INTRODUCTION Zika virus infection during pregnancy causes fetal microcephaly and brain damage. Congenital Zika syndrome (CZS) is characterized by systemic involvement with diffuse muscle impairment, a high frequency of arthrogryposis, and microphthalmia. Cardiac impairment in CZS has rarely been evaluated. Our study assessed morphology and biventricular cardiac function in children with CZS and advanced neurological dysfunction. METHODS This cross-sectional study was conducted on 52 children with CZS (Zika group; ZG) and 25 healthy children (control group; CG) in Paraiba, Brazil. Clinical evaluation, electrocardiogram (EKG), and transthoracic echocardiogram (TTE) were performed on all children. Additionally, troponin I and natriuretic peptide type B (BNP) levels, the degree of cerebral palsy, and neuroimaging findings were assessed in the ZG group. RESULTS The median age of the study population was 5 years in both groups, and 40.4% (ZG) and 60% (CG) were female. The most prevalent electrocardiographic alteration was sinus arrhythmia in both the ZG (n = 9, 17.3%) and CG (n = 4, 16%). The morphological parameters adjusted for Z score were as follows: left ventricular (LV) end-diastolic diameter in ZG: -2.36 [-5.10, 2.63] vs. CG: -1.07 [-3.43, 0.61], p<0.001); ascending aorta (ZG: -0.09 [-2.08, 1.60] vs. CG: 0.43 [-1.47, 2.2], p = 0.021); basal diameter of the right ventricle (RV) (ZG: -2.34 [-4.90, 0.97] vs. CG: -0.96 [-2.21, 0.40], p<0.01); and pulmonary artery dimension (ZG: -2.13 [-5.99, 0.98] vs. CG: -0.24 [-2.53, 0.59], p<0.01). The ejection fractions (%) were 65.7 and 65.6 in the ZG and CG, respectively (p = 0.968). The left atrium volume indices (mL/m2) in the ZG and CG were 13.15 [6.80, 18.00] and 18.80 [5.90, 25.30] (p<0.01), respectively, and the right atrium volume indices (mL/m2) were 10.10 [4.90, 15.30] and 15.80 [4.10, 24.80] (p<0.01). The functional findings adjusted for Z score were as follows: lateral systolic excursion of the mitral annular plane (MAPSE) (ZG: 0.36 [-2.79, 4.71] vs. CG: 1.79 [-0.93, 4.5], p = 0.001); tricuspid annular plane systolic excursion (TAPSE) (ZG: -2.43 [-5.47, 5.09] vs. CG: 0.07 [-1.98, 3.64], p<0.001); and the S' of the RV (ZG: 1.20 [3.35, 2.90] vs. CG: -0.20 [-2.15, 1.50], p = 0.0121). No differences in biventricular strain measurements were observed between the groups. Troponin I and BNP levels were normal in in the ZG. Grade V cerebral palsy and subcortical calcification were found in 88.6% and 97.22% of children in the ZG group, respectively. CONCLUSION A reduction in cardiac dimensions and functional changes were found in CZS patients, based on the TAPSE, S' of the RV, and MAPSE, suggesting the importance of cardiac evaluation and follow-up in this group of patients.

中文翻译：

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先天性寨卡综合征和严重神经缺陷儿童的形态和功能性心脏改变。

简介 怀孕期间感染寨卡病毒会导致胎儿小头畸形和脑损伤。先天性寨卡综合征 (CZS) 的特点是全身受累，伴有弥漫性肌肉损伤、关节挛缩和小眼畸形。CZS 的心脏损害很少被评估。我们的研究评估了患有 CZS 和晚期神经功能障碍的儿童的形态和双心室心脏功能。方法 这项横断面研究对巴西帕拉伊巴的 52 名 CZS 儿童（寨卡组；ZG）和 25 名健康儿童（对照组；CG）进行。对所有儿童进行临床评估、心电图（EKG）和经胸超声心动图（TTE）。此外，还对 ZG 组的肌钙蛋白 I 和 B 型利尿钠肽 (BNP) 水平、脑瘫程度和神经影像学结果进行了评估。结果 两组研究人群的中位年龄均为 5 岁，其中 40.4% (ZG) 和 60% (CG) 为女性。最常见的心电图改变是 ZG（n = 9，17.3%）和 CG（n = 4，16%）中的窦性心律失常。根据 Z 评分调整的形态学参数如下：ZG 中的左心室 (LV) 舒张末期内径：-2.36 [-5.10, 2.63] vs. CG：-1.07 [-3.43, 0.61]，p<0.001）；升主动脉（ZG：-0.09 [-2.08, 1.60] vs. CG：0.43 [-1.47, 2.2]，p = 0.021）；右心室基底直径 (RV)（ZG：-2.34 [-4.90, 0.97] 对比 CG：-0.96 [-2.21, 0.40]，p<0.01）；和肺动脉直径（ZG：-2.13 [-5.99，0.98] vs. CG：-0.24 [-2.53，0.59]，p<0.01）。ZG 和 CG 的射血分数 (%) 分别为 65.7 和 65.6 (p = 0.968)。ZG 和 CG 中的左心房容积指数 (mL/m2) 分别为 13.15 [6.80, 18.00] 和 18.80 [5.90, 25.30] (p<0.01)，右心房容积指数 (mL/m2) 为 10.10 [4.90, 15.30] 和 15.80 [4.10, 24.80] (p<0.01)。根据 Z 评分调整的功能结果如下：二尖瓣环平面收缩期横向偏移 (MAPSE)（ZG：0.36 [-2.79, 4.71] 对比 CG：1.79 [-0.93, 4.5]，p = 0.001）；三尖瓣环平面收缩期偏移 (TAPSE)（ZG：-2.43 [-5.47, 5.09] 对比 CG：0.07 [-1.98, 3.64]，p<0.001）；和 RV 的 S'（ZG：1.20 [3.35，2.90] 与 CG：-0.20 [-2.15，1.50]，p = 0.0121）。各组之间未观察到双心室应变测量值存在差异。ZG 中肌钙蛋白 I 和 BNP 水平正常。ZG组中V级脑瘫和皮质下钙化的发生率分别为88.6%和97.22%。结论 根据 TAPSE、RV 的 S' 和 MAPSE，发现 CZS 患者心脏尺寸减小和功能变化，这表明对这组患者进行心脏评估和随访的重要性。