Pediatric Cardiology最新文献

As a marker of cardiac wall stress, NT-proBNP offers high prognostic and diagnostic potential in patients with a functional single ventricle (fSV). Its levels depend on both age and stage of palliation. However, the impact of systemic ventricular morphology on this biomarker remains unclear. Children undergoing staged palliation, i.e. systemic-to-pulmonary shunt (SPS), ductal stenting (DS) and/or pulmonary artery banding (PAB) as stage 1, bidirectional cavopulmonary shunt (BCPS) as stage 2 or extracardiac total cavopulmonary connection (TCPC) as stage 3 at our institution between 2011 and 2023 were identified. Those, who had NT-proBNP determined at most 7 days before intervention or surgery were included. Furthermore, patients at least 6 months after TCPC with ambulatory measured NT-proBNP were enrolled. NT-proBNP levels were evaluated using its age-adjusted z-score ("zlog-NT-proBNP"), allowing comparison irrespective of the distinctive physiological decline with age. Overall, 618 children met the eligibility criteria. Thereof, 356 patients had a systemic right ventricle (SRV) and 262 a systemic left ventricle (SLV). At each stage of palliation, age-adjusted zlog-NT-proBNP was significantly higher in patients with an SRV compared to an SLV: before SPS/DS/PAB (median 3.43 vs 2.62, p < 0.001); before BCPS (median 3.33 vs 2.04, p < 0.001); before TCPC (median 1.50 vs 0.66, p < 0.001); and after TCPC (median 1.62 vs 0.81, p < 0.001). Systemic ventricular morphology highly affects (zlog-)NT-proBNP levels in fSV patients at each stage of palliation. When interpreting NT-proBNP levels in these patients, clinicians and future studies should take into account that children with an SRV reveal higher NT-proBNP levels than those with an SLV.

Early identification of critical congenital heart disease (CCHD) is essential in the management of neonates without a prenatal diagnosis. Adult-trained cardiac sonographers often perform initial neonatal transthoracic echocardiograms for outside interpretation. We sought to critically evaluate the accuracy and quality of these echocardiograms. Neonates treated at our center for postnatally diagnosed CCHD, who had an initial echocardiogram performed by an adult-trained sonographer at an outside birthing center were included. Each initial echocardiogram was evaluated using a 4-point Likert scale for diagnostic accuracy and quality, and a 3-point Likert scale assessing 5 standard echocardiogram views. Six paired graders independently assessed an equal distribution of echocardiograms. 52 echocardiograms from 4 states met all inclusion criteria. The most common diagnoses were aortic arch abnormalities (37%), followed by dTGA (19%), and TAPVR (17%). Ninety-eight percent of the original interpretations provided the correct primary diagnosis or high enough suspicion of the primary diagnosis to warrant appropriate escalation in care. Average scores of the echocardiograms were 3.13 ± 0.66 for diagnostic accuracy and 3.09 ± 0.54 for overall image quality. Average scores were highest for parasternal long-axis view (2.74 ± 0.31) and lowest for suprasternal notch (2.18 ± 0.46) and subcostal (2.07 ± 0.34) views. The average intraclass correlation between raters was > 0.9. Postnatal CCHD is discoverable by adult-trained sonographers with remote interpretation by pediatric cardiologists. Suprasternal notch and subcostal views are areas of educational opportunity. With appropriate support systems, adult-trained sonographers can be an invaluable asset in the early diagnosis and management of unexpected CCHD.

Regardless of the surgical approach to repair coarctation of the aorta (CoA), a portion of the distal transverse arch (DTA) remains incorporated within the anastomosis. We hypothesized that retention of a small DTA segment results in an elevated gradient. Infants were divided into two groups based on the surgical approach: (1) Sternotomy and aortic arch repair where the DTA was nearly excised and (2) Thoracotomy and extended end-to-end anastomosis (EEEA), which incorporates most of the DTA within the anastomosis. Follow-up echocardiograms quantified the aortic arch gradient, and children with a gradient in the upper quartile for each surgical approach were analyzed. From 230 infants, 51.3% (118) underwent sternotomy and aortic arch repair, and 48.7% (112) underwent thoracotomy and EEEA. Post-operatively, the sternotomy group had a significantly greater duration of ventilation and hospital length of stay but without a difference in mortality. Follow-up aortic arch gradients were significantly lower within the sternotomy group (11.9 ± 7.0 mmHg vs. 14.5 ± 7.5 mmHg; p = 0.002). Children with an aortic arch gradient in the upper quartile from the thoracotomy group had significantly smaller preoperative DTA dimensions. Multivariate regression demonstrated that sternotomy and aortic arch repair independently reduced the follow-up aortic arch gradient (Odds Ratio: 0.075 95% CI 0.006, 0.877; p value = 0.039). Incorporating smaller DTA segments within the anastomosis results in higher gradients that may have implications in the development of hypertension during adulthood and suggests the consideration of the DTA dimension during CoA repair.

