Coarctation of the aorta (CoA) is a congenital cardiovascular defect that may persist into adulthood. Endovascular stenting has become the preferred approach, with balloon-expandable stents (BES) and self-expandable stents (SES) being commonly used. However, there is a notable paucity of comparative data evaluating their relative safety and efficacy.
Objectives
We aimed to compare the outcomes of BES and SES in the endovascular management of adults with CoA.
Methods
A systematic review and meta-analysis were performed by searching MEDLINE, Scopus, and the Cochrane Library for studies directly comparing BES and SES in adult CoA patients. Eligible studies included randomized controlled trials and observational studies. Pooled odds ratios (OR) with 95 % confidence intervals (CI) were calculated using a random-effects model.
Results
Three studies (one RCT, two observational), comprising 282 patients, were included, of whom 53.5 % received BES. No significant differences were observed in the cumulative peri-procedural complications [OR 2.5; 95 % CI 0.4 to 18.2; p = 0.07, I2 = 9 %], stent migration [OR 1.1; 95 % CI 0.3 to 4.0; p = 0.94; I2 = 51 %], and persistent hypertension post-intervention [OR 0.8; 95 % CI 0.4 to 1.6; p = 0.60; I2 = 0 %]. Heterogeneity was minimal across most outcomes.
Conclusion
Our analysis suggests that BES and SES offer comparable safety and efficacy in the endovascular treatment of adult CoA. However, the small number of studies and wide confidence intervals warrant cautious interpretation. These findings highlight the need for larger, prospective randomized trials to better guide stent selection in this population.
背景：主动脉缩窄（CoA）是一种先天性心血管缺陷，可能持续到成年。血管内支架置入术已成为首选的方法，目前常用的有球囊可扩张支架（BES）和自扩张支架（SES）。然而，评估其相对安全性和有效性的比较数据明显缺乏。目的比较BES和SES在成人CoA患者血管内治疗中的效果。方法通过检索MEDLINE、Scopus和Cochrane图书馆，对成人CoA患者直接比较BES和SES的研究进行系统评价和meta分析。符合条件的研究包括随机对照试验和观察性研究。使用随机效应模型计算95%置信区间（CI）的合并优势比（OR）。结果纳入3项研究（1项RCT， 2项观察性研究），共282例患者，其中53.5%接受了BES。术中并发症的累积无显著差异[OR 2.5；95% CI 0.4 ~ 18.2；p = 0.07, I2 = 9%]，支架迁移[OR 1.1；95% CI 0.3 ~ 4.0；p = 0.94；I2 = 51%]，干预后持续高血压[OR 0.8；95% CI 0.4 ~ 1.6；p = 0.60；i2 = 0%]。大多数结果的异质性最小。结论BES和SES在血管内治疗成人CoA的安全性和有效性相当。然而，研究数量少，置信区间宽，值得谨慎解释。这些发现强调需要更大规模的前瞻性随机试验来更好地指导这一人群的支架选择。
{"title":"Balloon- versus self-expandable stents in the endovascular treatment of adults with aortic coarctation: A systematic review and meta-analysis","authors":"Kristine Santos , Luísa Zanelatto de Araujo , Sriharsha Koduru , Mislav Planinc","doi":"10.1016/j.ppedcard.2025.101854","DOIUrl":"10.1016/j.ppedcard.2025.101854","url":null,"abstract":"<div><h3>Background</h3><div>Coarctation of the aorta (CoA) is a congenital cardiovascular defect that may persist into adulthood. Endovascular stenting has become the preferred approach, with balloon-expandable stents (BES) and self-expandable stents (SES) being commonly used. However, there is a notable paucity of comparative data evaluating their relative safety and efficacy.</div></div><div><h3>Objectives</h3><div>We aimed to compare the outcomes of BES and SES in the endovascular management of adults with CoA.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were performed by searching MEDLINE, Scopus, and the Cochrane Library for studies directly comparing BES and SES in adult CoA patients. Eligible studies included randomized controlled trials and observational studies. Pooled odds ratios (OR) with 95 % confidence intervals (CI) were calculated using a random-effects model.</div></div><div><h3>Results</h3><div>Three studies (one RCT, two observational), comprising 282 patients, were included, of whom 53.5 % received BES. No significant differences were observed in the cumulative peri-procedural complications [OR 2.5; 95 % CI 0.4 to 18.2; <em>p</em> = 0.07, I<sup>2</sup> = 9 %], stent migration [OR 1.1; 95 % CI 0.3 to 4.0; <em>p</em> = 0.94; I<sup>2</sup> = 51 %], and persistent hypertension post-intervention [OR 0.8; 95 % CI 0.4 to 1.6; <em>p</em> = 0.60; I<sup>2</sup> = 0 %]. Heterogeneity was minimal across most outcomes.</div></div><div><h3>Conclusion</h3><div>Our analysis suggests that BES and SES offer comparable safety and efficacy in the endovascular treatment of adult CoA. However, the small number of studies and wide confidence intervals warrant cautious interpretation. These findings highlight the need for larger, prospective randomized trials to better guide stent selection in this population.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101854"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144662601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.ppedcard.2025.101856
Alex Ismael Catalán Cabrera, Hugo Martin Reyes Alban, Karen del Rosario Condori Alvino, Mónica Karem Medina Durand, Luis Jacinto De la Cruz Hilario, Nelly Tamayo Huiza
Introduction
Myxoma is the most common benign cardiac tumor in adults; however, in children, it is less frequent than rhabdomyoma and fibroma. It shows a female predominance, with an incidence 1.5 to 2 times higher than in males. Only 22 % of myxomas develop in the right atrium, 2 % in the ventricles, and 1 % in the atrioventricular valve.
