Myocarditis In Multisystem Inflammatory Syndrome In Children (Mis-C) Temporally Related To Covid-19

Background: Little is know about the pathophysiology of Multisystem Inflammatory syndrome in Children (MIS-C) temporally associated with COVID-19 Hypothesis: Patients with MIS-C may present with myocarditis. Cardiac magnetic resonance (CMR) may help in its diagnosis. Methods: Nine children and adolescents were identified to have clinically suspected myocarditis based on their clinical presentation, abnormal cardiac enzymes and evidence of ventricular dysfunction on echocardiogram. 5 patients underwent CMR. Results: All patients had evidence of current/recent SARS-COV-2 infection. Five were PCR+, 7 were IgG+. On echocardiogram at presentation, all the patients had mild-severe left ventricular dysfunction (EF: 25%-53%). Three had left ventricular dilation, 7 had evidence of valvulitis presenting as mitral regurgitation, 4 had pericardial effusion with no evidence of tamponade and 3 patients had associated coronary dilation. Seven patients presented in cardiogenic shock requiring inotropic support. Out of the 5 patients who underwent CMR, 2 had evidence of early and late gadolinium enhancement. Small focal area of late gadolinium enhancement was noted in the inferolateral segment of the subepicardial region of the left ventricle. There was evidence of myocardial edema in the other 3 patients. Conclusions: Children with Multi system Inflammatory Syndrome in Children can present as myocarditis. Cardiac magnetic resonance has a role in its diagnosis, prognosis, better understanding of this disease and may be useful for the long term follow up of these children. Table 1: Patient characteristics, labs, imaging findingsAbbreviations:-BNP: Brain natriuretic peptide, CRP:C-reactive protein, LV EF: Left ventricular ejection fraction, CAs: Coronary abnormalities, Valvar R: valvar regurgitation, EGE: Early gadolinium enhancement, LGE: Late gadolinium enhancement