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Rao. Vessel Plus 2022;6:35 https://dx.doi.org/10.20517/2574-1209.2021.109 Page 3 of 6

studies, presented methods of estimation of pulmonary artery pressure, reviewed methodology for
evaluation of ventricular (left, right, and single) function, and demonstrated the usefulness of echo in
evaluating multiple neonatal issues, including distressed neonate, infant of a diabetic mother, tracheo-
[5]
esophageal fistula, Down syndrome, and cardiomegaly. Part II of this review described echocardiographic
features of commonly encountered acyanotic CHDs. Echo-Doppler features of obstructive lesions, namely
aortic stenosis, coarctation of the aorta, pulmonary stenosis, and branch pulmonary artery stenosis, were
first presented, followed by a discussion of left-to-right shunt lesions, namely, ASD, patent foramen ovale,
VSD, PDA, and atrio-ventricular septal defect. A special section dedicated to evaluating hemodynamically
significant PDAs in premature infants was also included. Both congenital and acquired coronary artery
[6]
anomalies were reviewed at the conclusion of the paper. Part III of this review described
echocardiographic features of commonly encountered cyanotic CHDs. Echo-Doppler characteristics of
more commonly seen defects such as tetralogy of Fallot, transposition of the great arteries, tricuspid atresia,
total anomalous pulmonary venous connection, truncus arteriosus, and hypoplastic left heart syndrome
were first reviewed. Then, less commonly observed lesions such as double-outlet right ventricle, double-
inlet left ventricle, interrupted aortic arch, pulmonary atresia with intact ventricular septum, congenital
corrected transposition of the great arteries, Ebstein’s anomaly of the tricuspid valve, and mitral atresia with
normal aortic root were reviewed.

[7]
In the next paper, Dr. Misra et al. of Children’s Hospital of Michigan, Detroit, Michigan, detailed
multimodality imaging of tetralogy of Fallot (TOF) with a focus on postoperative residua. They discussed
the role of echocardiography, cardiac MRI, cardiac catheterization and cineangiography, and nuclear scan
in this evaluation, along with the advantages and limitations of each technique. They suggested continued
surveillance of post-operate TOF patients because of the existence of residual anatomic and hemodynamic
abnormalities and the potential need for re-intervention, including percutaneous pulmonary valve
replacement. They also stated that the afore-mentioned investigative methods are not exclusive of each
other but are complementary to one another. They opined that echocardiography is useful in evaluating
patients who are younger than 10 years of age. Beyond that age, the selection of the type of imaging
modality used is largely dependent upon the clinical scenario, issues to be addressed, and institutional
expertise while taking into consideration risks of the procedures such as radiation exposure and risk of
cancer. The authors also provided several illustrations demonstrating features of residua following surgical
correction of TOF. They concluded that the above investigative tools form the foundation of continuing
care and surveillance of surgically repaired TOF patients.

In a subsequent paper, Dr. Misra et al. of Children’s Hospital of Michigan, Detroit, Michigan, described
[8]
cardiovascular involvement in multisystem inflammatory syndrome in children with COVID-19. The
authors stated that SARS-CoV-2 infections in children usually have less severe COVID-19 infections than
those seen in adults. Nevertheless, some children may exhibit severe multisystem inflammatory disease. The
Center for Disease Control has named this entity a “Multisystem Inflammatory Syndrome in Children
(MIS-C)”. MIS-C results in important cardiovascular disease; the degree of cardiac involvement determines
the clinical course and eventual outcome. The presenting findings of MIS-C are constant fever,
gastrointestinal symptoms, polymorphic rash, conjunctivitis, and mucosal changes, somewhat similar to
those seen in Kawasaki syndrome. The inflammatory markers are often elevated. A subset of MIS-C patients
may present with hypotension and shock; this may be related to acute myocardial dysfunction or dilation of
the systemic vasculature. The cardiac involvement includes myocarditis, pericarditis, valvulitis, coronary
arteritis. Arrhythmias have also been documented. The authors reported the experience with MIS-C in 54
patients seen during the last year at their institution. They also reviewed cases reported in the recent
literature, and the clinical protocol to be used in the diagnosis and management of MIS-C secondary to