Main Findings
LV lateral wall and septal thickening, reduced biventricular diastolic
functions in both fetal, neonatal and infant periods, and impaired left
ventricular systolic functions in infant period were found in the COVID
group compared with controls. Most of the cases reported in the
literature focused specifically on maternal outcomes and possible
vertical transmission, but less attention was paid to the fetus as the
patient in such pregnancies [3,4].
The cardiovascular system is usually the main target of COVID-19
infection and post-infection hyperimmune response with myocarditis and
systemic vasculitis [15,16]. In keeping with this, MIS-N/MIS-C is
considered to be a multifactorial disease with an unknown
pathophysiology. The most widely accepted mechanism is the
postinfectious immune response to SARS-CoV-2 antibodies that initiate a
cascade of inflammation and multi-organ involvement [17]. Pawar et
al. were the first to distinguish early MIS-N with a case-series of
neonates. Eighteen of twenty neonates (90%) had cardiac involvement
with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary
dilatation [7]. Shaiba et al. presented a systematic review of 47
neonates and 77% of which had cardiovascular compromise (arrhythmias,
dilated coronaries/aneurysm, pericardial effusion, persistent pulmonary
hypertension, intracardiac thrombus)[18]. De Rose et al. had
investigated clinical features of MIS-N and MIS-C under six months of
age and they demonstrated that cardiovascular dysfunction and
respiratory distress are the prevalent findings both in neonates with
MIS-N and in neonates/infants with MIS-C differently from older children
with MIS-C. Moreover, cardiovascular dysfunction was the relevant
pathology of disease mortality [19]. However influence of maternal
COVID-19 to fetal and infant heart without clinical presentation of
MIS-N is still uncertain. In our present study, we focused to evaluate
the effects of maternal COVID-19 on cardiac features and functions of
these delicate patients. Mainly our study mentioned diastolic
dysfunction and persistent wall thickness in the foreground. These
findings may be due to pancarditis caused by inflammatory environment of
maternal COVID-19 infection.