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Differences in school preparedness for sudden cardiac arrest based on automated external defibrillator availability and staff training between schools of different enrollment size 基于自动体外除颤器可用性和不同招生规模学校员工培训的学校心脏骤停准备的差异

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-04-17 DOI: 10.1016/j.ppedcard.2025.101831

Ryan Kimball , Isaac J. Jacobs , Matthew W. Sorensen , Jeffrey A. Robinson

Background

A school has a 1–2 % chance of having a sudden cardiac arrest (SCA) on its campus in any given year. Schools can be prepared by having automated external defibrillators (AEDs) readily accessible with staff trained in their use. The overall survival rate of SCA is less than 10 %. However, those who suffer SCA at a school that has an AED on-site have more than a 60 % chance of surviving to discharge. Currently, AEDs are not required in schools across all 50 states in the US.

Objective

Investigate the availability of AEDs in high schools across a state prior to any formal mandate and explore discrepancies among schools of varying enrollment sizes.

Methods

A 16-question survey about AED availability, accessibility, and percentage of staff trained for its use was distributed to every high school in Nebraska in July 2022.

Results

Schools with smaller enrollments were more likely to have AEDs accessible to the public (p = 0.047), available at all events (p = 0.0002), and over 50 % of staff trained for its use (p = 0.00019) than schools with larger enrollments. There was no correlation between number of AEDs and enrollment (R² = 0.172).

Conclusions

Most high schools have automated external defibrillators (AEDs), even without statewide mandates; however, continuing efforts are needed to ensure that AEDs at all schools are accessible to the public and that staff are appropriately trained. This study highlights the need for increased advocacy and targeted resource allocation, particularly for larger schools, to ensure appropriate/adequate AED distribution and emergency preparedness across all high schools.

在任何一年中，一所学校都有1 - 2%的机会在校园内发生心脏骤停（SCA）。学校可以准备好配备自动体外除颤器（aed），并配备经过使用培训的工作人员。SCA的总生存率低于10%。然而，那些在有AED的学校里患SCA的人有超过60%的机会活到出院。目前，美国所有50个州的学校都不要求使用除颤器。目的调查在任何正式授权之前，在一个州的高中使用aed的情况，并探讨不同招生规模的学校之间的差异。方法于2022年7月向内布拉斯加州的每所高中分发了一份关于AED的可获得性、可获得性和培训人员使用AED的百分比的16个问题的调查。结果招生人数较少的学校更有可能向公众提供aed (p = 0.047)，在任何情况下都可以使用（p = 0.0002），超过50%的员工接受过使用aed的培训（p = 0.00019）。aed数量与入组人数无相关性（R2 = 0.172）。大多数高中都有自动体外除颤器（aed），即使没有全州范围的强制规定；然而，需要继续努力确保公众可以在所有学校使用除颤器，并确保工作人员得到适当的培训。这项研究强调需要加强宣传和有针对性的资源分配，特别是对规模较大的学校，以确保在所有高中分发适当/充分的AED和应急准备。

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引用次数: 0

Transcatheter occlusion of the neoaorta to augment mechanical circulatory support after stage 1 single ventricle palliation 经导管阻断新主动脉以增强1期单心室缓和后的机械循环支持

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-04-01 DOI: 10.1016/j.ppedcard.2025.101830

Chelsea Miller, Michael J. Shorofsky, Michael Hainstock

Aortic insufficiency can be a complication of continuous mechanical circulatory support that leads to inefficient circulation and decreased coronary perfusion. In adults, this has been addressed through both surgical and transcatheter approaches. However, this has rarely been reported in children with congenital heart disease. We present the case of a neonate who developed severe neoaortic insufficiency after stage one single ventricle palliation while on central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) that was managed with transcatheter neoaortic occlusion. We used an Amplatzer Vascular Plug II 10 mm device (Abbott Cardiovascular) to successfully improve neoaortic insufficiency and overall hemodynamics. This procedure was technically feasible and may be considered in rare cases to address aortic insufficiency while on mechanical circulatory support.

