To the Editor,I read with interest the case report by Barba et al, which is the first report of cardiac involvement in an infant with severe acute respiratory syndrome coronavirus 2 infection.
This case had mild elevated cardiac enzymes, such as troponin and creatine kinase MB levels. Echocardiography revealed mild pericardial effusion and normal cardiac function. This case suggests pericarditis with this aspect. The authors did not explain whether there was any coronary artery involvement. Cardiac magnetic resonance imaging did not show myocardial oedema. In this respect, sequences with late gadolinium enhancement should be made.The authors did not mention electrocardiographic findings including ST and T‐wave abnormalities other than sinus tachycardia. On the other hand, troponin elevation may be associated with both many cardiac and noncardiac pathologies in children.
Data about coronavirus disease 2019 (COVID‐19) in children are still quite scarce, and few severe cases have been reported up to now. Nevertheless children apparently are less prone to develop severe symptoms of COVID‐19. Cardiac involvement has been defined in a small number of children, thus showing that heart is a possible target of the disease at this age range as well. A recent systematic review describing cardiac involvement in children with COVID‐19 has been published.
The youngest case in this review was 55‐day‐old, who had multiple organ damage including heart. She had tachycardia. An increase in cardiac enzymes was reported on the 4th day of hospitalization as well. Her general condition had improved on seventh day and cardiac enzymes normalized along with respiratory distress on the 10th day. Wolfler et al
also described five children with cardiac injury who had mild to moderate cardiac dysfunction.In my opinion, children with COVID‐19 should be closely monitored to recognise cardiac involvement.
CONFLICT OF INTERESTS
The author declares that there are no conflict of interests.