Annals of Pediatric Cardiology最新文献

Introduction: Balloon pulmonary valvuloplasty (BPV) is the treatment of choice for valvular pulmonary stenosis (PS) in all age groups. However, there are limited data regarding its outcomes in newborns with critical PS in the current era. We are reporting the immediate and short-term outcomes of BPV in this population.

Materials and methods: The study population comprised of all neonates with critical valvular PS who underwent BPV at our center between January 2015 and December 2022. The clinical and echocardiographic data were collected retrospectively and stratified as preintervention, intervention, and follow-up.

Results: Twenty-four neonates with critical PS underwent BPV at a mean age of 7.0 ± 6.8 days. The median pulmonary and tricuspid valve (TV) Z-scores were - 0.49 and - 1.50, respectively. The procedure was performed through the femoral and jugular veins in 15 (62.5%) and 4 (16.7%) patients, respectively. The pulmonary valve could be crossed only through the retrograde route (patent ductus arteriosus) in 5 (20.8%) patients. The mean balloon annulus ratio was 1.02 ± 0.12. Eleven (45.8%) patients required graded balloon dilatation. The procedure was successful in 22/24 patients. There was a significant reduction in the pulmonary peak transvalvular gradient (83.9 ± 14.4 mmHg to 18.2 ± 7.6 mmHg; P < 0.05). Follow-up showed a progressive increase in Z-scores of pulmonary and tricuspid valve. Two patients who developed restenosis had dysplastic pulmonary valves.

Conclusion: Neonates undergoing BPV have good short-term outcomes with a low restenosis rate. In patients with small TV and severe regurgitation, crossing the pulmonary valve by retrograde approach (through ductus arteriosus) is an effective method.

This is a case of a 3-year-old child who presented with long-segment tracheal stenosis (LSTS) and complex congenital cardiovascular disease for surgical intervention. The ideal operation for this child will include slide tracheoplasty and multiple cardiac lesion repairs. However, the low birth weight and extremely young age present a dilemma as to whether to perform total repair simultaneously or in stages. Age and weight by which the first surgical procedure was done, cardiovascular abnormality details, preoperative respiratory support, preoperative tracheobronchomalacia, cardiopulmonary bypass, the complexity of the surgery, and preoperative extracorporeal membrane oxygenation support are known to be predictive factors of long-term outcomes. Comparative studies between simultaneous and staged operations have shown that it is best to manage children with LSTS and complex cardiovascular anomalies in stages.

Ascending aorta dilatation has been reported in some cases of congenital complete heart block (CHB). Although maternal autoantibodies are implicated in the causation, the exact mechanism, significance, and management are not fully understood. In this report, we describe dilated ascending aorta in two neonates with congenital CHB and their short-term follow-up results.

Superior vena cava (SVC) type of sinus venosus defect (SVD) associated with anomalous right upper pulmonary vein (RUPV) drainage is often corrected by open-heart surgery. Transcatheter-covered stent exclusion is an attractive emerging alternative using a covered stent in the lower end of SVC to close the SVD and redirect the RUPV to the left atrium. The location of SVD posterosuperior to oval fossa challenges its transthoracic echocardiographic identification and delays its diagnosis to adult age. Lifestyle adult diseases, including atherosclerosis, elevate the left ventricular end-diastolic pressures and increase the pretricuspid left-to-right shunt. Surgery addresses coronary stenosis and SVD, but lifestyle diseases increase surgical risks. We diagnosed significant coronary stenosis in three patients with SVD. These patients underwent percutaneous management of both lesions. Nonsurgical management of SVD and ischemic heart disease is a more viable alternative than a high-risk surgery in adults with comorbidities.

Objectives: Stent thrombosis, a potential complication of ductal stenting, is associated with high mortality. This is a catastrophic complication, which can occur acutely (within 24 h), subacutely (within 30 days), or late (≥30 days) after stent implantation, with rates between 0.8% and 25%. Oral antiplatelet drugs like aspirin have erratic and inconsistent absorption and antiplatelet effects in critically ill neonates. Intravenous (IV) glycoprotein IIb/IIIa inhibitors (GPIs) are antiplatelet agents with rapid effect (84% inhibition of platelet aggregation 15 min after bolus) that may help prevent this catastrophic complication.

Materials and methods: The study was conducted among 127 neonates with a median age of 1 month, of which 48% were male, undergoing ductal stenting procedures between January 2022 and March 2024 at our center who received an IV eptifibatide bolus of 180 µg/kg immediately postprocedure. Dosing simulations were generated based on extrapolation from the adult model. The primary outcome measures were stent thrombosis and bleeding events, whereas the secondary outcomes included platelet count.

Results: Stent thrombosis occurred in one of the patients after prophylactic treatment with eptifibatide. Five patients experienced bleeding complications. Eight patients had thrombocytopenia, as thrombosis is prevented via the adenosine diphosphate pathway. The treatment did not affect serum creatinine and liver function.

