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.