主动脉功能不全可能是持续机械循环支持的并发症，导致循环效率低下和冠状动脉灌注减少。在成人中，这已经通过手术和经导管入路来解决。然而，这在患有先天性心脏病的儿童中很少有报道。我们提出的情况下，一个新生儿谁发展严重的新主动脉功能不全后一期单心室姑息，而中央静脉-动脉体外膜氧合（VA-ECMO）是经导管处理的新主动脉闭塞。我们使用Amplatzer血管塞II 10毫米装置（雅培心血管公司）成功改善新主动脉功能不全和整体血流动力学。该手术在技术上是可行的，在极少数情况下可以考虑在机械循环支持下解决主动脉功能不全。

引用次数: 0

Hypothermia vs normothermia in neonatal arterial switch operation – Clinical outcomes and myocardial preservation 新生儿动脉开关手术中的低温与常温-临床结果和心肌保存

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-20 DOI: 10.1016/j.ppedcard.2025.101829

Uri Pollak , Asaf Mandel , Yshia Langer , Salmas Watad , Hiba Abuelhija , Yshai Salem , Hai Zemmour , Eitan Keizman , David Mishaly , Alain E. Serraf

Background

Cardiopulmonary bypass (CPB) management during pediatric cardiac surgery represents a critical aspect of optimizing patient outcomes. Historically, the arterial switch operation (ASO) for transposition of the great arteries (TGA) was performed using hypothermic CPB, but growing evidence suggests potential benefits of normothermic approaches.

Objectives

This study aimed to compare clinical outcomes and myocardial preservation between hypothermic (HT-CPB) and normothermic (NT-CPB) temperature management strategies during neonatal ASO, with special emphasis on cardiomyocyte injury assessed through tissue-specific cell-free DNA (cfDNA).

Methods

This retrospective observational study analyzed data from 27 neonates (12 HT-CPB, 15 NT-CPB) who underwent ASO between July 2017 and December 2018. Clinical parameters were compared between groups, including CPB duration, cross-clamp time, postoperative cardiac biomarkers, and cfDNA trajectories as markers of cellular damage.

Results

The NT-CPB group demonstrated significantly shorter CPB (71.93 ± 28.49 vs. 116.00 ± 20.15 min, p < 0.001) and cross-clamp times (54.73 ± 32.24 vs. 96.92 ± 21.66 min, p < 0.001). Maximal lactate (51.00 ± 18.11 vs. 65.33 ± 12.43 mg/dL, p = 0.028) and Troponin-I levels (10.57 ± 2.83 vs. 15.37 ± 1.55 ng/dL, p < 0.001) were significantly lower in the NT-CPB group in oppose to higher incidence of AKI. While total cfDNA levels were comparable between groups at most time points, cardiac cfDNA was significantly lower in the NT-CPB group at 24 h post-surgery (p = 0.002).

Conclusion

Normothermia during neonatal ASO was associated with shorter operative times, lower metabolic stress, and reduced myocardial injury compared to hypothermia. These findings support the non-inferiority of normothermia as a viable and potentially beneficial temperature management strategy for neonatal ASO, offering comparable safety with improved hemodynamic and myocardial preservation outcomes.

背景：小儿心脏手术期间的体外循环（CPB）管理是优化患者预后的关键方面。历史上，大动脉转位（TGA）的动脉转换手术（ASO）是使用低温CPB进行的，但越来越多的证据表明常温入路的潜在益处。本研究旨在比较新生儿ASO期间低温（HT-CPB）和常温（NT-CPB）温度管理策略的临床结果和心肌保存情况，特别强调通过组织特异性无细胞DNA （cfDNA）评估心肌细胞损伤。方法回顾性观察分析2017年7月至2018年12月27例接受ASO手术的新生儿（12例HT-CPB， 15例NT-CPB）的数据。比较两组间的临床参数，包括CPB持续时间、交叉钳夹时间、术后心脏生物标志物和作为细胞损伤标志物的cfDNA轨迹。结果NT-CPB组CPB时间明显缩短(71.93±28.49 min vs 116.00±20.15 min, p <；0.001)和交叉夹夹时间(54.73±32.24 vs. 96.92±21.66 min, p <；0.001)。最大乳酸（51.00±18.11 vs. 65.33±12.43 mg/dL, p = 0.028）和肌钙蛋白- i水平(10.57±2.83 vs. 15.37±1.55 ng/dL, p <；0.001)，与较高的AKI发生率相反，NT-CPB组的AKI发生率显著降低。虽然在大多数时间点，两组之间的总cfDNA水平具有可比性，但NT-CPB组在术后24小时的心脏cfDNA水平显著降低（p = 0.002）。结论与低体温相比，常温可缩短新生儿ASO手术时间，降低代谢应激，减少心肌损伤。这些研究结果支持常温无劣效性作为新生儿ASO可行且潜在有益的温度管理策略，具有相当的安全性和改善的血流动力学和心肌保存结果。