Case report
We present the case of a 10-year-old patient admitted with obstructive symptoms with right heart failure. Diagnostic imaging, including chest X-ray, transthoracic echocardiography, and computed tomography, revealed a giant intracardiac mass. Surgical excision of the tumor was performed 48 h after admission, with favorable postoperative evolution. Histopathological examination confirmed the diagnosis of cardiac myxoma.
Conclusions
Right atrial myxomas may present with dyspnea, syncope, ascites, and symptoms of right heart failure. Early diagnosis is crucial to prevent cerebrovascular events and allow for timely surgical treatment, thereby reducing preoperative and postoperative complications.
{"title":"Giant right atrial myxoma in pediatrics. Case report","authors":"Alex Ismael Catalán Cabrera, Hugo Martin Reyes Alban, Karen del Rosario Condori Alvino, Mónica Karem Medina Durand, Luis Jacinto De la Cruz Hilario, Nelly Tamayo Huiza","doi":"10.1016/j.ppedcard.2025.101856","DOIUrl":"10.1016/j.ppedcard.2025.101856","url":null,"abstract":"<div><h3>Introduction</h3><div>Myxoma is the most common benign cardiac tumor in adults; however, in children, it is less frequent than rhabdomyoma and fibroma. It shows a female predominance, with an incidence 1.5 to 2 times higher than in males. Only 22 % of myxomas develop in the right atrium, 2 % in the ventricles, and 1 % in the atrioventricular valve.</div></div><div><h3>Case report</h3><div>We present the case of a 10-year-old patient admitted with obstructive symptoms with right heart failure. Diagnostic imaging, including chest X-ray, transthoracic echocardiography, and computed tomography, revealed a giant intracardiac mass. Surgical excision of the tumor was performed 48 h after admission, with favorable postoperative evolution. Histopathological examination confirmed the diagnosis of cardiac myxoma.</div></div><div><h3>Conclusions</h3><div>Right atrial myxomas may present with dyspnea, syncope, ascites, and symptoms of right heart failure. Early diagnosis is crucial to prevent cerebrovascular events and allow for timely surgical treatment, thereby reducing preoperative and postoperative complications.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101856"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-29DOI: 10.1016/j.ppedcard.2025.101857
Sofia Rito , João Dias , Patrícia Vaz Silva , Iolanda Ferreira , Maria Emanuel Amaral , Paula Martins , António Pires
Tricuspid valve dysplasia (TVD) is a rare congenital heart defect that can lead to a life-threatening fetal circulation compromise. We report a case of a fetus with TVD diagnosed at 22 weeks gestation, characterized by severe tricuspid regurgitation, retrograde flow through the ductus arteriosus, and pulmonary regurgitation (circular shunt). Prenatal management with nonsteroidal anti-inflammatory drugs (NSAIDs), both ibuprofen (400–600 mg, every 8 h) and indomethacin (50 mg, every 8 h), was initiated at 28 weeks gestation, and continued until birth, to promote ductal constriction and antegrade flow through it, thus terminating or reducing the circular shunt. Despite the challenging management with NSAIDs, it was possible to achieve a near term delivery and conservative neonatal management.
This case highlights the potential of NSAIDs as a therapeutic option in managing severe TVD with a circular shunt, improving fetal survival and prolonging pregnancy for better neonatal outcomes.
{"title":"Prenatal management of severe tricuspid dysplasia with circular shunt using NSAID therapy: A novel approach","authors":"Sofia Rito , João Dias , Patrícia Vaz Silva , Iolanda Ferreira , Maria Emanuel Amaral , Paula Martins , António Pires","doi":"10.1016/j.ppedcard.2025.101857","DOIUrl":"10.1016/j.ppedcard.2025.101857","url":null,"abstract":"<div><div>Tricuspid valve dysplasia (TVD) is a rare congenital heart defect that can lead to a life-threatening fetal circulation compromise. We report a case of a fetus with TVD diagnosed at 22 weeks gestation, characterized by severe tricuspid regurgitation, retrograde flow through the ductus arteriosus, and pulmonary regurgitation (circular shunt). Prenatal management with nonsteroidal anti-inflammatory drugs (NSAIDs), both ibuprofen (400–600 mg, every 8 h) and indomethacin (50 mg, every 8 h), was initiated at 28 weeks gestation, and continued until birth, to promote ductal constriction and antegrade flow through it, thus terminating or reducing the circular shunt. Despite the challenging management with NSAIDs, it was possible to achieve a near term delivery and conservative neonatal management.</div><div>This case highlights the potential of NSAIDs as a therapeutic option in managing severe TVD with a circular shunt, improving fetal survival and prolonging pregnancy for better neonatal outcomes.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101857"},"PeriodicalIF":0.6,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-28DOI: 10.1016/j.ppedcard.2025.101858
Sayed Ali Amin, Sumer Nady Mohamed Elfakhrany, Ahmed Mahmoud Abd Elmoktader
Background
Congenital heart disease (CHD) is a significant structural irregularity in the heart's chambers or major vessels, affecting its function.
