Archives of Cardiovascular Diseases Supplements最新文献

Introduction

Healthcare professionals working in a pediatric cardiology department (PCD) could be exposed to a cardiac arrest (CA).

The expertise required for the interprofessional management of a CA could be achieved through in situ simulation.

The lack of a simulation culture within the department hinders the development of a simulation-based teaching program.

Objective

Does an educational session composed of a simulation-based bootcamp followed by an in situ simulation focused on the management of a shockable pediatric CA lead the intention of modifying behaviours among health professionals in the PCD? The primary objective is to assess the intention that pediatric cardiology healthcare professionals have in modifying their involvement when managing pediatric CA, following an educational simulation session. The secondary objective is to identify latent safety threats (LSTs) in the current work environment during the in situ simulation sessions.

Methods

Members of the pediatric cardiology department participated in an educational session (bootcamp and an in situ simulation session).

The educational session focused on the multidisciplinary management of a shockable cardiac arrest until the arrival of the code blue team.

Intention to modify behaviors was documented using the REACTION questionnaire (Figure 1). Simulations and debriefings were be video-recorded and reviewed to identify LSTs in the current workplace.

Results/Expected results

After participating in the educational simulation session, participants have a clear intention in modifying their involvement when managing pediatric CA (initiation and participation)

The simulation sessions identified moderate and severe LSTs. A serious problem of calling for help in the department was identified.

Conclusion/Perspectives

The educational session consisting of a simulation-based bootcamp followed by an in situ simulation focused on the management of CA led to the intention of changing the behaviors of healthcare professionals in the PDC.

Almost the entire department is now introduced to simulation, and we observe culture change is underway.

Introduction

Modeling of tricuspid annuli (TA) is recently available from three-dimensional transthoracic echocardiography (3D-TTE).

Objective

We aimed to compare remodeling of TA geometry in children with CHD according to the type of right ventricle (RV) overload.

Methods

Patients were divided in 3 groups: control groups (healthy children), pre-tricuspid overload group (atrial septal defect and anomaly of pulmonary venous return) and post- tricuspid overload group (pulmonary regurgitation after RVOT surgery). Patients with tricuspid valve anomaly were excluded. TA were modeled using 3D-TTE (Vivid E95, GE) and integrated semi-automatic tricuspid valve analysis algorithm. RV end-diastolic (RVEDV) and end- systolic volumes were calculated from 3D-TTE using integrated RV analysis algorithm. Measurements were indexed to body surface area (BSA).

Results/Expected results

In total, 103 patients were included (27 control, 30 pre-tricuspid and 34 post-tricuspid overload), mean age 10.5 ± 4.3 years old and mean weight 36.7 ± 17.1 kg. The 3 groups were matched for age and BSA. RV was dilated in pre- and post-tricuspid groups (89.1 ± 26.0 and 102.4 ± 21.6 ml/m² respectively vs. 57.5 ± 12.2 ml/m² in control group). TA surface were significantly larger in pre-tricuspid group compared to control and post-tricuspid group (6.6 ± 1.6, 4.9 ± 0.9 and 5.5 ± 1.2 mm/cm² respectively, P < 0.0001 and P = 0.009 respectively) but did not differ significantly between the control and post-tricuspid group (P = 0.32). Same results were found for TA short and long axis diameters. However, the tenting volume was greater in post-tricuspid group compared to control and pre-tricuspid group (1.3 ± 0.5, versus 0.9 ± 0.4 and 1.0 ± 0.3 ml/m² respectively, P < 0.0001 and P = 0.03 respectively) but didn’t differ significantly between pre-tricuspid and control group (P = 0.15). Tenting volume was not correlated to RVEDV (Figure 1).

Conclusion/Perspectives

3D modeling of TA is feasible from 3D-TTE and allow understanding remodeling of TA geometry in different situation of RV overload. This could have an impact on the therapeutic strategies in patients with tricuspid regurgitation.

Introduction

Coarctation of the aorta is one of the most common congenital heart diseases (5–8%) with various clinical presentations (neonatal vs. pediatric, with or without cardiac insufficiency). On a surgical point of view, there are many different techniques that will take into account the anatomy of the aortic arch and whether or not it is hypoplastic, the associated heart defect and the patient's characteristics. The choice of this surgical technique is one of the predominant elements of the future prognosis (recoarctation, arterial hypertension). However, the choice of the surgeon whether to treat or not the aortic arch with an extended plasty is not very codified as the definition of hypoplasia itself can be discussed. Moreover there is a need to evaluate the contribution of different imaging techniques into the decision making process. This retrospective multicentric study intends to assess the potential influencing factors of the type of surgery and to make an epidemiological description of neonatal coarctation.