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引用次数: 0

Cor triatrium dexter as a rare cause of central cyanosis: A case report 右心房三室心是一种罕见的中枢性紫绀的病因：1例报告

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-19 DOI: 10.1016/j.ppedcard.2025.101826

Hend A. Khalil , Rami A. Sabri , Alaa Abdorahman , Mohamed-Magdy Abuelkheir , Hany M. Abo-Haded

Cor triatrium dexter (CTD) is considered a rare congenital heart disease and accounts for 0.1 % of cardiac malformations. This condition occurred due to failure of regression of the right venous valve at the opening of the sinoatrial orifice in the right atrium, dividing the right atrium into 2 parts and forming a tri-atrial heart.

Case presentation: A 7-year-old child presented with fatigue and exertional dyspnea. Examination revealed oxygen saturation of 85 % and an ejection systolic murmur over the pulmonary area. Echocardiography showed moderate valvular pulmonary stenosis and a suspected membrane in the right atrium, while transesophageal echocardiography revealed a high secundum atrial septal defect (ASD) with bidirectional flow and a non-obstructive membrane in the right atrium, CTD. The patient underwent successful surgical closure of the ASD and resection of the CTD, resulting in improved oxygen saturation (98 %) and significant clinical improvement.

Conclusion, Cor triatriatum dexter is a rare congenital cardiac anomaly that can be missed on transthoracic echocardiography despite being a potential cause of central cyanosis.

心房右三房（CTD）是一种罕见的先天性心脏病，占心脏畸形的0.1%。这种情况的发生是由于右心房窦房孔开口处的右静脉瓣膜退行失败，将右心房分成两部分，形成三房心。病例介绍：一名7岁儿童表现为疲劳和用力性呼吸困难。检查显示血氧饱和度85%，肺区有射血性收缩期杂音。超声心动图示中度瓣膜性肺动脉狭窄，右心房疑有膜，经食管超声心动图示高窦性房间隔缺损（ASD）伴双向血流，右心房非阻塞性膜（CTD）。患者成功完成了ASD的手术闭合和CTD的切除，改善了血氧饱和度（98%）和显著的临床改善。结论：右三心房是一种罕见的先天性心脏异常，尽管它可能是中枢性紫绀的潜在原因，但在经胸超声心动图上却可能被遗漏。

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引用次数: 0

Investigating cardiopulmonary complications in cirrhotic pediatrics with contrast echocardiography 对比超声心动图研究肝硬化儿科的心肺并发症

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-18 DOI: 10.1016/j.ppedcard.2025.101828

Pejman Rohani , Elahe Motamedi , Arian Kariman , Koroush Vahidshahi , Maryam Fathi Khorasani , Mohammad Hassan Sohouli

Background

Liver cirrhosis is a rare but serious form of liver dysfunction that can lead to severe complications including cardiopulmonary involvement in children.

Objectives

In this study, our aim is to investigate the cardiopulmonary complications in children with cirrhosis by using contrast echocardiography.

Method

In this observational cross-sectional study, all pediatrics diagnosed with cirrhosis were enrolled from 2020 to 2024. Demographic data, weight, height, BMI, z-score, consanguinity, patient's history, cause of cirrhosis, family history of cirrhosis, laboratory data, abdominal sonography, liver biopsies, and saline contrast echocardiography for arteriovenous malformation (AVM) were evaluated and recorded.

