Çocuklarda COVID-19 İlişkili Multisistem İnflamasyon Sendromu: Kardiyovasküler Ve Koroner Değerlendirme

Year 2023, Volume: 1 Issue: 1, 8 - 15, 31.12.2023

Ayşegül Elbir Şahin

Abstract

Amaç: COVID-19 hastalığı dünya genelinde büyük ilgi çekmesine rağmen halen tam olarak anlaşılamamıştır. Bu hastalıkta çok önemli olan kardiyovasküler etkiler büyük ölçüde vaka serilerinden ve derlemelerden elde edilmekte olup prospektif çalışmaların derinliğinden yoksundur. Bu tek kollu gözlemsel çalışma, COVID-19 ile ilişkilendirilen “Multisistem İnflamatuar Sendrom” (MIS-C) tanısı konmuş çocuklarda koroner arterleri inceleyerek ve sol ventrikülün sistolik/diyastolik fonksiyonlarını değerlendirerek bu boşluğu doldurmayı amaçlamaktadır.
Materyal ve metot: Yaş aralığı 0-18 yıl olan 36 MIS-C hastasını içeren, kardiyovasküler tutuluma odaklanan ve koroner arterlerdeki değişikliklerin yanı sıra sol ventrikülün sistolik ve diyastolik fonksiyonlarını hastalık seyri boyunca izleyen prospektif bir çalışma yürüttük.
Bulgular: Hastaların %11,1’inde endokardit, %5,5’inde miyokardit, %0’ında perikardiyal effüzyon, %16,6’sında koroner dilatasyon ve %0’ında koroner anevrizma tespit edilmiştir. Kardiyovasküler tutulumu olmayan hastalarda bile, sistolik ve diastolik sol ventrikül fonksiyonlarında azalma, sol ana koroner arterin z skorunda artış gibi belirgin değişiklikler gözlenmiştir. Ancak bu gözlemlere rağmen, tüm hastalar taburcu edildikten sonra tam bir iyileşme hali göstermiş ve herhangi bir ölüm veya komplikasyon durumu bildirilmemiştir.
Sonuç: Bu çalışma, MIS-C’deki kardiyovasküler belirtilerin nadir olduğunu ve genellikle hafif seyir izlediğini vurgulamaktadır. Tedavinin zamanında yapılması, hastalığın olumlu seyrine katkıda bulunmuş olabilir. Klinik belirtiler olmasa bile, MIS-C’nin sol ventrikül fonksiyonu ve sol ana koroner arter üzerindeki etkileri göz önünde bulundurulmalıdır.

Keywords

Çocuklar, Koroner arter, Sol ventrikül fonksiyonu, SARS koronavirüsü

COVID-19-Related Multisystem Inflammation Syndrome In Children: Cardiovascular And Coronary Assessment

Abstract

Objective: Despite the global attention directed towards coronavirus-19 (COVID-19) disease, a comprehensive understanding of the condition remains elusive. The cardiovascular implications, pivotal in this disease, are largely derived from case series and reviews, lacking the depth of prospective studies. This single-arm observational study aims to fill this void by examining the coronary arteries and assessing the systolic/diastolic functions of the left ventricle in children diagnosed with “Multisystem Inflammatory Syndrome” associated with COVID-19 (MIS-C).
Material and methods: We conducted a prospective study involving 36 MIS-C patients aged 0-18 years, focusing on cardiovascular involvement and tracking changes in the coronary arteries, as well as the systolic and diastolic functions of the left ventricle during the disease course.
Results: Among the patients, 11.1% exhibited endocarditis, 5.5% myocarditis, 0% pericardial effusion, 16.6% coronary dilation, and 0% coronary aneurysm. Even in patients without cardiovascular involvement, subtle changes were noted, including a decrease in systolic and diastolic left ventricular function and an increase in the z score of the left main coronary artery. Despite these observations, all patients experienced full recovery upon discharge, with no reported deaths or complications.
Conclusion: This study underscores the rarity of cardiovascular manifestations in MIS-C, often following a benign course, particularly with prompt treatment. Even in the absence of clinical symptoms, MIS-C affects the left ventricular function and the left main coronary artery.

Keywords

Children, Coronary artery, Left ventricular function, SARS coronavirus

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