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Characteristics of Cardiac Abnormalities in Pediatric Patients With Acute COVID-19

Pasternack, Daniel; Singh, Rakesh K; Minocha, Prashant K; Farkas, Jon S; Ramaswamy, Prema; Better, Donna; Verma, Sourabh; Phoon, Colin K
Introduction Coronavirus disease 2019 (COVID-19) is known to cause cardiac abnormalities in adults. Cardiac abnormalities are well-described in multisystem inflammatory syndrome in children, but effects in children with acute COVID-19 are less understood. In this multicenter study, we assessed the cardiac effects of acute COVID-19 among hospitalized children (<21 years) admitted to three large healthcare systems in New York City. Methods We performed a retrospective observational study. We examined electrocardiograms, echocardiograms, troponin, or B-type natriuretic peptides. Results Of 317 admitted patients, 131 (41%) underwent cardiac testing with 56 (43%) demonstrating cardiac abnormalities. Electrocardiogram abnormalities were the most common (46/117 patients (39%)), including repolarization abnormalities and QT prolongation. Elevated troponin occurred in 14/77 (18%) patients and B-type natriuretic peptide in 8/39 (21%) patients. Ventricular dysfunction was identified in 5/27 (19%) patients with an echocardiogram, all of whom had elevated troponin. Ventricular dysfunction resolved by first outpatient follow-up. Conclusion Electrocardiogram and troponin can assist clinicians in identifying children at risk for cardiac injury in acute COVID-19.
PMID: 37065296
ISSN: 2168-8184
CID: 5459202

Multivalvular Endocarditis With Abscess: A Wild Goose Chase

Abuso, Stephanie; Rubin, Lily; Geraghty, Brian; Hoque, Tasneem; Better, Donna; Kumar, T K Susheel; Small, Adam; Halpern, Dan; Weisenberg, Scott; Fiorito, Theresa M
We report a case of Streptococcus mutans multivalvular infective endocarditis complicated by aortic root abscess and septic emboli in a 19-year-old male with a bicuspid aortic valve. This case illustrates the progression of untreated subacute bacterial endocarditis and highlights the importance of ongoing clinical suspicion for infective endocarditis in patients with underlying valvular defects.
PMID: 35389950
ISSN: 1532-0987
CID: 5205002

Strain in children with MIS-C and acute COVID-19

Minocha, Prashant K; Srinivasan, Ranjini; Babb, James; Singh, Rakesh K; Phoon, Colin K L; Better, Donna; Bhatla, Puneet
CONTEXT/UNASSIGNED:Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. AIMS/UNASSIGNED:We sought to describe strain findings in both the groups on initial presentation and follow-up. SETTINGS AND DESIGN/UNASSIGNED:A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. SUBJECTS AND METHODS/UNASSIGNED:TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. RESULTS/UNASSIGNED:= 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. CONCLUSIONS/UNASSIGNED:Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.
PMID: 37152504
ISSN: 0974-2069
CID: 5544462

Recurrence of Acute Myocarditis Temporally Associated with Receipt of the mRNA Coronavirus Disease 2019 (COVID-19) Vaccine in a Male Adolescent [Case Report]

Minocha, Prashant K; Better, Donna; Singh, Rakesh K; Hoque, Tasneem
PMID: 34166671
ISSN: 1097-6833
CID: 4940912

Pattern of pulmonary venous blood flow in the hypoplastic left heart syndrome in the fetus

Better, D J; Apfel, H D; Zidere, V; Allan, L D
OBJECTIVE:To determine whether restriction at the atrial septum in the newborn with hypoplastic left heart syndrome can be predicted accurately by examining the pattern of pulmonary venous flow in the fetus. A restrictive atrial septum can contribute to haemodynamic instability before surgery for this lesion and has been associated with an increased mortality. DESIGN/METHODS:Pulmonary venous pulsed Doppler tracings were compared between fetuses with hypoplastic left heart syndrome and controls. The size of the atrial septal defect on the postnatal echocardiogram was graded according to the degree of restriction. Pulsed Doppler tracings of pulmonary venous blood flow were obtained in 18 fetuses with left atrial outflow atresia and compared with 77 controls, adjusted for gestational age. Postnatal echocardiograms were available for analysis in 13 of 18 neonates. SETTING/METHODS:A tertiary referral centre for fetal cardiology and paediatric cardiac surgery. RESULTS:Fetuses with hypoplastic left heart syndrome were different from controls in all pulmonary vein indices measured. As assessed from the postnatal echocardiogram, there were seven fetuses with a restrictive atrial septum. In these fetuses, the systolic flow velocity (p < 0.01), S/D ratio (p < 0.01), and peak reversal wave (p < 0.001) in the pulmonary vein tracing showed a good correlation with the degree of restriction. CONCLUSIONS:The Doppler pattern of pulmonary venous flow in the fetus with hypoplastic left heart syndrome appears to be a reliable predictor of restriction of the atrial septum in the neonate. This may help in the immediate post-delivery management of these infants before surgery.
PMID: 10336926
ISSN: 1355-6037
CID: 3487752

The normal pattern of pulmonary venous flow on pulsed Doppler examination of the human fetus

Better, D J; Kaufman, S; Allan, L D
The pattern of pulmonary venous flow was studied in 52 normal fetuses between 16 weeks gestation and term. A characteristic flow profile was defined. This was similar to that described in the child and adult and different from the pattern of flow in the systemic veins described in the fetus. The velocity of flow increased with gestation and was not influenced by heart rate. The velocity-time integral showed that systolic flow was 2.0 +/- 0.3 times the flow in diastole. Pulsed Doppler echocardiography demonstrates a distinctive pattern of pulmonary venous blood flow that reflects left atrial hemodynamics.
PMID: 8736011
ISSN: 0894-7317
CID: 3487762