Result

A total of twenty-two children were observed, with 59 % of them being boys. The average age of all the children was 8.43 ± 4.6 years. During the study, it was found that 27.3 % of the patients had mild left ventricular diastolic dysfunction, 13.6 % had mild AVM, and 4.5 % had moderate AVM in the contrast echocardiography. No relationship was found between cardiopulmonary complications with age, sex, and laboratory data. However, there was a significant relationship between moderate AVM diagnosed in contrast echocardiography and nodular formation, as well as a significant relationship between left ventricular enlargement (LVE) and nodular formation. One patient had nodular formation in the liver biopsy concurrent with LVE and moderate AVM. Mild AVM was seen in a patient with severe vascular change and giant cell transformation. Additionally, there was a relationship between contrast echocardiography and BUN, creatinine, and vitamin D levels (all P-values <0.05).

Conclusion

The results of contrast echocardiography are correlated with some complications of cirrhosis and can be used as a method to evaluate cardiopulmonary complications in children with cirrhosis.

背景：肝硬化是一种罕见但严重的肝功能障碍，可导致严重的并发症，包括儿童心肺受累。目的通过对比超声心动图分析肝硬化患儿的心肺并发症。方法在这项观察性横断面研究中，纳入了2020年至2024年诊断为肝硬化的所有儿科患者。评估并记录患者的人口统计学资料、体重、身高、BMI、z-score、血亲关系、患者病史、肝硬化原因、肝硬化家族史、实验室资料、腹部超声检查、肝活检、生理盐水超声心动图检查动静脉畸形（AVM）。结果共观察到22例患儿，其中男生占59%。所有患儿平均年龄为8.43±4.6岁。在研究过程中，超声造影发现27.3%的患者有轻度左室舒张功能不全，13.6%的患者有轻度AVM， 4.5%的患者有中度AVM。没有发现心肺并发症与年龄、性别和实验室数据之间的关系。然而，超声造影诊断的中度AVM与结节形成有显著相关性，左心室增大（LVE）与结节形成也有显著相关性。1例患者在肝活检中出现结节形成，同时伴有LVE和中度AVM。轻度AVM见于严重血管改变和巨细胞转化的患者。此外，超声心动图造影与BUN、肌酐和维生素D水平之间存在相关性（p值均为0.05）。结论超声心动图造影结果与肝硬化部分并发症有一定的相关性，可作为评价肝硬化患儿心肺并发症的一种方法。

{"title":"Investigating cardiopulmonary complications in cirrhotic pediatrics with contrast echocardiography","authors":"Pejman Rohani , Elahe Motamedi , Arian Kariman , Koroush Vahidshahi , Maryam Fathi Khorasani , Mohammad Hassan Sohouli","doi":"10.1016/j.ppedcard.2025.101828","DOIUrl":"10.1016/j.ppedcard.2025.101828","url":null,"abstract":"<div><h3>Background</h3><div>Liver cirrhosis is a rare but serious form of liver dysfunction that can lead to severe complications including cardiopulmonary involvement in children.</div></div><div><h3>Objectives</h3><div>In this study, our aim is to investigate the cardiopulmonary complications in children with cirrhosis by using contrast echocardiography.</div></div><div><h3>Method</h3><div>In this observational cross-sectional study, all pediatrics diagnosed with cirrhosis were enrolled from 2020 to 2024. Demographic data, weight, height, BMI, z-score, consanguinity, patient's history, cause of cirrhosis, family history of cirrhosis, laboratory data, abdominal sonography, liver biopsies, and saline contrast echocardiography for arteriovenous malformation (AVM) were evaluated and recorded.</div></div><div><h3>Result</h3><div>A total of twenty-two children were observed, with 59 % of them being boys. The average age of all the children was 8.43 ± 4.6 years. During the study, it was found that 27.3 % of the patients had mild left ventricular diastolic dysfunction, 13.6 % had mild AVM, and 4.5 % had moderate AVM in the contrast echocardiography. No relationship was found between cardiopulmonary complications with age, sex, and laboratory data. However, there was a significant relationship between moderate AVM diagnosed in contrast echocardiography and nodular formation, as well as a significant relationship between left ventricular enlargement (LVE) and nodular formation. One patient had nodular formation in the liver biopsy concurrent with LVE and moderate AVM. Mild AVM was seen in a patient with severe vascular change and giant cell transformation. Additionally, there was a relationship between contrast echocardiography and BUN, creatinine, and vitamin D levels (all <em>P</em>-values <0.05).</div></div><div><h3>Conclusion</h3><div>The results of contrast echocardiography are correlated with some complications of cirrhosis and can be used as a method to evaluate cardiopulmonary complications in children with cirrhosis.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"77 ","pages":"Article 101828"},"PeriodicalIF":0.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715127","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}