Objectives
To determine the occurrence of CHD among newborns in the Fayoum district of Egypt.
Methods
This cross-sectional observational study included 2247 live births. Subjects were selected over a two-year period from neonates born at Fayoum University Hospital, Fayoum Insurance Hospital, and five other general hospitals between January 2018 and December 2019.
Results
Among the studied sample, 2192 newborns (97.6 %) had no congenital heart defect, while 55 (2.4 %) were diagnosed with CHD. Parental consanguinity was reported in 19 cases (34.5 %) with CHD. Among the acyanotic CHD cases: 13 (23.6 %) had ventricular septal defect, 7 (12.7 %) had patent ductus arteriosus, 6 (10.9 %) had atrial septal defect, 5 (9.1 %) had pulmonary stenosis, 2 (3.6 %) had aortic stenosis, 2 (3.6 %) had atrioventricular canal defect, 1 (1.8 %) had coarctation of the aorta, and 1 (1.8 %) had peripheral pulmonary stenosis. Regarding cyanotic CHD, 7 patients (12.7 %) had tetralogy of Fallot, 4 (7.3 %) had pulmonary atresia, 3 (5.5 %) had transposition of the great arteries, and one patient (1.8 %) each had complex CHD, single ventricle, total anomalous pulmonary venous return, and tricuspid atresia.
Conclusion
The study reveals that the birth prevalence of CHD in the Fayoum district is consistent with global estimates. Acyanotic CHD, particularly ventricular septal defect, was the most commonly observed cardiac anomaly.
{"title":"Prevalence of congenital heart disease among neonates in Fayoum district","authors":"Sayed Ali Amin, Sumer Nady Mohamed Elfakhrany, Ahmed Mahmoud Abd Elmoktader","doi":"10.1016/j.ppedcard.2025.101858","DOIUrl":"10.1016/j.ppedcard.2025.101858","url":null,"abstract":"<div><h3>Background</h3><div>Congenital heart disease (CHD) is a significant structural irregularity in the heart's chambers or major vessels, affecting its function.</div></div><div><h3>Objectives</h3><div>To determine the occurrence of CHD among newborns in the Fayoum district of Egypt.</div></div><div><h3>Methods</h3><div>This cross-sectional observational study included 2247 live births. Subjects were selected over a two-year period from neonates born at Fayoum University Hospital, Fayoum Insurance Hospital, and five other general hospitals between January 2018 and December 2019.</div></div><div><h3>Results</h3><div>Among the studied sample, 2192 newborns (97.6 %) had no congenital heart defect, while 55 (2.4 %) were diagnosed with CHD. Parental consanguinity was reported in 19 cases (34.5 %) with CHD. Among the acyanotic CHD cases: 13 (23.6 %) had ventricular septal defect, 7 (12.7 %) had patent ductus arteriosus, 6 (10.9 %) had atrial septal defect, 5 (9.1 %) had pulmonary stenosis, 2 (3.6 %) had aortic stenosis, 2 (3.6 %) had atrioventricular canal defect, 1 (1.8 %) had coarctation of the aorta, and 1 (1.8 %) had peripheral pulmonary stenosis. Regarding cyanotic CHD, 7 patients (12.7 %) had tetralogy of Fallot, 4 (7.3 %) had pulmonary atresia, 3 (5.5 %) had transposition of the great arteries, and one patient (1.8 %) each had complex CHD, single ventricle, total anomalous pulmonary venous return, and tricuspid atresia.</div></div><div><h3>Conclusion</h3><div>The study reveals that the birth prevalence of CHD in the Fayoum district is consistent with global estimates. Acyanotic CHD, particularly ventricular septal defect, was the most commonly observed cardiac anomaly.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101858"},"PeriodicalIF":0.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144662046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-26DOI: 10.1016/j.ppedcard.2025.101855
Joseph Casadonte, Jose Andres Morales Hernandez, Danyal Khan
Background
Aortopulmonary collaterals (APCs) are commonly found in patients with cyanotic heart disease. These APCs compete with normal pulmonary blood flow in patients who have undergone Glenn or Fontan surgery. APCs are also seen in patients with cystic fibrosis (CF), where they are known to cause hemoptysis. Transcatheter occlusion of APCs has previously been described using coils, vascular plugs, and polyvinyl alcohol (PVA) particles. We present a series of patients in which the APCs were embolized using Trufill n-BCA liquid.
Objectives
This study aims to evaluate the safety and effectiveness of Trufill® N-Butylcyanoacrylate (n-BCA) for transcatheter embolization of aortopulmonary collateral vessels in patients with congenital heart disease and cystic fibrosis, particularly in cases where traditional embolization methods are limited or in patients with significant hemoptysis.
