Pediatric Cardiology最新文献

Acute myocarditis (AM) is an inflammatory disease of the heart muscle that can progress to fulminant myocarditis (FM), a severe and life-threatening condition. The cytokine profile of myocarditis in children, especially in relation to fulminant myocarditis, is not well understood. This study aims to evaluate the cytokine profiles of acute and fulminant myocarditis in children. Pediatric patients diagnosed with myocarditis were included in the study. Cytokine levels were measured using a multiplexed fluorescent bead-based immunoassay. Statistical analysis was performed to compare patient characteristics and cytokine levels between FM, AM, and healthy control (HC) groups. Principal component analysis (PCA) was applied to cytokine groups that were independent among the FM, AM, and HC groups. The study included 22 patients with FM and 14 with AM patients. We identified four cytokines that were significantly higher in the FM group compared to the AM group: IL1-RA (p = 0.002), IL-8 (p = 0.005), IL-10 (p = 0.011), and IL-15 (p = 0.005). IL-4 was significantly higher in the AM group compared to FM and HC groups (p = 0.006 and 0.0015). PDGF-AA, and VEGF-A were significantly lower in the FM group than in the AM group (p = 0.013 and <0.001). Similar results were obtained in PCA. Cytokine profiles might be used to differentiate pediatric FM from AM, stratify severity, and predict prognosis. The targeted therapy that works individual cytokines might provide a potential treatment for reducing the onset of the FM and calming the condition, and further studies are needed.

Extensive research has consistently demonstrated that humans frequently diverge from rational decision-making processes due to the pervasive influence of cognitive biases. This paper conducts an examination of the impact of cognitive biases on high-stakes decision-making within the context of the joint pediatric cardiology and cardiothoracic surgery conference, offering practical recommendations for mitigating their effects. Recognized biases such as confirmation bias, availability bias, outcome bias, overconfidence bias, sunk cost fallacy, loss aversion, planning fallacy, authority bias, and illusion of agreement are analyzed concerning their specific implications within this conference setting. To counteract these biases and enhance the quality of decision-making, practical strategies are proposed, including the implementation of a no-interruption policy until all data is reviewed, leaders refraining from immediate input, requiring participants to formulate independent judgments prior to sharing recommendations, explicit probability estimations grounded in base rates, seeking external opinions, and promoting an environment that encourages dissenting perspectives.

This is a case of an infant with duct-dependent pulmonary circulation, who required 6 stents delivered over three procedures to fully stent the arterial duct, which originated in a very unusual fashion. The attainable angiographic projections were unable to profile its origin, and only a CT scan was ultimately able to delineate the (stenotic) ductal origin from the aorta.

The article "Pulmonary Flow Management by Combination Therapy of Hemostatic Clipping and Balloon Angioplasty for Right Ventricular-Pulmonary Artery Shunt in Hypoplastic Left Heart Syndrome" offers valuable insights into Right Ventricular-Pulmonary Artery Shunt in Hypoplastic Left Heart Syndrome. This letter commends the study for its relevance and potential to improve patient care but highlights several limitations. Notably, the study overlooks the impact of Balloon angioplasty is a useful treatment for recoarctation in individuals with HLHS, but it frequently necessitates further operations. Following Norwood or Fontan palliation, stenting is safe, adaptable, and can be used to control uncommon neointimal growth. The risk of pulmonary artery stenosis may be decreased by the hemi-Fontan the technique. BA is better for recoarctation because it has fewer risks, whereas endovascular stenting helps high-risk patients avoid surgery.

In response to the article "Early Postoperative ECG Changes as a Predictor of Post-Pericardiotomy Syndrome Following Atrial Septal Defect Repair" by Hyberg et al. I commend the authors for their valuable insights into early ECG changes predicting postoperative complications. However, I raise several concerns regarding their study's methodology. Specifically, the use of European Society of Cardiology (ESC) criteria without incorporating pediatric-specific criteria, such as those proposed by Heching et al. potentially limits the study's applicability to younger patients. Additionally, reliance solely on ST-segment elevation and PR segment depression for assessing pericardial inflammation overlooks the significance of Spodick's sign. The lack of a standardized timing for postoperative ECGs and the omission of independent risk factors for Post-Pericardiotomy Syndrome (PPS), including history of pericarditis and pneumonia, further limit the study's comprehensiveness. I suggest that future research should address these aspects to refine diagnostic and monitoring strategies.