引用次数: 0

Fontan assist devices; A systematic review of twenty years of experimental and in vivo trials 方坦辅助装置；二十年实验和体内试验的系统回顾

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-17 DOI: 10.1016/j.ppedcard.2025.101827

Antoine Fakhry AbdelMassih , Zahraa Allami , Moyasar H. AlTatari , Rahaf Z. AbuGhosh , Alma AlFakhori , Omar J. AlMistarihi , Laila AlKhouli

Background

The Fontan completion represents the final phase of univentricular repair, which drains the inferior vena cava against gravity into a higher-pressure pulmonary arterial circulation. The passive and anti-gravity characteristics of this circulation make encountering a failing Fontan not uncommon. Twenty years ago, experiments exploring the potential of vascular pumps to bolster the passive Fontan have started, and trials are still ongoing.

Aim of review

Through this review, our aim is to summarize the outcomes of these trials.

Key scientific concepts and findings of review

A total of ten trials have been included, encompassing 23 different settings. Three distinct designs were identified, of which two are classified as pump designs: the connecting chamber and the intravascular pump designs. Only one trial investigated the potential use of a compression device. The most frequently encountered design in vivo was the intravascular pump, accounting for 67 % of the cases. There were no reports of significant hemolysis or thrombosis. However, an increasing flow rate exceeding 5 L/min was associated with negative outcomes in the connecting chamber design due to rising upstream pressure in the SVC. In contrast, intravascular pumps did not exhibit this limitation.

Fontan完成代表了单心室修复的最后阶段，它将下腔静脉引流到高压肺动脉循环中。这种环流的被动和反重力特性使得遇到失败的丰滩并不罕见。20年前，探索血管泵增强被动Fontan的潜力的实验已经开始，试验仍在进行中。综述的目的通过这篇综述，我们的目的是总结这些试验的结果。综述的主要科学概念和发现共纳入10项试验，涵盖23种不同的环境。确定了三种不同的设计，其中两种被归类为泵设计：连接腔和血管内泵设计。只有一项试验调查了压缩装置的潜在用途。体内最常见的设计是血管内泵，占67%的病例。没有明显的溶血或血栓的报道。然而，当流量超过5升/分钟时，由于SVC上游压力的上升，连接室的设计结果会出现负面影响。相比之下，血管内泵没有表现出这种局限性。

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引用次数: 0

Pediatric cardiac surgery preparation: Enhancing psychological resilience and coping skills in congenital heart defect patients and families 儿童心脏手术准备：提高先天性心脏缺陷患者和家庭的心理弹性和应对技能

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-17 DOI: 10.1016/j.ppedcard.2025.101825

Miho Takeuchi , Muneaki Matsubara , Bryan J. Mathis , Rie Wakimizu , Yuji Hiramatsu

Background

Preparation support—defined as structured, age-appropriate educational and psychological interventions to familiarize patients with upcoming procedures—is important for emotionally vulnerable children undergoing heart surgery.

Objectives

This pilot study evaluated a preparation program for pediatric cardiac surgery patients and identified effective components for psychological support.

Methods

Six patients (aged 5–16 years) undergoing cardiac surgery and their parents participated in our preparation program, which included role-play with medical equipment, age-appropriate videos demonstrating perioperative flow and sensory information, and coping strategy instruction. Data were collected through perioperative observations, post-discharge interviews with children, and parental questionnaires, then analyzed using qualitative content analysis.