Methods
From 2009 to 2012, a total of 18 catheterization procedures were performed (in 15 patients), in which APCs were embolized using n-BCA. The mean age was 8.5 years (range: 4 months to 21 years), with a mean weight of 29 kg (range: 7–72 kg). Three patients had cystic fibrosis (CF) and presented with hemoptysis. The remaining patients had cyanotic congenital heart disease and had undergone Bidirectional Glenn or Fontan procedures. One of the congenital heart disease patients had two catheterization procedures (2.5 years apart) for hemoptysis.
Results
n-BCA embolization of APCs was technically successful in all patients. The three patients with cystic fibrosis who presented with hemoptysis had symptomatic improvement and have not needed repeat catheterization. One patient with cyanotic congenital heart disease and hemoptysis had acute improvement; however, 2.5 years later, she had recurrent hemoptysis and required additional APCs to be embolized. A complication attributable to n-BCA use also occurred in this patient. Following occlusion of an APC arising from the left lateral thoracic artery, she developed erythema of the overlying skin, followed a few days later by the formation of a small ulcer (presumably due to ischemia of the soft tissue/skin). The ulcer resolved without any specific treatment.
The only other complication occurred when n-BCA unintentionally embolized to the ulnar artery during APC embolization, causing partial occlusion in a patient with a previously occluded radial artery. Vascular surgery successfully removed the material, and the patient had no lasting effects. There were no other major n-BCA-related complications such as cerebrovascular accident, pulmonary embolism, or catheter adhesion.
Conclusion
n-BCA is a liquid embolic agent that is FDA-approved for the embolization of cerebral arteriovenous malformations. PVA particles, previously used for cerebral AVMs, have a high recanalization rate and have
{"title":"Transcatheter embolization of aortopulmonary collaterals using the Trufill® n-Butylcyanoacrylate (n-BCA) liquid embolic system; A single-center experience","authors":"Joseph Casadonte, Jose Andres Morales Hernandez, Danyal Khan","doi":"10.1016/j.ppedcard.2025.101855","DOIUrl":"10.1016/j.ppedcard.2025.101855","url":null,"abstract":"<div><h3>Background</h3><div>Aortopulmonary collaterals (APCs) are commonly found in patients with cyanotic heart disease. These APCs compete with normal pulmonary blood flow in patients who have undergone Glenn or Fontan surgery. APCs are also seen in patients with cystic fibrosis (CF), where they are known to cause hemoptysis. Transcatheter occlusion of APCs has previously been described using coils, vascular plugs, and polyvinyl alcohol (PVA) particles. We present a series of patients in which the APCs were embolized using Trufill n-BCA liquid.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate the safety and effectiveness of Trufill® N-Butylcyanoacrylate (n-BCA) for transcatheter embolization of aortopulmonary collateral vessels in patients with congenital heart disease and cystic fibrosis, particularly in cases where traditional embolization methods are limited or in patients with significant hemoptysis.</div></div><div><h3>Methods</h3><div>From 2009 to 2012, a total of 18 catheterization procedures were performed (in 15 patients), in which APCs were embolized using n-BCA. The mean age was 8.5 years (range: 4 months to 21 years), with a mean weight of 29 kg (range: 7–72 kg). Three patients had cystic fibrosis (CF) and presented with hemoptysis. The remaining patients had cyanotic congenital heart disease and had undergone Bidirectional Glenn or Fontan procedures. One of the congenital heart disease patients had two catheterization procedures (2.5 years apart) for hemoptysis.</div></div><div><h3>Results</h3><div>n-BCA embolization of APCs was technically successful in all patients. The three patients with cystic fibrosis who presented with hemoptysis had symptomatic improvement and have not needed repeat catheterization. One patient with cyanotic congenital heart disease and hemoptysis had acute improvement; however, 2.5 years later, she had recurrent hemoptysis and required additional APCs to be embolized. A complication attributable to n-BCA use also occurred in this patient. Following occlusion of an APC arising from the left lateral thoracic artery, she developed erythema of the overlying skin, followed a few days later by the formation of a small ulcer (presumably due to ischemia of the soft tissue/skin). The ulcer resolved without any specific treatment.</div><div>The only other complication occurred when n-BCA unintentionally embolized to the ulnar artery during APC embolization, causing partial occlusion in a patient with a previously occluded radial artery. Vascular surgery successfully removed the material, and the patient had no lasting effects. There were no other major n-BCA-related complications such as cerebrovascular accident, pulmonary embolism, or catheter adhesion.</div></div><div><h3>Conclusion</h3><div>n-BCA is a liquid embolic agent that is FDA-approved for the embolization of cerebral arteriovenous malformations. PVA particles, previously used for cerebral AVMs, have a high recanalization rate and have ","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101855"},"PeriodicalIF":0.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-18DOI: 10.1016/j.ppedcard.2025.101852
Anders C. Jenson , Nathaniel W. Taggart
Background
Recurrence of coarctation of the aorta (CoA) is a relatively common complication following surgical correction in neonates. Balloon angioplasty is the favored treatment for recurrent CoA in infancy and early childhood, but persistent or recurrent obstruction remains a challenging complication.
