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.