Results

Preparatory counseling improved illness acceptance, treatment motivation, and self-coping skills during the perioperative period. Children demonstrated positive emotional and cooperative responses during hospitalization, with qualitative analysis revealing two main categories of children's experiences: 1) understanding of treatment and sense of accomplishment, and 2) fluctuating anxiety and stress. Parental responses similarly formed two categories: concerns about communication and expectations for healthcare collaboration. Some children initially experienced increased fear that typically resolved over time.

Conclusion

Preparation counseling effectively supports pediatric cardiac surgery patients psychologically while helping parents provide appropriate emotional support. The mixed emotional responses observed highlight the need for ongoing program refinement. Enhanced preparation programs specifically designed for children with congenital heart disease can reduce psychological distress during extended hospitalizations and improve overall well-being in this vulnerable population.

背景准备支持——定义为结构化的、与年龄相适应的教育和心理干预，以使患者熟悉即将进行的手术——对接受心脏手术的情感脆弱儿童很重要。目的本初步研究评估了儿童心脏手术患者的准备方案，并确定了心理支持的有效成分。方法6例5 ~ 16岁的心脏外科手术患者及其家长参与预备课程，包括使用医疗器械进行角色扮演、播放适合年龄的围手术期流程和感觉信息视频、指导应对策略等。通过围手术期观察、出院后患儿访谈和家长问卷收集数据，并采用定性内容分析法进行分析。结果术前咨询可提高围手术期患者的疾病接受度、治疗动机和自我应对能力。儿童在住院期间表现出积极的情绪和合作反应，定性分析揭示了儿童体验的两大类：1)对治疗的理解和成就感，2)波动的焦虑和压力。家长的反应类似地形成了两类：对沟通的关注和对医疗合作的期望。一些孩子最初会感到越来越害怕，这种恐惧通常会随着时间的推移而消退。结论准备咨询在帮助家长提供适当的情感支持的同时，对小儿心脏手术患者提供了有效的心理支持。观察到的复杂情绪反应突出了持续改进程序的必要性。专门为先天性心脏病儿童设计的强化准备方案可以减少长期住院期间的心理困扰，并改善这一弱势群体的整体健康状况。

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引用次数: 0

Long-term outcomes following patent foramen ovale device closure: A single-center experience 卵圆孔装置闭合术后的长期疗效：单中心经验

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-14 DOI: 10.1016/j.ppedcard.2025.101824

Sahar El Shedoudy , Reem Rashed , Asmaa El Fiky , Eman El Doklah

Background

Patent foramen ovale (PFO) transcatheter closure is recommended for carefully selected patients with cryptogenic stroke and transient ischemic attack (TIA). It has also been associated with significant improvement in the severity of refractory migraine headaches.

Objective

To report long-term outcome after PFO closure for patients with stroke, TIA, and refractory migraine.

Methods

This retrospective study represents a single-center experience including patients undergoing PFO transcatheter closure for stroke, TIA, or refractory migraine. Patients were followed at 1 and 6 months, one year, and then annually for at least 5 years after closure. After that, patients either attended annually or were followed by telephone interviews. Holter monitoring was done 1–3 months after closure, then selectively according to patient symptoms.

Results

We enrolled 480 patients undergoing PFO transcatheter closure between March 2001 and July 2020. 432 patients completed follow-up through August 2024. The follow-up duration ranged from (4–23) years. PFO closure was successful in all patients without complications. New onset atrial fibrillation (AF) occurred in 6 patients (1.39 %), typically later during follow-up (14.0 ± 4.1 years), all with cardiovascular risk factors. Cerebrovascular events recurred 0.31 events/100 person/years. Using the Log-rank test, event recurrence was more observed in patients >40 years in the presence of other cardiovascular risk factors and AF. Regarding Migraine, (82.4 %) of patients experienced complete resolution of symptoms, and (17.6 %) reported mild symptoms (Migraine Disability Assessment Questionnaire (MIDAS) grade I). The mean MIDAS score significantly improved; the mean before closure was 28.3 ± 7.23 and 0.83 ± 1.82 after closure (P = 0.001). The migraine persistence rate was 1.9 events per 100 person-years.