Cardiac index (CI) may be derived from the Fick method, using measured or estimated oxygen consumption (VO₂), or from thermodilution. In children, LaFarge VO₂ estimates correlate poorly with measured VO₂ values. In a large adult cohort, there was only modest correlation between estimated Fick CI (eFick CI) and thermodilution CI (TDCI). We evaluated the extent of agreement between eFick CI using LaFarge estimates of VO₂ and TDCI in a pediatric cohort. A retrospective, single-center chart review of patients 3-18 years of age who underwent cardiac catheterization with documented eFick CI and TDCI from 2004 to 2020 included 201 catheterizations from 161 unique patients. The mean patient age at catheterization was 12.2y (SD 4.4y). The most frequent diagnosis was cardiomyopathy, followed by congenital heart disease and pulmonary hypertension. TDCI and eFick CI differed by > 20% in 49% of catheterizations. eFick CI systematically exceeded TDCI by a mean percentage difference of 24% (SD 31%). Higher mean CI ((eFick CI + TDCI)/2) and older age were predictive of greater percent difference between eFick CI and TDCI. For each increase in mean CI by 1.0 L/min/m², the expected percent difference in CI increased by 9.9% (p < 0.001). In pediatric patients undergoing cardiac catheterization, eFick CI with LaFarge VO₂ systematically exceeds TDCI. The difference between methods is frequently > 20%, which may have clinically significant implications. Discrepancies between eFick CI and TDCI increase at higher mean CI.

Duct-dependent pulmonary circulation has traditionally been addressed by the Blalock-Taussig-Thomas shunts (BTTS). Recently, catheter-based alternatives such as ductal stenting have emerged as a particularly advantageous option, especially in resource-constrained settings. This article delves into the nuances of ductal stenting within low-resource environments, highlighting its relative ease of application, reduced morbidity, and cost-effectiveness as key factors in its favor. Comparisons in mortality between the two procedures are however likely to be confounded by selection biases. Ductal stenting appears to be particularly beneficial for palliating older infants and children with cyanotic congenital heart disease and diminished pulmonary blood flow who present late. Additionally, it serves as a valuable tool for left ventricular training in late-presenting transposition with an intact ventricular septum. A meticulous pre-procedure echocardiographic assessment of anatomy plays a pivotal role in planning access and hardware, with additional imaging seldom required for this purpose. The adaptation of adult coronary hardware has significantly enhanced the technical feasibility of ductal stenting. However, challenges such as low birth weight and sepsis specifically impact the performance of ductal stenting and patient recovery in low-resource environments. There is potential for systematic application of quality improvement processes to optimize immediate and long-term outcomes of ductal stenting. There is also a need to prospectively examine the application of ductal stenting in low-resource environments through multi-center registries.

Noonan syndrome is an autosomal dominant genetic condition associated with cardiac manifestations that may necessitate heart transplantation. This case series describes the short- and medium-term outcomes in five patients with Noonan syndrome status-post heart transplant followed at our institution. Retrospective, single center chart review of the electronic medical record in post-heart transplant patients with a diagnosis of Noonan syndrome. Five out of 88 heart transplant patients at our institution had genetically confirmed Noonan syndrome with either RAF1 or PTPN11 mutations. All patients were noted to have hypertrophic cardiomyopathy. Severe outflow tract obstruction, in conjunction with comorbidities such as intractable arrhythmias, recurrent syncope, and failure to thrive were leading indications for heart transplant. The most common complications post-heart transplant included recurrent viral infections and pleural and pericardial effusions. Isolated complications included lymphangiectasias, posterior reversible encephalopathy syndrome, and aspergillus pneumonia. Feeding difficulties were common. All patients are alive at the time of this publication. Noonan syndrome is highly associated with hypertrophic cardiomyopathy, and severe cases may necessitate heart transplantation. The post-heart transplant complications seen in our cohort are not unique to the Noonan syndrome population. Survival post-heart transplant is high.

Chylothorax following pediatric cardiac surgery increases morbidity and mortality. The clinical outcomes of patients with chylothorax with prolonged drainage compared to prompt resolution have not been described. This is a retrospective cohort study across eight United States pediatric cardiac intensive care units (ICU). Patients < 18 years old treated for chylothorax within 30 days of cardiac surgery were included, excluding Fontan palliations. Patients with chest tube duration ≥ 14 days were classified as long chylothorax (LC) vs. < 14 days as short chylothorax (SC). Univariable and multivariable logistic regression modeled patient characteristics associated with LC vs. SC. 134 patients had chylothorax, and 51 (38%) were LC. The proportion of LC increased with surgical complexity. LC was diagnosed later and had longer duration of mechanical ventilation, and ICU and hospital lengths of stay. In-hospital mortality was not different between groups. On POD 7, chest tube output (CTO, ml/kg) difference between LC and SC was greatest, with an area under the receiver operating characteristic curve of 0.76 for CTO predicting chylothorax. By multivariable analysis, clinical events associated with LC were sepsis or CLABSI (adjusted odds ratio (aOR) 8.8), postoperative open sternum (aOR 3.3), and CTO > 20 ml/kg on POD 7 (aOR 7.3). High chest tube output on POD 7 may predict LC in children post-cardiac surgery. LC is associated with increased resource utilization and morbidity. Early identification of patients at risk for LC may allow for tailored treatment strategies and improved outcomes.