PROGRESS IN PEDIATRIC CARDIOLOGY最新文献

Background: At present, the majority of aortic valve diseases have been traditionally treated by prosthetic valve replacement, whether using a mechanical or a bio-prosthetic valve. Surgical management of aortic valve disease in pediatric patients is still a great challenge, especially the surgical timing, selection of surgical approach, and optimal surgical materials. Aim of Review: In this paper, the main perspective is to propose the use of an aortic stent coating with endothelial cells and smooth muscle cells on both sides as aortic valve in the Ozaki procedure. Owing to its good biocompatibility, stability, thin but high tensile strength, anti-calcification, anticoagulant properties, and rapid endothelialization in vivo, long-term results from that instead of autologous pericardium in the Ozaki procedure may be superior to Ross in pediatric patients. Key Scientific Concepts of Review: The key scientific concepts are as follows: (1) a one-step, rapid, and robust concept for the preparation of aortic stent coating with endothelial cells and smooth muscle cells, and (2) Ozaki procedure.

The utilization of ventricular assist devices (VAD) in the treatment of patients with congenital heart disease has expanded significantly in the pediatric population, largely due to the improved outcomes and availability of paracorporeal devices. Here, we describe a unique case of a non-verbal 5-year-old male with a complicated medical history of autism spectrum disorder and dextrocardia with complex two-ventricle congenital heart disease who was successfully bridged to transplant through the use of a VAD. Patient-tailored management was necessary in the successful use of the VAD with the goal of reducing stress and anxiety during his hospital stay.

Background

Secondhand smoke exposes children to numerous toxic chemicals. Passive cigarette smoke causes a number of diseases, such as respiratory disease. Pulmonary arterial hypertension (PAH) is a progressive disease with a dismal prognosis. Some research studies have identified hypoxia and genetic variables as the etiological factors for PAH. As a result, it appears that environmental factors, such as tobacco smoke, disrupt the function of vascular endothelial cells.

Objectives

1) Evaluating the correlation between parental smoking and PAH in infants. 2) Examining the correlation between the number of cigarettes smoked per day by parents and systolic pulmonary arterial pressure (SPAP) during a year.

Method

In a cohort study, 140 neonates were classified into smokers and non-smokers. Birth weight and SPAP in neonates were measured in the smoker parental group. Following the measurement of the variables, the second group consisted of neonates with non-smoking parents whose birth weight and SPAP were matched one-to-one with the first group. After one year, we measured SPAP in two groups.

Result

At birth, all neonates had normal SPAP. The mean infant SPAP was different between smoker and non-smoker parents; this difference was statistically significant (P-value <0.0001). Over 45 % of infants whose parents smoked developed PAH. There was an association between the number of cigarettes that parents smoke daily and infant SPAP levels (P-value <0.0001). There was no association between PAH and the gender of the infants (p-value = 0.497).

Conclusion

This research revealed a significant association between parental smoking and PAH in infants. Also, the infant SPAP was significantly linked to the number of cigarettes that the parents smoked per day.

Salmonella infections are prevalent globally and cause invasive infections in adults and children alike. Here, we present a rare case report and literature review based on a complicated presentation of S. enteritidis endocarditis in an immunocompetent 8-year-old child with a mechanical aortic valve. The child initially presented with gastrointestinal symptoms, leading to an 11-day hospitalization for gastroenteritis and bacteremia caused by Salmonella. After a 1.5-week hospitalization, receiving intravenous Ceftriaxone and oral Ciprofloxacin, the child was discharged and underwent another week of treatment. Two weeks post-discharge, recurrent fever led to rehospitalization. During this admission, the diagnosis of infective endocarditis was made, revealing complications including pseudoaneurysms and aortic root abscesses. This diagnosis necessitated cardiac surgery and an extended course of antibiotic treatment for an additional seven weeks. The child made a full recovery and was well at follow up. This is the twelfth reported case of Salmonella endocarditis in a child. The overall mortality rate of Salmonella Endocarditis in children is approximately 50 %, and it predominantly affects males. Though rare, Salmonella endocarditis can lead to severe cardiovascular complications. Therefore, it is important to maintain a high index of suspicion for endocarditis when risk factors are present and promptly initiate treatment.

Background

Little is known about the management of this high-risk subgroup of patients because only a few small retrospective studies were available in the literature.

Objectives

This study was designed to identify the determinants of post operative mortality and to assess during 10 years follow-up functional and hemodynamic variables for children presenting at surgery with pulmonary vascular disease associated with congenital heart defect.

Methods

This is a prospective study that enrolled children with pulmonary arterial hypertension associated with congenital heart disease and presenting beyond the optimal time frame for surgery. Inclusion criteria were late presentation for surgery and severe pulmonary arterial hypertension, defined as mean pulmonary arterial pressure > 50 mmhg. An univariable analysis, receiver operating characteristic curves, and Kaplan-Meier curves were used for survival analysis.