Conclusions

Percutaneous PFO closure is a safe and effective long-term intervention for preventing recurrent cerebrovascular events and significantly improves migraine symptoms.

背景：对于隐源性卒中和短暂性脑缺血发作（TIA）的患者，建议经导管闭锁卵圆孔未闭。它还与难治性偏头痛严重程度的显著改善有关。目的报告卒中、TIA和难治性偏头痛患者PFO关闭后的长期预后。方法本回顾性研究为单中心研究，包括因卒中、TIA或难治性偏头痛而接受PFO经导管闭合的患者。随访时间分别为1个月、6个月、1年，然后每年随访至少5年。在那之后，患者要么每年来一次，要么接受电话采访。关闭后1-3个月进行动态心电图监测，然后根据患者症状选择性监测。结果我们在2001年3月至2020年7月期间纳入了480例PFO经导管闭合患者。到2024年8月，432名患者完成了随访。随访时间为4-23年。所有患者均成功闭合PFO，无并发症。6例（1.39%）患者发生新发房颤（AF），通常发生在随访后期（14.0±4.1年），均伴有心血管危险因素。脑血管事件复发0.31例/100人/年。使用Log-rank检验，在存在其他心血管危险因素和AF的40岁患者中观察到的事件复发更多。对于偏头痛，（82.4%）的患者症状完全缓解，（17.6%）的患者报告轻度症状（偏头痛残疾评估问卷（MIDAS） I级）。平均MIDAS评分显著改善；闭合前平均值为28.3±7.23，闭合后平均值为0.83±1.82 （P = 0.001）。偏头痛持续率为每100人年1.9次。结论经皮PFO闭合术是一种安全有效的预防脑血管事件复发的长期干预措施，可显著改善偏头痛症状。

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引用次数: 0

RVOT stenting in unconventional circumstances in the pediatric age group: A case series RVOT支架在儿科年龄组的非常规情况下：一个病例系列

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-08 DOI: 10.1016/j.ppedcard.2025.101822

Mohammad Moaaz Kidwai , Shaad Abqari , Shamayal Rabbani , Mohammad Mirza Kamran , Mohammad Azam Haseen

Background

Right ventricular outflow tract stenting (RVOTS) has emerged as an acceptable alternative to Blalock-Taussig-Thomas shunt surgery. This approach is indicated for patients with Tetralogy of Fallot (TOF) and unfavorable pulmonary artery anatomy. The utility of RVOTS has not been established outside the domain of classical TOF patients, i.e., in unconventional circumstances.

Objectives

This study was performed to analyze the utility of RVOTS in unconventional circumstances, including reintervention following RVOTS.

Methods

This was a retrospective analysis performed in a tertiary care pediatric cardiac center. The details of all patients who underwent RVOTS were analyzed. All patients who underwent RVOTS under unconventional circumstances and who underwent RVOT reintervention were included in this analysis. The patients' immediate outcomes and last follow-up visit were analyzed.

Results

Of the 56 patients who underwent RVOTS at our center, 5 patients were included in this analysis; the median age was 3 years (range = 1–13 years). A total of 7 RVOT interventions (including one re-stenting and one balloon dilatation) were performed in these 5 patients. Four patients underwent RVOTS under unconventional circumstances, and one patient underwent re-stenting. All 5 patients had excellent immediate outcomes, and all were discharged in satisfactory condition.

Conclusion

RVOTS can be utilized in unconventional situations with good immediate and short-term outcomes, as shown in this case series.