Methods

Retrospective multicentric observational study including patients of less than 1 years-old operated of coarctation of the aorta between 2011 and 2021 in four surgical centers in south France.

Results/Expected results

In total, 686 patients included. 43% of antenatal diagnosis; Sex ratio M/F: 68/32%; 6% of genetic test positive; the global mortality rate was 3%. 23% of patients presented cardiac insufficiency at diagnosis. Prostaglandin perfusion was necessary in 58% of cases. In echocardiography, an aortic arch hypoplasia was described between 53–57% of cases, depending of analysis method. A CT angiography was performed in 19% of patients with 58% of hypoplasia described. Concerning surgery, an aortic arch plasty was performed in only 18% of patients. The main predictors of surgical technique was antenatal screening, cardiac malformations associated, use of prostin, the horizontal aortic size, mitral hypoplasia. Standard deviation was not significant.

Conclusion/Perspectives

These preliminary results give an interesting view of the epidemiology of coarctation in France. Further extended data will be presented.

Introduction

Transcatheter persistent ductus arteriosus (PDA) in extremely-low-birth-weight infants has proved to be feasible and safe but midterm outcomes data are scarce. We report herein results from the French nationwide Premiclose registry.

Objective

We report herein results from the French nationwide Premiclose registry.

Methods

All infants who attempted device PDA closure at a procedural weight < 2 kg were prospectively included from 7 tertiary institutions between October 2017 and June 2022. Demographic and procedural data were reviewed as well as respiratory and cardiac follow-up.

Results/Expected results

In total, 274 patients (mean birth weight: 812 ± 213 grams, mean gestational age: 25.8 ± 1.9 weeks) were included. Mean procedural age and weight were 31 ± 12 days and 1250 ± 330 grams respectively. Patients were all symptomatic with a hemodynamically significant PDA. Procedure was performed under both fluoroscopy (fluoro time: 4.5 ± 4 min) and transthoracic echocardiography guidance in all patients; 240 (87.6%) procedures were contrast free. Successful PDA closure was achieved in 97%. Complications occurred in 10 patients, with major adverse events in 3 (1.1%) consisting in device embolization in 2 and tamponnade in 1. There was no procedural death. Post ligation cardiac syndrome was noted in 4% and escalation of respiratory support in 20% of the cases. During follow-up, 8 late complications were reported with 3 patients requiring aortic coarctation treatment and one patient awaiting LPA stenosis treatment. Over time, significantly smaller patients were treated with significantly lower complications. Neurologic assessment is ongoing and will be presented.

Conclusion/Perspectives

Our large series confirms favorable results of transcatheter PDA closure in extremely-low-birth-weight infants, along with demonstrating learning curve, high procedural success, low procedural complications and low rate of post ligation cardiac syndrome but escalation in respiratory support. Late cardiac complications were few but long-term follow-up remains mandatory.

Introduction

Transoesophageal echocardiography (TEE) remains essential in paediatrics to assist interventional catheter procedures and to assess residual lesions after cardiac surgery. 3D TEE was restricted until now to adults due to the size of the probe. A new paediatric matrix TEE probe (GE 9VT-D) has recently been marketed but its use in practice has not yet been reported.

Objective

The aim of this study is to assess handling and imaging quality of the new 3D paediatric TEE probe.

Methods

Children who underwent TEE with the new probe were enrolled during 15 days in October 2023. Probe insertion and handling were assessed. All imaging modalities quality were rated by 2 operators from 1 (very bad) to 4 (very good).

Results/Expected results

Fifteen children were included, median age 10 month (range: 2 month-14 years) median weight 7.8 kg (range: 4.3–40 kg). Twenty TEE were performed: 6 (30.0%) before cardiac surgery, 6 (30.0%) after cardiac surgery, 7 (35%) during a percutaneous procedure, 1 (5.0%) in the intensive care unit. Insertion and handling of the probe were “very easy” in all patients and no adverse event related to probe use was recorded even in small children. The mean score of 2D, 2D color and doppler image quality were 4, and was 3.8 ± 0.4 for 3D images and 3.5 ± 0.4 for 3D color images. The quality of the 3D image did not differ depending on whether the patient weighed more or less than 10 kg (P = 0.32). Postoperative TEE, including transillumination, was useful to assess surgical results, but no residual lesions required reintervention. TEE guiding for percutaneous intervention was always useful (Figure 1).