Results

75 patients underwent repair of their cardiac lesions. The operative mortality rate was 16%(12 patients); 43 patients (57 %) had right heart catheterization, and all of them were positive for acute vasodilatatory challenge (NO, oxygen). In the postoperative period, 32 % of patients had pulmonary hypertensive crisis, and 72 % had right heart failure. During follow-up, pulmonary arterial hypertension subclass 4 was present in 5% of our patients.

Conclusion

Our study indicated that for operable patients but beyond the optimal time frame the surgical mortality remained high despite using iNO. However, for those who survived they achieved good results in functional exercise, their PAP dropped to normal level and small proportion had persistent pulmonary arterial hypertension encouraging surgical closure of the defect.

Background

Despite improvements in digital electrocardiograms (ECGs), current standard of care requires physician confirmation. Mismatched expectations between ordering providers and ECG readers, often pediatric cardiologists and electrophysiologists (EPs), are common, especially since there are no standardized practices for pediatric ECG reading.

Objectives

The aim of this study was to understand current practices in pediatric ECG reading.

Methods

An electronic survey was sent to members of the Pediatric and Congenital Electrophysiology Society (PACES). Participation was optional; results were recorded from 12/19/22–1/9/23. Only complete and non-duplicate entries were included.

Results

A total of 127 responses were received, 93 were analyzed. Most responses were from centers in North America (n = 65, 70 %), including the US (n = 58, 62 %), Canada (n = 6, 6 %), and Mexico (n = 1, 1 %). The remaining were from Europe (n = 18, 19 %), Asia (n = 7, 8 %), Australia (n = 2, 2 %), and South America (n = 1, 1 %). Most (n = 46, 49 %) were from small centers (0–25 ECGs read per day), 27 respondents (29 %) were from medium centers (26–50 ECGs read per day), 20 respondents (22 %) were from large centers (>50 ECGs read per day). The majority (n = 65, 70 %) reported >3 readers/day for inpatient and emergency department ECGs. 49 % (n = 46) of centers read ECGs >2 times/day on weekdays with more variable practice on weekends. For critical/time sensitive findings, most centers (n = 90, 97 %) used verbal communication +/− the EMR. There was consensus (≥50 % agreement) that the following findings are critical/time sensitive: QTc >500 ms, T-wave alternans, narrow complex tachycardia, wide complex tachycardia, pre-excited atrial fibrillation, focal ischemic changes, second degree heart block type II, complete heart block, and pacemaker malfunction.

Conclusion

Reading practices are variable. Critical/time sensitive findings are most often communicated verbally, however, there is no agreed upon standard. There was consensus in critical/time-sensitive findings. Improved understanding of common practices and resource allocation may lead to increased consistency in pediatric ECG reading.

Here, we demonstrate the capability of implanting the MITRIS RESILIA mitral valve in pediatric patients with severe mitral valve disease requiring mitral valve replacement. The MITRIS RESILIA valve is a bioprosthetic valve with a unique design allowing for improved physiological flow dynamics (minimizing left ventricular outflow obstruction) and potential for future valve-in-valve intervention. We retrospectively analyzed two cases: a 9-year-old with rheumatic heart disease and a 12-year-old with juvenile idiopathic arthritis-related mitral valve deterioration. Both patients underwent successful mitral valve replacement with the MITRIS RESILIA valve, demonstrating significant postoperative improvement in valve function and symptom relief. Follow-up echocardiograms 1 year later showed stable valve function with no significant regurgitation or stenosis, indicating satisfactory short-term outcomes.

Prior to the establishment of a subclavian flap or end–to–end anastomosis, an ascending–descending aortic bypass was conducted to address coarctation of the aorta. Although good results for ascending-descending bypass have been reported in adulthood, reports about its long-term complications after repair in childhood are scarce. We performed reintervention in two adult patients with aneurysmal formation who underwent ascending–descending aortic bypass in childhood. Anatomical repair was performed through median sternotomy with deep hypothermic circulatory arrest. Case 1 is doing well 13 years postoperatively, whereas Case 2 died 4 months postoperatively due to hepatic failure. Close observation is imperative, and early reintervention is necessary when aneurysmal formation is observed.

Congenital extrahepatic portosystemic shunt is an abnormal connection between portal vein (prior to its branching) and one of the systemic veins. It is a rare cause of pulmonary hypertension. We report a 2-year-old child who presented with severe pulmonary artery hypertension and a unique form of congenital extrahepatic portosystemic shunt draining directly into right atrium. The shunt was successfully closed percutaneously, and pulmonary artery pressure fell from severe pulmonary artery hypertension to moderate pulmonary artery hypertension on follow up.