Annals of Pediatric Cardiology最新文献

Background: An abnormal variation in blood electrolytes, such as potassium, contributes to mortality in children admitted to intensive care units. Continuous and real-time monitoring of potassium serum levels can prevent fatal arrhythmias, but this is not currently practical. The study aims to use machine learning to estimate blood potassium levels with accuracy in real time noninvasively.

Methods: Hospitalized patients in the Pediatric Department of the Rajaie Cardiology and Medical Research Center and Tehran Heart Center were recruited from December 2021 to June 2022. The electrocardiographic (ECG) features of patients were evaluated. We defined 16 features for each signal and extracted them automatically. The dimension reduction operation was performed with the assistance of the correlation matrix. Linear regression, polynomials, decision trees, random forests, and support vector machine algorithms have been used to find the relationship between characteristics and serum potassium levels. Finally, we used a scatter plot and mean square error (MSE) to display the results.

Results: Of 463 patients (mean age: 8 ± 1 year; 56% boys) hospitalized, 428 patients met the inclusion criteria, with 35 patients having a high noise of ECG were excluded. After the dimension reduction step, 11 features were selected from each cardiac signal. The random forest regression algorithm showed the best performance with an MSE of 0.3.

Conclusion: The accurate estimation of serum potassium levels based on ECG signals is possible using machine learning algorithms. This can be potentially useful in predicting serum potassium levels in specific clinical scenarios.

Data on the safety and efficiency of perventricular device closure of complex ventricular septal defects (VSDs) are scarce. We report successful one-stage combined hybrid perventricular and percutaneous closure of the muscular VSDs in a critically ill 4-kg infant, using the new multifunctional occluder.

Dual drainage of a pulmonary vein is an unusual anomaly of pulmonary venous drainage. While being evaluated for hypertension, a child was found with dual drainage of the upper left lobe through a vertical vein that connects to the normal pulmonary vein as well as the innominate vein with no symptoms from his effective left-to-right shunt.

Obstruction of the superior vena cava (SVC) is a rare complication after cardiac surgery in infants and children. We present the case of an 8-year-old boy who underwent bi-directional Glenn shunt followed by takedown of Glenn shunt and complete repair for cyanotic congenital heart disease. After 4 years of surgery, the child developed features of superior vena caval (SVC) syndrome. Echocardiography and CT angiography revealed complete obstruction of SVC without any forward flow. Transcatheter intervention was performed successfully to re-canalize and stent the SVC to maintain its patency. The patient was doing well at follow-up appointments, with good laminar flow through the stent. In conclusion, transcatheter management of post cardiac surgery SVC obstruction was successful in this patient.

Mitral annular disjunction (MAD) is defined as a separation between the mitral annulus and the left ventricular myocardium and is most often seen in association with mitral valve prolapse (MVP). MAD has been linked to ventricular arrhythmias in adults, independent of MVP. However, it has rarely been reported in children. We, hereby, report two cases of MAD associated with a large atrial septal defect (ASD). Thus far, there are no consensus guidelines for the management of MAD. The additional association of large ASD further complicates the decision-making in these patients. To the best of our knowledge, this is the first report of the association of MAD with ASD. We further discuss the challenges in the management of this condition.

Hypoplastic left heart syndrome (HLHS) is a complex congenital heart defect (CHD) characterized by a spectrum of underdeveloped left-sided cardiac structures. It is a serious defect and warrants either 3-staged surgical palliation or a heart transplant. Despite numerous surgical advancements, long-term outcomes remain challenging and still have significant morbidity and mortality. There have been notable advancements in stem cell therapy for HLHS, including developments in diverse stem cell origins and methods of administration. Clinical trials have shown safety and potential benefits, including improved ventricular function, reduced heart failure, and fewer adverse events. Younger myocardium seems particularly receptive to stem cell signals, suggesting the importance of early intervention. This review explores the potential of emerging stem cell-based therapies as an adjunctive approach to improve the outcomes for HLHS patients.