Research analyzing the link between different screen time activities and childhood health have had varied results. We examined the relationship between total screen time and subtype to beneficial diet and physical activity behaviors (BDPAB) in middle-school children. This cross-sectional study analyzed data from 110 middle schools participating in a school-based health program between September 2013 and February 2023. Based on self-reported health behavior surveys, data from 12,751 sixth graders were available for analysis. BDPAB included ≤ 1 serving/day of sugary beverages; ≤ 1 serving/day sugary foods/chocolate candy; ≤ 1 serving/day fried or fatty foods; ≥ 1 servings/day of fruits or vegetables; ≥ 1 day/week physical education class; ≥ 1 out-of-school sport/year; ≥ 1 team sport/year, and ≥ 1 session/week of moderate to vigorous activity. Independent of media subtype (television, computer, video game, mobile device), consuming > 2 h of screen time was associated with lower odds of all BDPAB, with the exception of physical education class participation. Both moderate screen time (4 - < 8 h) and high screen time (≥ 8 h) usage were associated with lower odds of performing the majority of BDPAB. Temporal trends (2013-2014, 2015-2016, 2017-2019, and 2020-2023) revealed an upward trend of BDPAB up until the COVID-19 pandemic, in which the proportion of students exhibiting BDPAB decreased. Increasing use of screen time, regardless of modality, is associated with reduced frequency of BDPAB. These findings re-enforce the potential negative impact of extensive screen use. Promoting balanced and healthy screen habits represents a potential intervention to promote BDAPB.

Multicenter studies describing electrocardiogram (ECG) patterns in children presenting with anomalous left coronary artery from the pulmonary artery (ALCAPA), to our knowledge, have not been published. This study aimed to describe the ECG findings at presentation and over time in a multicenter cohort of children with ALCAPA and assess their association with clinical outcomes. We performed a retrospective ECG analysis of 188 patients with ALCAPA who presented between 1/2009 and 3/2018 at 21 centers affiliated with Collaborative Research for the Pediatric Cardiac Intensive Care Society. ECGs were categorized apriori as Classic (pathologic Q waves in anterolateral leads), non-classic (abnormal but without pathologic Q waves), and normal. The primary outcome was major adverse cardiac events (MACE) following ALCAPA repair, defined as extracorporeal support, cardiopulmonary resuscitation, heart transplantation, or death. Classic, non-classic, and normal ECG findings were seen at presentation in 124 (66%), 49 (26%), and 15 (8%) patients, respectively. There was no association between ECG category and MACE. Patients with non-classic or normal ECG findings were significantly more likely to present with normal or mildly diminished left ventricular systolic function and had significantly shorter duration of ventilation and hospital stay. Among 70 patients with ECGs at ~ 3 years following surgery, classic, non-classic, and normal ECG patterns were seen in 6 (8%), 29 (41%), and 35 (50%) patients, respectively. In conclusion, one-third of patients with ALCAPA presented with non-Classic or normal ECG patterns, and these patients were more likely to have preserved cardiac function and recover more quickly following surgical repair.

Transcatheter pulmonary valve replacement (TPVR) is associated with an increased risk of valve leaflet thrombosis and leaflet dysfunction requiring thromboprophylaxis. The use of direct oral anticoagulants (DOACs) in pediatric patients with TPVRs is currently off-label without established data on safety and efficacy. The primary objective was a composite safety score consisting of clinically relevant non-major bleeding, major bleeding, bleeding-related re-admission, and medication discontinuation. The secondary objective consisted of the individual components of the composite score, in addition to valve thrombosis as represented by increasing transvalvular gradient by echocardiogram and valve complication requiring re-intervention. A single center, retrospective, descriptive study of pediatric patients who underwent TPVR placement. Patients were included in this study if they were less than 18 years old and received a DOAC in addition to low dose aspirin (standard of care) post procedure for thromboprophylaxis. Thirty-one patients were identified, of which 21 were males (68%) with a median age of 14 years (IQR: 13, 16) and median weight of 49 kg (IQR: 49, 60). Of the 31 patients, 4 (13%) met the composite outcome with all 4 patients having minor bleeding (13%), and one patient requiring hospital readmission for a minor bleed (3.2%). There were no major bleeds or bleeding-related deaths. No patients developed a valve thrombosis or valve complication requiring re-intervention. DOACs may be safe in pediatric patients after TPVR. No patients experienced major bleeding, and only one had clinically relevant non-major bleeding. Further evaluation of pediatric DOAC use, dosing, and long-term benefits of thromboprophylaxis in TPVR should be evaluated.