Objectives
This retrospective cohort study aims to assess outcomes of balloon angioplasty for infants with recurrent CoA based on the complexity of cardiac defects at the time of surgical intervention.
Methods
Data were analyzed from patients at a single tertiary care center who underwent balloon angioplasty for recurrent CoA within their first year of life between 2002 and 2021.
Results
A total of 41 patients were included and separated into simple (n = 26) or complex (n = 15) cohorts based on the coexisting cardiac defects present. These cohorts were similar in age, weight, sex, and time since initial surgical repair. The complex cohort had a significantly higher rate of subsequent coarctation re-intervention within a 2-year follow-up period (73 % vs. 31 %, p = 0.003, RR = 2.4; 95 % CI = 1.2–4.6, p = 0.003).
Conclusion
Our findings suggest that recurrent CoA in the presence of additional complex congenital heart disease may not be as amenable to balloon angioplasty in infants and should be considered when counseling patient families.
背景：主动脉缩窄（CoA）复发是新生儿手术矫治后较为常见的并发症。球囊血管成形术是治疗婴儿期和幼儿期复发性CoA的首选方法，但持续性或复发性梗阻仍然是一个具有挑战性的并发症。目的：本回顾性队列研究旨在评估基于手术干预时心脏缺陷复杂性的球囊血管成形术治疗复发性CoA婴儿的结果。方法对2002年至2021年间在单一三级护理中心接受球囊血管成形术治疗复发性CoA的患者进行数据分析。结果共纳入41例患者，根据合并心脏缺陷情况分为单纯组（n = 26）和复杂组（n = 15）。这些队列在年龄、体重、性别和首次手术修复后的时间上相似。复杂队列在2年随访期间的缩窄再干预率显著较高(73% vs. 31%, p = 0.003, RR = 2.4；95% CI = 1.2 ~ 4.6, p = 0.003)。结论：我们的研究结果表明，在伴有其他复杂先天性心脏病的婴儿中，复发性CoA可能不适合球囊血管成形术，在咨询患者家属时应予以考虑。
{"title":"Outcomes of balloon angioplasty in infants with simple or complex recurrent coarctation of the aorta","authors":"Anders C. Jenson , Nathaniel W. Taggart","doi":"10.1016/j.ppedcard.2025.101852","DOIUrl":"10.1016/j.ppedcard.2025.101852","url":null,"abstract":"<div><h3>Background</h3><div>Recurrence of coarctation of the aorta (CoA) is a relatively common complication following surgical correction in neonates. Balloon angioplasty is the favored treatment for recurrent CoA in infancy and early childhood, but persistent or recurrent obstruction remains a challenging complication.</div></div><div><h3>Objectives</h3><div>This retrospective cohort study aims to assess outcomes of balloon angioplasty for infants with recurrent CoA based on the complexity of cardiac defects at the time of surgical intervention.</div></div><div><h3>Methods</h3><div>Data were analyzed from patients at a single tertiary care center who underwent balloon angioplasty for recurrent CoA within their first year of life between 2002 and 2021.</div></div><div><h3>Results</h3><div>A total of 41 patients were included and separated into simple (<em>n</em> = 26) or complex (<em>n</em> = 15) cohorts based on the coexisting cardiac defects present. These cohorts were similar in age, weight, sex, and time since initial surgical repair. The complex cohort had a significantly higher rate of subsequent coarctation re-intervention within a 2-year follow-up period (73 % vs. 31 %, <em>p</em> = 0.003, RR = 2.4; 95 % CI = 1.2–4.6, <em>p</em> = 0.003).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that recurrent CoA in the presence of additional complex congenital heart disease may not be as amenable to balloon angioplasty in infants and should be considered when counseling patient families.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101852"},"PeriodicalIF":0.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-10DOI: 10.1016/j.ppedcard.2025.101849
Andrés David Aranzazu-Ceballos , Juan Fernando Agudelo Uribe , Juan David Ramírez Barrera , Cesar Orlando Breton Pinto , Rafael Correa Velásquez
We report the case of an adolescent with incessant ectopic atrial tachycardia (EAT) originating from a rhabdomyoma located on the posterior wall of the right atrium, complicated by tachycardiomyopathy. The patient underwent a combined endocardial and epicardial ablation procedure in the electrophysiology laboratory. The intervention resulted in both short- and medium-term success, with resolution of ventricular dysfunction and elimination of the arrhythmia confirmed at the 3-month follow-up.
