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Giant coronary aneurysms in an infant: Dilemma of MIS-C

Alexandra Drury1, Kelsey Wold2, Steven Healan3

  • 1Washington State University/Elson S. Floyd College of Medicine, Spokane, Washington, USA.

Echocardiography (Mount Kisco, N.Y.)
|June 25, 2022
PubMed

Insights

Multisystem inflammatory syndrome in children (MIS-C) following COVID-19 can cause giant coronary artery aneurysms. Early detection and aggressive treatment are crucial for managing this pediatric condition.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • COVID-19 can trigger multisystem inflammatory syndrome in children (MIS-C).
  • Cardiovascular complications, including coronary artery abnormalities, are common in MIS-C.
  • Most coronary artery issues in MIS-C are transient dilations or small aneurysms.

Observation:

  • A 3-month-old infant developed giant coronary artery aneurysms (LAD and RCA) 26 days post-COVID-19 diagnosis.
  • The infant received treatment with IVIG, infliximab, glucocorticoids, aspirin, clopidogrel, and enoxaparin.
  • Despite treatment, persistent giant aneurysms with high z-scores (LAD ~35, RCA ~30) were noted.

Findings:

  • The case highlights persistent giant coronary artery aneurysms in MIS-C, exceeding typical transient presentations.
  • The patient showed no signs of coronary ischemia or cardiac dysfunction despite severe aneurysms.
  • Aggressive medical management did not lead to resolution of the giant aneurysms in this case.

Implications:

  • Emphasizes the need for vigilant monitoring of coronary arteries in children with MIS-C.
  • Suggests that some MIS-C cases may develop severe, persistent coronary artery aneurysms requiring further investigation.
  • Underscores the importance of early diagnosis and tailored, aggressive management strategies for pediatric cardiovascular complications of MIS-C.

Keywords:
COVID-19MIS-Ccoronary artery aneurysmspediatrics

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