Myocardial dystrophic calcifications in children: a case series and literature review Calcificaciones heterotópicas del miocardio en niños: serie de casos y revisión de la literatura

Abstract

Objective: To describe the clinical and imaging findings of seven children with dystrophic myocardial calcifications as seen on computed tomography (CT). Methods: In this retrospective study, we reviewed CT images of children with myocardiac dystrophic calcifications. Clinical information including diagnosis, comorbidities, and treatment was extracted from patients’ medical records. A literature search was perfomed in PubMed and Scielo for case reports and case series that included patients younger than 18 years old with myocardial calcifications. Results: Seven patients, 5 (71.4%) boys, with a median age of 1.1 years [IQR 0.8 - 6.3] were included. All CT images demonstrated transmural myocardial calcifications, that were first seen by echocardiography in three patients. Myocardiac calcifications involved the left ventricle in 3 patients, both ventricles in 2 and only the right ventricle in another 2 patients. One patient also had dystrophic vascular and lung calcifications. In the literature search we found 23 original articles including 20 case reports and 3 case series. While need of ECMO and history of cardiac transplant were the most common asociated comorbidities in our series, renal failure and sepsis are most commonly described in the literature.Mortality was high in both our cohort (43%) and the literature (40%). Conclusions: Pediatric patients experiencing critical conditions, including sepsis, renal insufficiency, the requirement for ECMO, and those subjected to heart transplantation, may manifest transmural myocardial calcifications. These calcifications do not exhibit a characteristic ventricular distribution corresponding to a specific underlying disease. Nonetheless, in aggregate, they are linked with elevated mortality rates.