{"title":"Transcatheter ablation of incessant ectopic atrial tachycardia in a patient with intracardiac rhabdomyomas","authors":"Andrés David Aranzazu-Ceballos , Juan Fernando Agudelo Uribe , Juan David Ramírez Barrera , Cesar Orlando Breton Pinto , Rafael Correa Velásquez","doi":"10.1016/j.ppedcard.2025.101849","DOIUrl":"10.1016/j.ppedcard.2025.101849","url":null,"abstract":"<div><div>We report the case of an adolescent with incessant ectopic atrial tachycardia (EAT) originating from a rhabdomyoma located on the posterior wall of the right atrium, complicated by tachycardiomyopathy. The patient underwent a combined endocardial and epicardial ablation procedure in the electrophysiology laboratory. The intervention resulted in both short- and medium-term success, with resolution of ventricular dysfunction and elimination of the arrhythmia confirmed at the 3-month follow-up.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101849"},"PeriodicalIF":0.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-08DOI: 10.1016/j.ppedcard.2025.101850
Atefa Ahmadi
<div><h3>Background</h3><div>Acute kidney injury (AKI) is a significant complication in pediatric cardiac surgery, especially among congenital heart disease (CHD) patients. Its incidence is rising globally due to increased cardiac procedures. Children with cardiac surgery-associated AKI (CSA-AKI) face worse postoperative outcomes, including prolonged mechanical ventilation, higher morbidity, mortality, and healthcare costs. Mechanisms of AKI are multifactorial, involving prolonged cardiopulmonary bypass (CPB), hypoperfusion, and inflammatory responses such as systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS). Hemolysis during CPB releases free hemoglobin, causing endothelial dysfunction, while reactive oxygen species (ROS) exacerbate kidney injury.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the incidence of AKI in pediatric patients undergoing cardiac surgery, utilizing estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) levels while considering factors like age, gender, surgery type, complexity, and CPB duration to enhance understanding of postoperative renal outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional study was conducted at the French Medical Institute for Mother and Children (FMIC) in Kabul, analyzing data from 383 pediatric patients (ages 0–18) who underwent open-heart surgery between January 1, 2022, and September 30, 2024. Patients with pre-existing renal dysfunction or incomplete data were excluded. AKI was defined and staged using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Logistic regression analyses identified AKI predictors, reporting odds ratios (OR), and <em>p</em>-values.</div></div><div><h3>Results</h3><div>Among 383 pediatric patients (median age 5 years; 57 % male), renal function declined significantly post-surgery, with median GFR decreasing from 123.9 to 89.9 mL/min/1.73 m<sup>2</sup> (30% reduction; <em>p</em> < 0.001). AKI occurred in 33 % (<em>n</em> = 128), classified as Stage 1 (13 %), Stage 2 (16 %), and Stage 3 (4 %) per KDIGO criteria. Significant predictors of AKI included higher preoperative creatinine (aOR = 32.97, <em>p</em> = 0.02), elevated postoperative BUN (aOR = 1.11, <em>p</em> = 0.010), longer bypass duration (aOR = 1.02 per minute, <em>p</em> = 0.014), higher baseline GFR (aOR = 1.012, <em>p</em> = 0.009), and younger age (aOR = 0.26, <em>p</em> = 0.03). Higher postoperative GFR was protective (aOR = 0.97, <em>p</em> < 0.001). The model demonstrated moderate explanatory power (Nagelkerke R<sup>2</sup> = 0.44) and showed good discrimination (AUC = 0.81; 95 % CI: 0.76–0.86; p < 0.001).</div></div><div><h3>Conclusion</h3><div>AKI occurred in 33 % of pediatric cardiac surgery patients, with key risk factors including younger age, higher preoperative creatinine, elevated postoperative BUN, longer bypass time, and higher baseline GFR. Postoperative
背景：急性肾损伤（AKI）是小儿心脏手术的重要并发症，尤其是先天性心脏病（CHD）患者。由于心脏手术的增加，其发病率在全球范围内正在上升。心脏手术相关AKI （CSA-AKI）患儿术后预后较差，包括机械通气时间延长、发病率、死亡率和医疗费用较高。AKI的机制是多因素的，包括长时间体外循环（CPB）、灌注不足和炎症反应，如全身炎症反应综合征（SIRS）和代偿性抗炎反应综合征（CARS）。CPB过程中的溶血释放游离血红蛋白，引起内皮功能障碍，而活性氧（ROS）加重肾损伤。本研究旨在评估接受心脏手术的儿科患者AKI的发生率，利用估计的肾小球滤过率（eGFR）和血尿素氮（BUN）水平，同时考虑年龄、性别、手术类型、复杂性和CPB持续时间等因素，以加强对术后肾脏结局的了解。方法在喀布尔的法国母婴医学研究所（FMIC）进行了一项回顾性横断面研究，分析了2022年1月1日至2024年9月30日期间接受心脏直视手术的383名儿童患者（0-18岁）的数据。排除既往存在肾功能不全或数据不完整的患者。AKI的定义和分期采用肾脏疾病：改善全球预后（KDIGO）标准。Logistic回归分析确定AKI预测因子，报告优势比（OR）和p值。结果383例患儿(中位年龄5岁；57%男性)，术后肾功能明显下降，GFR中位数从123.9 mL/min/1.73 m2下降到89.9 mL/min/1.73 m2(下降30%；p & lt;0.001)。33% （n = 128）发生AKI，根据KDIGO标准分为1期（13%）、2期（16%）和3期（4%）。AKI的显著预测因素包括术前肌酐升高（aOR = 32.97, p = 0.02）、术后BUN升高（aOR = 1.11, p = 0.010）、旁路持续时间延长（aOR = 1.02 / min, p = 0.014）、基线GFR升高（aOR = 1.012, p = 0.009）、年龄更小（aOR = 0.26, p = 0.03）。术后较高的GFR具有保护作用(aOR = 0.97, p <；0.001)。该模型具有中等解释力（Nagelkerke R2 = 0.44），具有良好的判别性(AUC = 0.81；95% ci: 0.76-0.86；p & lt;0.001)。结论33%的小儿心脏手术患者发生aki，其主要危险因素包括年龄较小、术前肌酐升高、术后BUN升高、搭桥时间较长和基线GFR较高。术后GFR具有保护作用。这些发现强调了早期识别和有针对性的围手术期管理对于降低AKI风险和改善易感人群预后的重要性。
