Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Table 6 Description of the case or case series of cardiac involvement in pediatric patients without pre-existing cardiac condition and coronavirus disease-2019

Ref.	Mechanism	Description
Dong et al[16]	Myocardial injury	Nationwide case series of 2135 pediatric patients with COVID-19 reported to the Chinese Center for Disease Control and Prevention. Cardiovascular involvement was found in 13 patients with myocardial injury or heart failure. No deaths were reported.
Cui et al[115]	Myocardial injury	Description of a 55-d-old otherwise healthy female case with COVID-19 in China. Abnormal myocardial enzyme values on admission and increased troponin I indicated myocardial injury. The patient evolved favourably.
Del Barba et al[116]	Myocardial injury	A 38-d-old male tested positive for SARS-CoV-2 and developed mild cardiovascular inflammation. An increase in troponin T was observed and a cardiac magnetic resonance was also performed which showed a minimal amount of pericardial effusion. The patient evolved favourably.
Gnecchi et al[117]	Myocardial injury	A previously healthy 16-yr-old boy presented at the emergency department with fever and chest pain. The ECG showed inferolateral ST-segment elevation and the echocardiogram showed hypokinesia of the inferior and anterolateral segments of the left ventricle, with preserved function (EF 52%). Troponin I was very increased. Cardiac MRI supported the diagnosis of myocarditis. On day 3 of illness a nasopharyngeal swab test confirmed SARS-CoV-2 infection. The patient presented a full recovery on day 12 of illness.
Craver et al[122]	Myocardial injury	The authors reported a previously healthy 17-yr-old male that presented with sudden cardiac death. The autopsy showed diffuse myocarditis with mixed inflammatory infiltrate with a predominance of eosinophil as the cause of the death.
Sun et al[123]	Myocardial injury	In a small series of 8 critically ill patients infected by SARS-CoV-2, the authors reported the case of a 13-mo-old male who developed heart failure within a multiple organ failure with full recovery after support therapy (plasmapheresis and oxygen).
Su et al[124]	Myocardial injury	Clinical data from nine previously healthy children and their 14 families were collected, including general status, clinical, laboratory test, and imaging characteristics. In this study, they found six children with high CK-MB, which means that SARS-CoV-2 could cause heart injury. All children presented a full recovery.
Kesici et al[119]	Myocardial injury	A 2-yr-old, otherwise healthy boy with a history of respiratory distress secondary to COVID-19 developed cardiogenic shock the second day of hospitalization. The patient presented elevated cardiac Troponin and severe left ventricular failure on echocardiography. The patient required ECMO support and presented cardiac arrest. The autopsy confirmed a dilated cardiomyopathy secondary to viral myocarditis with SARS-CoV-2 RT-PCR positivity in the cardiac tissue as the cause of the death.
Giacomet et al[118]	Myocardial injury	A 2-mo-old boy presented with fever, vomiting and diarrhoea within a confirmed SARS-CoV-2 infection. The cardiac work-up revealed increased Troponin I and NT-proBNP levels and mild left ventricular dysfunction on echocardiogram. IL-6 was elevated. After therapy with IVIG the patient presented a rapid full recovery. The clinical diagnosis was myocarditis.
Rodriguez-Gonzalez et al[114]	Pulmonary hypertension	A 6-mo-old male with history of small bowel disease presented with a pneumonia, cardiogenic shock and severe hypoxemia. Cardiac biomarkers and IL-6 were increased, and echocardiography showed severe pulmonary hypertension and severe right ventricular failure. Pulmonary thromboembolism was ruled-out through angio-CT scan. The patient received inotropic and respiratory support and improved rapidly with full recovery after the initiation of Tocilizumab. SARS-CoV-2 infection was confirmed by serology.
Samuel et al[120]	Arrhythmia	Thirty-six pediatric patients with active PCR positive SARS-CoV-2 infection were included in the study. No patients presented pre-exiting cardiac condition. Of them 6 cases developed significant arrhythmias (non-sustained ventricular tachycardia in 5 and sustained atrial tachycardia in 1). All were self-resolving episodes, and 3 of them were started on prophylactic anti-arrhythmic therapy. Four of them presented abnormal echocardiograms with mild dilation/dysfunction of the left ventricle that recovered at discharge.
Xia et al[121]	Arrhythmia	The authors reported the clinical, laboratory, and chest CT features of 20 pediatric inpatients with COVID-19 infection confirmed by pharyngeal swab COVID-19 nucleic acid test. The authors observed self-limited ECG alterations in four of these patients during admission (Sinus tachycardia, Atrial arrhythmia, First-degree atrioventricular block, atrial and ventricular premature beats). The patients did not require any treatment and presented a full recovery.

COVID-19: Coronavirus disease-2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; IL: Interleukin; IVIG: Intravenous immunoglobulin; MRI: Magnetic resonance imaging; ECMO: Extracorporeal membrane oxygenation; NT-proBNP: N-terminal pro–B-type natriuretic peptide; RT-PCR: Reverse transcriptase–polymerase chain reaction.