key: cord-1032570-rcimjwwz authors: Schranz, Dietmar title: COVID-19 in children: acute endotheliopathy, but forgotten prostacyclin replacement? date: 2021-06-21 journal: Cardiol Young DOI: 10.1017/s1047951121002626 sha: 786b805bedfa3800a3a13b078e18ff3f07e89ca1 doc_id: 1032570 cord_uid: rcimjwwz nan of D-dimer and concerning the coronary involvement by falling troponin levels. Based on previous experience with prostacyclin treatment in life-threatening paediatric "purpura fulminans", partly together with substitution of activated protein-C, 19 we also used successfully ilomedin, but currently only anecdotally in infants with paediatric inflammatory multisystem syndrome (PIMS). It can be hypothesised that prostacyclin infusion is a promising replacement therapy, suitable for COVID-19-associated microvascular diseases with thrombotic and ischaemic consequences. Prostacyclin combines platelet inhibition and support of microvascular function, which is not limited to pulmonary circulation. A Danish study on the use of ilomedin (1 ng/kg/min) in COVIDpatients is planned and already started in adults. 20 In contrast to prostacyclin, which is not yet generally used, low-dosed acetyl salicylic acid has proven to be beneficial in moderately to severely ill COVID-19 patients, if prophylactically applicated. 21 Adapted to follow-up treatment for Kawasaki syndrome and from COVID-19 patients with a history of elevated troponin-I and D-dimer levels, low-dose aspirin (1-2 mg kg once a day) is recommended for follow-up treatment for 3-6 months. 22 In patients with an additional myocarditis phenotype, we also combine low-dose aspirin with clopidogrel for 3 months, which is not proved, yet. Financial support. This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. Conflict of interest. None. Covid-19 FAQs in paediatric and congenital cardiology: AEPC position paper. CY 2021 Cytokine storm Risk factors associated with acute respiratory distress syndrome and Death in patients with Coronavirus Disease Endothelial cell infection and endotheliitis in COVID-19 Kawasaki-like disease: emerging complication during the COVID-19 pandemic Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study SARS-CoV-2 B.1.1.7 and B.1.351 spike variants bind human ACE2 with increased affinity ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic 2020 Molecular pathology of inflammatory cardiomyopathy Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin Myocardial localization of coronavirus in COVID-19 cardiogenic shock Severe COVID-19 Is a Microvascular Disease Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study Toll-like receptors and COVID-19: a two-faced story with an exciting ending The endothelium as Achilles' heel in COVID-19 patients Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia Potential Therapeutic Options for COVID-19: current Status, Challenges, and Future Perspectives Surviving sepsis campaign international guidelines for the management of septic shock and sepsisassociated organ dysfunction in children Purpura fulminans in severe congenital protein C deficiency: monitoring of treatment with protein C concentrate The effect of prostacyclin (Iloprost) infusion at a dose of 1 ng/ kg/min for 72 hours compared to placebo in mechanically ventilated patients with COVID-19: A structured summary of a study protocol for a randomized controlled trial Enhanced platelet inhibition treatment improves hypoxemia in patients with severe Covid-19 and hypercoagulability. A case control, proof of concept study American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the