Conclusion/Perspectives

The 3D paediatric TEE probe is safe and efficient for use in paediatric cardiology.

It may enhance the confidence of imaging interpretation and may improve the accuracy and efficiency of the procedures.

Introduction

Congenitally corrected transposition of great arteries (ccTGA) is a relatively rare cardiopathy, occurring in 1 case in 33 000 live births. It is rarely isolated and is often associated with other anomalies such as ventricular septal defects (80% cases), tricuspid valve anomalies (70% cases), pulmonary tract obstructions (30–50% cases), and sub aortic tract obstructions (rarely). However, association with coarctation of the aorta remains fairly rare, with prevalence poorly defined in the literature. Conduction disorders are frequent due to the existence of two AV nodes, with an annual risk of AVB of 2%.

Objective

To describe a clinical case associating ccTGA with a coarctation of the aorta revealed by a complete AV block.

Methods

We report the case of a 41-year-old man, hypertensive on dual antihypertensive therapy with poorly controlled hypertension, presenting with syncope and stage II NYHA dyspnea. The EKG showed complete AV block Transthoracic echocardiography showed double atrioventricular and ventriculoarterial discordance, situs solitus,levocardia, severe systemic right ventricular dysfunction and severe coarctation of the aorta. A thoracic CT scan confirmed coarctation of the aorta (Figure 1).

Expected results

The AV block and coarctation of aorta were considered to be the two main factors in systemic ventricular dysfunction.

It was decided to implant the patient with ventricular resynchronization (CRT-P), while the coarctation of the aorta was treated percutaneously.

Perspectives

Systemic ventricular failure should raise the suspicion of pressure overload, such as coarctation of the aorta. Early removal of the obstruction can delay deterioration of the contractile function of the systemic ventricle.

Introduction

Anomaly of birth of the coronary artery from the pulmonary artery (ACAPA) is the most common coronary anomaly. More classic in pediatrics, it is a rare congenital heart disease that is sometimes fatal.

Objective

Share the experience of our service by determining the prevalence, the clinical and paraclinical characteristics as well as the prognosis of the disease.

Methods

This is a retrospective, descriptive study of 08 children with ACAPA followed in the unit of cardio-paediatrics of the cardiac department, Ibn ROCHD Hospital, over a period of 5 years from September 2018 to September 2023.

Results/Expected results

The prevalence of ACAPA compared to the number of congenital heart diseases diagnosed during the same study period: 0.16%.

Distribution:

– 2 ALCAPA, and 6 ARCAPA;

– 5 boys, 3 girls;

– Average age: 1 year 9 months.

The most frequent reason for consultation is a food difficulty with the signs respiratory.

ECG showed in 2 patients a Q wave of necrosis which is a very specific sign of the disease.

TTE: shows indirect signs such as hypokinetic dilated cardiomyopathy which is present in all our patients, valvular leaks are also frequent. Direct signs are less frequent and difficult to objectivise: absence of visualization of the origin of the coronary artery a the base of the aorta, or visualization of the hyper refractile endocardium, with image abnormal birth of a coronary artery.

Cardiac catheterization with angiography is performed in case of diagnostic doubt.

After the positive diagnosis, 5 of our patients underwent surgery, only 1 patient died in the post-operative follow-up, the evolution was favorable for the 4 other patients.

Conclusion/Perspectives

ACAPA is a rare but serious ischemic cardiomyopathy because it involves the patient's vital prognosis. Only early diagnosis and surgery aimed at restoring a dual coronary artery system have excellent results and allow progressive myocardial recovery.

Introduction

Double aortic arch (DAA) is one of the classes of congenital anomalies of the aortic arch system called vascular ring.

Abnormal circular formation of blood vessels are incircled around the trachea and oesophagus resulting in airway compression.

Objective

We report a case of a 2-month-old infant that was born at full term and had no medical or surgical history who presented with progressive stridor and dyspnea reported by the parents.

Methods

On examination, we noticed a stridor, with suprasternal and intercostal recessions.

Oxygen saturations on room air was 93% and chest auscultation revealed bilateral transmitted stridor. A chest X-ray was normal. Echocardiography was performed and revealed a left-right shunting atrial septal defect with dilated right chambers, in addition to a persistent ductus arteriosus with a doubt on double aortic arch.

Results/Expected results

Thoracic computed tomography (CT) was performed and a vascular ring, consisting of a double aortic arch, was found compressing and narrowing the trachea (Figure 1).

