extracorporeal membrane oxygenation and lethal cases are rare. The possibility of developing myocarditis (including fatal), pulmonary hypertension and cardiac arrhythmias associated with COVID-19 in pediatric patients with discussion of possible pathophysiological mechanisms was also described. Long-term observation of this category of persons is necessary due to the uncertain prognosis and the risk of progression of cardiac manifestations. An early comprehensive diagnosis of cardiac disorders and monitoring of the identified changes in children with MIS and acute coronavirus infection are needed.