Conclusion: IV GPIs are safe in neonates after a ductal stenting procedure as an adjunct to oral antiplatelet therapy. Dosing considerations should include age and renal function. Randomized trials are warranted to establish efficacy and compare with current anticoagulation practices.

A term newborn boy was diagnosed with aortic atresia and ventricular septal defect with duplicated subclavian arteries bilaterally. Computed tomography angiography demonstrated highly unusual aortic arch vasculature. A diminutive aortic arch and complex head vessel anatomy precluded standard surgical palliation with a Damus-Kaye-Stansel, arch reconstruction, and systemic to pulmonary artery shunt. Instead, the patient underwent placement of bilateral pulmonary artery bands and stenting of the patent arterial duct (PDA). At 2 months of age, the patient underwent PDA stent dilation. At 4 months of age, he underwent balloon angioplasty of pulmonary artery bands with transverse aortic stenting. At the most recent follow-up at 15 months of age, there was no significant growth of the aortic arch, and the patient was mildly hypertensive but otherwise hemodynamically stable. He is currently being evaluated for heart transplantation due to his complex vascular anatomy.

The modified Blalock-Taussig-Thomas shunt (mBTT shunt) is an effective palliation for cyanotic congenital heart diseases. However, a late obstruction of the mBTT shunt may present as a life-threatening complication. In this setting, a redo-surgery or a transcatheter recanalization is necessary to restore adequate pulmonary blood flow. We report three cases of transcatheter recanalization and stenting of a completely obstructed mBTT shunt, highlighting the tips and tricks of the percutaneous approach.

Introduction: Congenital heart disease (CHD)-associated malnutrition is a systemic consequence of CHD. Dietary recommendations to fulfill nutritional requirements are lacking. This randomized controlled trial (RCT) was conducted to determine the efficacy of early enteral feeding with supplemented expressed breast milk (suppl-EBM) versus expressed breast milk (EBM) in improving the weight of postoperative cardiac surgical infants.

Objective: The primary objective was the weight change between the EBM group and the suppl-EBM group at the 15^th postoperative day (POD) or intensive care unit (ICU) discharge. The secondary objectives were to compare the ventilation duration (VD), length of ICU stay (LOICUS), length of hospital stay (LOHS), macronutrient consumption, adverse events, sepsis, and mortality between the two groups.

Materials and methods: This study was a parallel-group, open-labeled, single-blinded, variable block size RCT conducted at a tertiary care teaching hospital in northern India. Full-term breastfed infants ≤6 months, weighing ≥2.5 kg at birth, and undergoing congenital cardiac repair were enrolled in this study. The infants were fed either EBM or supplemented EBM in control and intervention groups, respectively. Weight and length were measured at baseline and 15^th POD or at ICU discharge. Biochemical parameters at baseline and every alternate day, sepsis parameters every third POD and VD, LOICUS, LOHS, macronutrient consumption, and adverse events were assessed daily.

Results: The mean weight, weight change percentage, and weight for age z score were significantly higher in the supplemented EBM group (P < 0.05). The macronutrient consumption was significantly higher in the intervention group (P < 0.05). No significant difference was found between the two groups for VD, LOICUS, and LOHS (P > 0.05). The sepsis was higher in the EBM group. However, the mortality rate did not differ between the two groups (P > 0.05).

Conclusion: Supplemented feeding may improve the weight of postoperative cardiac infants with no serious adverse events.

The right venous valve is critical to the proper development of the fetal heart. As the right venous valve degenerates later in fetal development, residual structures can remain, such as the terminal crest, Eustachian valve, Thebesian valve, and a prominent Chiari network, with a sail-like appearance resembling a spinnaker. While these structures are often incidentally found on adult echocardiograms, we present a case of a term neonate with hypoxia secondary to a persistent right valve of the sinus venosus.

Coronary sinus (CS) defects are rare congenital cardiac anomalies that occur in isolation or with other congenital heart diseases. Persistent left superior vena cava (LSVC) is a relatively common entity that usually drains into the CS, is of no hemodynamic consequence, and is easily diagnosed on echocardiography by a dilated CS and an antegrade flow toward the heart. However, a combination of LSVC and CS defect may reverse its flow direction and CS dilation may be absent. In the absence of echocardiographic clues, the reversed flow can be easily misdiagnosed for other structures such as the more common vertical vein of anomalous pulmonary venous connection or the rarer levoatrial cardinal vein. Here, we report a 2-year-old boy with ventricular septal defect, patent ductus arteriosus, absent CS, and a persistent LSVC with retrograde flow producing a hemodynamically significant pretricuspid left-to-right shunt along with its diagnostic challenges. He underwent successful surgical closure of these defects and had been asymptomatic on follow-up.