To investigate relationships between unplanned readmissions and social determinants of health in pediatric cardiac disease. Retrospective cohort study of pediatric (< 18 years) cardiac admissions in the Pediatric Health Information System (1/2019-3/2023). Social determinants included Child Opportunity Index (lower opportunity indicates fewer neighborhood-level resources), insurance, urbanicity, race, and ethnicity. Primary outcomes were unplanned all-cause and cardiac-related 90- and 365-day readmissions. Sub-analyses were performed in cardiac surgical and cardiac medical (congenital versus acquired) cohorts. Of 320,225 admissions, 90- and 365-day all-cause readmission rates were 22.0%, and 33.6% (cardiac-related: 13.8% and 20.9%). Cardiac-surgical patients accounted for 9.4% of readmissions. All-cause 90- and 365-day readmissions were higher among children with Hispanic/Latino ethnicity, Black/African American race, Medicaid, and low/very low opportunity (p < 0.001). Adjusted odds of 90-day readmissions were greater for children with Hispanic/Latino ethnicity (aOR 1.04[95%CI 1.01-1.07]), Medicaid insurance (aOR 1.17[1.14-1.19]), and urban residence (aOR 1.11[1.08-1.14]). At 365 days, odds were also higher for children with Multiracial backgrounds (aOR 1.07[1.01-1.14]) and residing in low/very low opportunity areas (aOR 1.08[1.03-1.12]). All-cause readmission findings were primarily driven by cardiac medical patients with less pronounced effects in surgical readmissions. All-cause readmission rates decreased as opportunity increased for children with Asian and White race but not other racial/ethnic backgrounds. Cardiac-related readmissions had similar results, except for lower readmissions in children with Black/African American race. Children with cardiac disease with fewer resources, public insurance, and underrepresented racial/ethnic backgrounds have more unplanned readmissions. The child opportunity index modified race-readmission relationships. Opportunities exist to optimize discharge planning, follow-up, and preventative care.

The PErioperative ACHd (PEACH) score is a mortality risk assessment tool for adult congenital heart disease (ACHD) patients created to address the unique surgical risks in this population. Evaluation of the PEACH score's validity in a US cohort is needed. This paper sought to assess the PEACH score's performance in ACHD patients undergoing cardiac surgery. Secondary objectives included comparison of the PEACH score to other surgical risk assessment tools, score association with post-operative morbidities, and exploration of additional variables that may improve the score. A retrospective cohort study was conducted in ACHD patients who underwent cardiac surgery at the University of Colorado Hospitals between 2010 and 2022. Patients were identified by the institutional STS database. Components of the PEACH score and additional risk factors were evaluated by univariable analysis and subsequent logistic regression. A ROC curve compared the PEACH score to existing risk models. 516 patients were included with a median age of 30 years and 51% male. There were 9 (1.7%) deaths. Zero of 240 low-risk patients died, 6 of 229 intermediate-risk patients died (2.6%), and 3 of 41 high-risk patients died (7.3%). Model comparison revealed PEACH score AUC 0.832, ACHS score AUC 0.869, and STAT AUC 0.769. The addition of platelet level (< 150,000) improved the PEACH score (AUC 0.843, 95% CI 0.747-0.939). The PEACH score provided strong predictive ability for perioperative mortality in this ACHD cardiac surgery cohort and was associated with increased morbidity. The addition of platelet level to the score may improve its accuracy.

L-loop congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart defect that may remain undiagnosed for decades and lead to significant morbidities, making it of interest for early detection. In this study, we address this gap by developing and internally testing an artificial intelligence-enabled electrocardiogram (AI-ECG) model to diagnose ccTGA from standard 12-lead ECGs. The dataset included the first ECG from 61,482 patients (0.7% with ccTGA), which was partitioned into training (70%) and testing (30%) cohorts. The convolutional neural network model achieved an area under the receiver-operating characteristic curve of 0.95 [95% CI 0.94-0.96] and an area under the precision-recall curve of 0.16 [95% CI 0.12-0.21]. The model performed well across different age groups, with slightly lower performance in patients < 1 month old. Key features identified by the model included widened QRS complexes, negative QRS complexes in leads V1-V2, and the lack of Q waves in lateral precordial leads. This study highlights the potential of AI-ECG to detect subtle patterns in rare congenital heart defects, providing a scalable method for early diagnosis and improving access to care. Future studies may include external validation in diverse clinical settings and multi-modal models to enhance performance and clinical utility.

Parents of children with congenital heart disease (CHD) experience higher rates of stress compared with the general population, which adversely affects their health-related quality of life (HRQoL). The purpose of this cross-sectional study was to examine coping strategies as mediators and moderators between perceived stress and HRQoL in parents of children with CHD. The effects of sociodemographic factors on perceived stress and HRQoL were also explored. Parents of children with CHD were recruited to participate from October 2023 to July 2024. Participants completed a self-report, online questionnaire containing the Perceived Stress Scale (PSS), Brief COPE, PedsQL Family Impact module, and the Protocol for Responding to and Assessing Patients Assets, Risks, and Experiences (PRAPARE). SPSS v27.2 and the PROCESS macro extension were used for analysis of mediator and moderator effects of coping strategies. Participants included 53 parents who met criteria and agreed to participate in the study. Parents with Medicaid and other non-private insurance types had higher PSS scores than parents with private insurance. Avoidant coping, self-blame, and behavioral disengagement were positively correlated with PSS and negatively correlated with HRQoL. Regression analysis indicated that coping strategies did not directly mediate the relationship between PSS and HRQoL. Problem-focused coping, active coping, emotional support, acceptance, and self-distraction moderated the effects of PSS on HRQoL. More research is needed to develop and test evidence-based coping interventions that reduce stress and improve HRQoL in parents of children with CHD.