Introduction
The coronavirus disease-2019 (COVID-19) pandemic has had an unprecedented impact on patients and patient care management worldwide, including the field of congenital cardiology and cardiac surgery.1 Traditional management algorithms are challenged by the unpredictable nature of COVID-19. This case report highlights an important, treatable diagnosis complicated by a concomitant COVID-19 infection.
Primary cardiac tumors in children are extremely rare.2–4 Most tumors are reported as case reports or as single institution case series. These are usually benign, and the most common pathology in the pediatric population is the rhabdomyoma, followed by fibromas, myxomas, teratomas, and hemangiomas. Up to 12% will be found incidentally but the rate of growth, location, and size of the tumor determines the clinical presentation.5 Most children will present with a one or more of the following symptoms: murmur, arrhythmia, cyanosis, dyspnea, or cardiac failure.6 Surgical resection remains the standard of care for primary cardiac tumors in children. Echocardiography and magnetic resonance imaging are the gold standard for diagnosing cardiac tumors; computed tomography can be a useful adjunct.
Pediatric cardiac fibromas most often arise from the left ventricle.7 Noninvasive, fibromas of the heart can exert pressure on vital parts of the heart including the coronary arteries and valves. A multicenter European study of pediatric primary cardiac tumors reported a 10% rate of arrhythmias associated with cardiac fibromas and a 20% overall rate of arrhythmias associated with all cardiac tumors.2 These rhythm disturbances were most often ectopic atrial or ventricular beats, followed by atrial flutter and paroxysmal supraventricular tachycardia. Due to the association with sudden cardiac death, pediatric cardiac fibromas are typically resected even in asymptomatic patients.8 We report a pediatric case of cardiac fibroma in a child who was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) on a pre-operative work-up. No institutional review, consent, or clinical trial registration was required for this case report and review.