{"title":"Assessment of acute kidney injury using estimated glomerular filtration rate and blood urea nitrogen in pediatric patients undergoing cardiac surgery: Experience from single institution in Afghanistan","authors":"Atefa Ahmadi","doi":"10.1016/j.ppedcard.2025.101850","DOIUrl":"10.1016/j.ppedcard.2025.101850","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a significant complication in pediatric cardiac surgery, especially among congenital heart disease (CHD) patients. Its incidence is rising globally due to increased cardiac procedures. Children with cardiac surgery-associated AKI (CSA-AKI) face worse postoperative outcomes, including prolonged mechanical ventilation, higher morbidity, mortality, and healthcare costs. Mechanisms of AKI are multifactorial, involving prolonged cardiopulmonary bypass (CPB), hypoperfusion, and inflammatory responses such as systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS). Hemolysis during CPB releases free hemoglobin, causing endothelial dysfunction, while reactive oxygen species (ROS) exacerbate kidney injury.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the incidence of AKI in pediatric patients undergoing cardiac surgery, utilizing estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) levels while considering factors like age, gender, surgery type, complexity, and CPB duration to enhance understanding of postoperative renal outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cross-sectional study was conducted at the French Medical Institute for Mother and Children (FMIC) in Kabul, analyzing data from 383 pediatric patients (ages 0–18) who underwent open-heart surgery between January 1, 2022, and September 30, 2024. Patients with pre-existing renal dysfunction or incomplete data were excluded. AKI was defined and staged using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Logistic regression analyses identified AKI predictors, reporting odds ratios (OR), and <em>p</em>-values.</div></div><div><h3>Results</h3><div>Among 383 pediatric patients (median age 5 years; 57 % male), renal function declined significantly post-surgery, with median GFR decreasing from 123.9 to 89.9 mL/min/1.73 m<sup>2</sup> (30% reduction; <em>p</em> < 0.001). AKI occurred in 33 % (<em>n</em> = 128), classified as Stage 1 (13 %), Stage 2 (16 %), and Stage 3 (4 %) per KDIGO criteria. Significant predictors of AKI included higher preoperative creatinine (aOR = 32.97, <em>p</em> = 0.02), elevated postoperative BUN (aOR = 1.11, <em>p</em> = 0.010), longer bypass duration (aOR = 1.02 per minute, <em>p</em> = 0.014), higher baseline GFR (aOR = 1.012, <em>p</em> = 0.009), and younger age (aOR = 0.26, <em>p</em> = 0.03). Higher postoperative GFR was protective (aOR = 0.97, <em>p</em> < 0.001). The model demonstrated moderate explanatory power (Nagelkerke R<sup>2</sup> = 0.44) and showed good discrimination (AUC = 0.81; 95 % CI: 0.76–0.86; p < 0.001).</div></div><div><h3>Conclusion</h3><div>AKI occurred in 33 % of pediatric cardiac surgery patients, with key risk factors including younger age, higher preoperative creatinine, elevated postoperative BUN, longer bypass time, and higher baseline GFR. Postoperative","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101850"},"PeriodicalIF":0.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A seven-month-old baby girl presented with recurrent heart failure hospitalizations from dilated cardiomyopathy. The baby had multiple associated co-morbidities, including hypothyroidism, global developmental delay, failure to thrive, recurrent lower respiratory tract infections, and feeding difficulties. She was diagnosed with Prader-Willi syndrome (PWS) due to monosomy 15q11.2q13.1. While dilated cardiomyopathy (DCM) has been reported in adults with PWS, to our knowledge, its occurrence in the pediatric population, particularly during infancy, has not been documented. This case suggests that DCM could be associated with PWS in children. It highlights how DCM complicates the management of PWS and illustrates the interplay of genetic, cardiac, developmental, and metabolic factors, emphasizing the need for a multidisciplinary approach.
{"title":"A rare case report of an infant with Prader-Willi syndrome presenting with dilated cardiomyopathy and recurrent congestive heart failure","authors":"Naimisha Yenduri , Navaneetha Sasikumar , Hisham Ahamed , Dhanya Yesodharan , Raman Krishna Kumar","doi":"10.1016/j.ppedcard.2025.101848","DOIUrl":"10.1016/j.ppedcard.2025.101848","url":null,"abstract":"<div><div>A seven-month-old baby girl presented with recurrent heart failure hospitalizations from dilated cardiomyopathy. The baby had multiple associated co-morbidities, including hypothyroidism, global developmental delay, failure to thrive, recurrent lower respiratory tract infections, and feeding difficulties. She was diagnosed with Prader-Willi syndrome (PWS) due to monosomy 15q11.2q13.1. While dilated cardiomyopathy (DCM) has been reported in adults with PWS, to our knowledge, its occurrence in the pediatric population, particularly during infancy, has not been documented. This case suggests that DCM could be associated with PWS in children. It highlights how DCM complicates the management of PWS and illustrates the interplay of genetic, cardiac, developmental, and metabolic factors, emphasizing the need for a multidisciplinary approach.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101848"},"PeriodicalIF":0.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The treatment of pediatric heart failure continues to have a poor outcome, such as significant mortality, morbidity, and hospitalization. Irrespective of the poor outcomes of children admitted with heart failure (HF) all over the globe, there is limited data on the status of children with HF in low-income settings, including Ethiopia.