The CT allowed confirmation of the anomaly, its location and the severity of airway and oesophageal compression.

Three-dimensional reconstruction helped to plan surgical intervention.

The patient was then referred to the cardiothoracic surgery.

The intervention consisted of resecting the minor arch freeing the trachea.

Conclusion/Perspectives

DAA is a rare issue mostly diagnosed in childhood due to symptoms related to oesophageal and/or tracheal compression and obstruction.

It can be associated to cardiac malformations including ventricular septal defect and Fallot's tetralogy.

Left untreated, it may lead to significant morbidity and mortality from airway obstruction.

Surgical repair remains the mainstay of treatment and is indicated for patients with symptoms of airway or digestive compression or as a supplementary procedure in patients undergoing other cardiac surgery.

The principle of surgery is to relieve the vascular compression on the trachea and/or esophagus by the division of the lesser arch.

Introduction

Acute fulminant myocarditis in children is associated with elevated mortality and morbidity with few advances in its medical management. In adults with acute myocarditis, activation of the inflammasome through the production of pro-inflammatory mediators such IL-1β, IL-18 is widely recognized.

Objective

Here we report a preliminary experience of children treated with IL-1 receptor antagonist associated with rapid myocardial function recovery.

Methods

A retrospective case series of children admitted to the Pediatric Intensive Care Unit of Bicêtre Hospital (AP–HP Paris Saclay University) between April 2020 and January 2023 with acute myocarditis. Children were treated with subcutaneous Anakinra (an IL-1 receptor antagonist). Patients’ characteristics, and outcome are reported.

Results/Expected results

Of twenty-four children admitted with acute fulminant myocarditis, fifteen were treated with sub-cutaneous anakinra. Twelve children had SARS-CoV-2 post-infective myocarditis associated with multisystem inflammatory syndrome in children (MIS-C), one child had Parvovirus B19 myocarditis, one child had idiopathic encephalomyelitis and myocarditis and one child had idiopathic myocarditis. Nine of fifteen children were in cardiogenic shock and needed vasopressor drugs, one required central extracorporeal membrane oxygenation (ECMO). Only three of the fifteen children had ventricular arrhythmia, one evolving toward malignant ventricular fibrillation. In all treated patients, a rapid (< 24 h) improvement in myocardial function was observed with concomitant decrease in myocardial enzymes. All patients survived with full myocardial recovery except from one who had a heart transplantation (Figure 1).

Conclusion/Perspectives

In this pilot study, use of IL-1 receptor antagonist in the initial treatment of acute fulminant myocarditis in children seems to be associated with rapid stabilization and recovery.

Introduction

Transcatheter closure of patent ductus arteriosus (PDA) is expanding due to the fast development of new techniques and new materials. Miniaturization of devices currently allows transcatheter closure of ducts in very small patients. Few published data are however available in the 2 et 6 kilograms population.

Objective

This study aims to evaluate recent practices in our department and eventually prove the non-inferiority of transcatheter closure in this population.

Methods

Observational retrospective monocentric study comparing percutaneous and surgical duct closure in children weighing between 2 et 6 kilos, at the University Hospital of la Timone enfants, Marseille, France. This work is part of a large international study, still on-going. Clinical and catheterization/surgical data were analysed. Success was defined as absent residual shunt. The cost of the procedure, based on reimbursement endorsed by the national social security, was compared.

Results

Between 2014 and 2021, 31 patients weighing 2 to 6 kg, had percutaneous closure and 29 patients had surgical closure of the PDA. Mean age was respectively 20 (± 10) and 13 weeks (± 8), mean weight 4,5 kg (± 1) and 3,5 kg (± 1,3). The success rate was 77,42 % (n = 24/31) for the transcatheter group versus 96,43 % (n = 27/28) for the surgical group. Complication rate was 29 % (n = 8) and 7,14 % (n = 2) respectively. One major adverse event was observed in the percutaneous group (3,2 %). Hospitalisation stay was longer in the surgical group (p < 0,0001). Surgery might be more expensive (p < 0,0001). In univariate analysis, pre-procedural ventilation was a risk factor for complications (p = 0,04).

Conclusion/Perspectives

In our experience, percutaneous closure remained less efficient than surgery in the 2 to 6 kg patients. Results are however promising and the procedure seems safe. The hospital stay is shorter and the procedure might be less expensive. However, our small numbers do not allow us to make strong conclusions. Larger, multicentre studies are needed.