Cardiovascular Compromise in Pediatrics in the Times of COVID-19: SARS-CoV-2 Infection and Kawasaki Disease

Abstract

Introduction: The pandemic caused by the new SARS-CoV-2 virus has reported an increase in morbidity and mortality worldwide during the years 2020 to 2022. Many pediatric infections have been reported as mild. The cardiovascular complications due to COVID-19 described in the literature are mainly in adults, however, reports in the pediatric population have been less frequent. Objective: To describe the clinical characteristics and evolution of patients treated in two centers with cardio-pediatric care services who presented cardiovascular involvement during the COVID-19 pandemic related to the presence of SARS-CoV-2 infection and Kawasaki disease (KD). Materials and Methods: Through a descriptive, retrospective study, the medical records, electrocardiographic and echocardiographic studies were reviewed in both groups of patients between May 2020 and May 2022 at the National Institute of Child Health and Alberto Sabogal Hospital. None of the cases had a history of previous structural heart disease. Results: The patients studied were 31 in total, with 21 cases of COVID-19 (SARS-CoV-2 infection) and 10 of KD. The female sex predominated, with an average age of 6.2 years (COVID-19) and 2.9 years (Kawasaki). In the echocardiogram, mild pericardial effusion was the most common finding. Coronary alterations were found in 60% of patients with KD and in only 18% of COVID-19 cases. We found 15 patients who met the criteria for the so-called multisystem syndrome (MIS-C) among COVID-19 cases, 5 of them with hemodynamic compromise. Conclusion: During the COVID-19 pandemic, the clinical picture in both groups: SARS-CoV-2 infection and KD presented some similar characteristics, mainly in relation to coronary involvement (greater involvement in KD), and in the evolution, a greater hemodynamic compromise was evidenced in cases of SARS-CoV-2 infection but without associated mortality.