背景：右心室流出道支架植入术（RVOTS）已成为Blalock-Taussig-Thomas分流术的可接受替代方法。该入路适用于法洛四联症（TOF）和肺动脉解剖不良的患者。RVOTS的效用尚未在经典TOF患者领域之外建立，即在非常规情况下。目的分析RVOTS在非常规情况下的应用，包括RVOTS后的再干预。方法回顾性分析某三级儿科心脏中心的病例。分析所有接受RVOTS的患者的细节。所有在非常规情况下接受RVOTS和RVOT再干预的患者均纳入本分析。分析患者的即时预后和最后一次随访情况。结果在我们中心接受RVOTS的56例患者中，有5例患者被纳入本分析；中位年龄为3岁（范围= 1-13岁）。这5例患者共进行了7次RVOT干预（包括1次重新支架置入术和1次球囊扩张术）。4例患者在非常规情况下行RVOTS， 1例患者行支架置入术。5例患者均有良好的即时预后，出院时均满意。结论rvots可用于非常规情况，具有良好的即时和短期效果，如本病例系列所示。

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引用次数: 0

Mindfulness based stress reduction program in teenage patients with a cardiac implanted electronic device 心脏植入电子设备的青少年患者的正念减压计划

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY

Pub Date : 2025-03-07 DOI: 10.1016/j.ppedcard.2025.101821

Lisa Roelle , Maeve M. Sargeant , Nathan Miller , Anthony G. Pompa , William B. Orr , Samuel F. Sears , Jennifer N. Avari Silva

Background

Increased psychosocial stress and decreased quality of life (QOL) are commonly seen in adolescents with cardiac implanted electronic devices (CIEDs). Mindfulness based stress reduction (MBSR) interventions have been shown to decrease psychosocial stress and improve QOL in cardiovascular patients.

Objective

This pilot study assessed the feasibility and effectiveness of an MBSR-teen (MBSR-T) program in adolescents with CIEDs.

Methods

Patients aged 14–21 with CIEDs for >1 month enrolled and completed an 8-week MBSR-T course. The program was implemented in two formats: an in-person program for the first cohort of participants and a virtual program for the second cohort. Participants completed pre and post-program surveys: Peds Quality of Life Short Form (PedsQL 4.0 SF), Florida Patient Acceptance Survey (FPAS), and a post-program qualitative survey.

Results

Twelve patients (10 with pacemakers, 2 with ICDs, 8 in-person, 4 virtual) completed the course, with a mean age of 16 ± 2 years. Following the intervention, patients reported significantly greater acceptance of their cardiac implantable devices (t(11) = −2.67, p = 0.022). Although not statistically significant, patients reported clinically relevant decreased depression (mean change [MΔ] = −0.75), increased emotional functioning (MΔ = 1.17), and increased social functioning (MΔ = 0.50). Post-program qualitative survey results showed that all participants (100 %) found the program useful and appropriate in both duration and setting, with 9 participants (75 %) recommending it to other teenagers with CIEDs.

Conclusion

In-person and virtual MBSR-T programs were feasible and demonstrated decreased device-related distress and improved device acceptance in children with CIEDs.

心理社会压力增加和生活质量下降在植入心脏电子设备（cied）的青少年中很常见。正念减压（MBSR）干预已被证明可以减少心血管患者的心理社会压力并改善生活质量。目的本初步研究评估了MBSR-T治疗cied青少年的可行性和有效性。方法14-21岁的cied患者病程1个月，接受为期8周的MBSR-T课程。该计划以两种形式实施：第一组参与者的面对面计划和第二组参与者的虚拟计划。参与者完成了计划前和计划后的调查：儿科生活质量简短表格（PedsQL 4.0 SF），佛罗里达州患者接受调查（FPAS），以及计划后的定性调查。结果12例患者（带起搏器10例，带icd 2例，亲历8例，虚拟4例）完成疗程，平均年龄16±2岁。干预后，患者对心脏植入装置的接受度显著提高（t(11) = - 2.67, p = 0.022）。虽然没有统计学意义，但患者报告临床相关的抑郁减少（平均变化[MΔ] =−0.75），情绪功能增加（MΔ = 1.17），社会功能增加（MΔ = 0.50）。项目后的定性调查结果显示，所有参与者（100%）都认为该项目在持续时间和环境方面都是有用和合适的，其中9名参与者（75%）向其他患有cied的青少年推荐该项目。结论面对面和虚拟MBSR-T方案在cied患儿中是可行的，并能减少设备相关的困扰，提高设备接受度。

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