Objectives
This study aimed to assess the magnitude of and factors associated with in-hospital mortality among admitted children at selected public hospitals in Eastern Ethiopia.
Methods
A retrospective cohort study design was conducted. A simple random sampling method was used to select medical records of 671 pediatric patients with HF admitted between June 01, 2017, and May 31, 2022, and data was collected from the medical records. Descriptive statistics were used to analyze information about patient's characteristics. A survival analysis by Cox regression was used to analyze the collected data. Hazard ratios with 95 % confidence interval and p-values were used to examine factors associated with in-hospital mortality of children with heart failure. A p-value of <0.05 was used to declare a significant association.
Results
The study analyzed 671 pediatric patients hospitalized with HF. Regarding the in-hospital outcomes, 386 (57.5 %) patients were discharged with improvement, 132 (19.7 %) patients were self-discharged or left against medical advice, 49 (7.3 %) patients were referred, and 104 (15.5 %) patients died while they were at the hospital. In a multivariate Cox regression analysis, participants with female gender (adjusted hazard ratio: 1.665, 95 % confidence interval: 1.111–2.494, p = 0.013), under-nutrition (adjusted hazard ratio: 1.517, 95 % confidence interval: 1.018–2.259, p = 0.04), age between one year to <5 years (adjusted hazard ratio: 1.834, 95 % confidence interval: 1.177–2.858, p = 0.007), and congenital heart disease (adjusted hazard ratio: 0.357, 95 % confidence interval: 0.151–0.654, p = 0.002) were significantly associated with in-hospital mortality of children with HF.
Conclusion
The overall in-hospital mortality rate was 15.5 %. Malnutrition, age group of one year to <5 years, and female gender were associated with pediatric mortality. These findings highlight the need for screening for malnutrition at each follow-up for under-five children.
{"title":"In-hospital mortality and associated factors among pediatric patients with heart failure at selected public hospitals of eastern Ethiopia","authors":"Ahmedyasin Abdi , Tadesse Bekele , Mesay Dechasa , Kirubel Minsamo Minshore","doi":"10.1016/j.ppedcard.2025.101847","DOIUrl":"10.1016/j.ppedcard.2025.101847","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of pediatric heart failure continues to have a poor outcome, such as significant mortality, morbidity, and hospitalization. Irrespective of the poor outcomes of children admitted with heart failure (HF) all over the globe, there is limited data on the status of children with HF in low-income settings, including Ethiopia.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the magnitude of and factors associated with in-hospital mortality among admitted children at selected public hospitals in Eastern Ethiopia.</div></div><div><h3>Methods</h3><div>A retrospective cohort study design was conducted. A simple random sampling method was used to select medical records of 671 pediatric patients with HF admitted between June 01, 2017, and May 31, 2022, and data was collected from the medical records. Descriptive statistics were used to analyze information about patient's characteristics. A survival analysis by Cox regression was used to analyze the collected data. Hazard ratios with 95 % confidence interval and <em>p</em>-values were used to examine factors associated with in-hospital mortality of children with heart failure. A p-value of <0.05 was used to declare a significant association.</div></div><div><h3>Results</h3><div>The study analyzed 671 pediatric patients hospitalized with HF. Regarding the in-hospital outcomes, 386 (57.5 %) patients were discharged with improvement, 132 (19.7 %) patients were self-discharged or left against medical advice, 49 (7.3 %) patients were referred, and 104 (15.5 %) patients died while they were at the hospital. In a multivariate Cox regression analysis, participants with female gender (adjusted hazard ratio: 1.665, 95 % confidence interval: 1.111–2.494, <em>p</em> = 0.013), under-nutrition (adjusted hazard ratio: 1.517, 95 % confidence interval: 1.018–2.259, <em>p</em> = 0.04), age between one year to <5 years (adjusted hazard ratio: 1.834, 95 % confidence interval: 1.177–2.858, <em>p</em> = 0.007), and congenital heart disease (adjusted hazard ratio: 0.357, 95 % confidence interval: 0.151–0.654, <em>p</em> = 0.002) were significantly associated with in-hospital mortality of children with HF.</div></div><div><h3>Conclusion</h3><div>The overall in-hospital mortality rate was 15.5 %. Malnutrition, age group of one year to <5 years, and female gender were associated with pediatric mortality. These findings highlight the need for screening for malnutrition at each follow-up for under-five children.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"78 ","pages":"Article 101847"},"PeriodicalIF":0.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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