Cardiology in the Young最新文献

While transcatheter atrial septal defect closure is routinely performed, acute biventricular failure is an extraordinary complication in adolescents, with only anecdotal reports in the literature. We present a 16-year-old male with borderline left ventricular systolic function and biventricular diastolic dysfunction who developed transient severe biventricular failure immediately following Amplatzer Septal Occluder (Abbott, Plymouth, MN, USA) deployment. Preprocedural echocardiography revealed right ventricular dilation, a D-shaped septum in diastole. Intraprocedural haemodynamic assessment demonstrated elevated right ventricular diastolic pressures (right ventricular minimal diastolic pressure: 11 mmHg; end-diastolic pressure: 17 mmHg). Haemodynamic collapse occurred within minutes of device release, necessitating emergent dopamine infusion and urgent coronary angiography to rule out device-related complications. Remarkably, ventricular function normalised within 2 hours, enabling extubation the same day. Reports of transient biventricular failure following atrial septal defect closure in adolescents without comorbidities are exceedingly rare, underscoring the critical role of preexisting diastolic dysfunction in precipitating acute decompensation. This case advocates for preprocedural balloon occlusion testing and vigilant haemodynamic monitoring in adolescents with impaired ventricular compliance to mitigate catastrophic outcomes.

Background: Left ventricular assist devices are increasingly used in paediatric patients with end-stage heart failure. Although they improve survival and functional capacity, serious complications can occur.

Case: We report an 11-year-old girl with dilated cardiomyopathy supported by a left ventricular assist device (HeartMate 3) as a bridge to transplant. Despite periodic education about the use of a left ventricular assist device, she entered the sea, leading to driveline and battery seawater exposure. She presented with device alarms but was initially stable. Given the risk of corrosion, emergent battery and lead replacement were performed under intensive monitoring with inotropic support. She experienced transient hypotension during left ventricular assist device cessation but recovered uneventfully.

Conclusion: This is the first paediatric case describing left ventricular assist device seawater exposure. The case highlights the importance of repeated education, psychological support, and preparedness for high-risk interventions. This case also underlines potential infectious and corrosive risks following seawater exposure.

Background: Our study aimed to explore risk factors for medium-giant coronary artery aneurysms in children with Kawasaki disease.

Methods: 6,540 eligible children with Kawasaki disease who were diagnosed in Wuhan Children's Hospital from January 2011 to December 2023 were retrospectively analysed. The clinical and laboratory data were compared between medium-giant group and non-medium-giant group.

Results: A total of 6,540 patients with Kawasaki disease were included, and 162 (2.5%) developed medium-giant coronary artery aneurysms, of whom 56 (0.9%) were giant. Univariate analysis showed a statistically significant difference between the two groups in 22 variables (P< 0.05). The least absolute shrinkage and selection operator regression analysis revealed that intravenous immunoglobulin resistance, haemoglobin, platelet count, and albumin were the most significant risk factors for medium-giant coronary artery aneurysms. The result of binary logistic regression analysis showed that intravenous immunoglobulin resistance (OR = 6.474, 95%CI = 4.399 ∼ 9.528, P< 0.001), platelet count elevation (OR = 1.003, 95%CI = 1.002 ∼ 1.004, P< 0.001), and albumin reduction (OR = 0.912, 95%CI = 0.879 ∼ 0.946, P< 0.001) were independent risk factors affecting the occurrence of medium-giant coronary artery aneurysms, and the area under the curve of the regression model was 0.75, with a sensitivity of 62.3% and a specificity of 79.2%.

Conclusions: Intravenous immunoglobulin resistance, platelet counts elevation, and albumin levels reduction may be significant predictors of medium-giant coronary artery aneurysms and can serve as a reference for early diagnosis of medium-giant coronary artery aneurysms.

Syncope in children is commonly benign, yet rare cardiovascular anomalies may be causative. We present a child with recurrent syncope, ultimately diagnosed with an aorto-right atrial connection. Transcatheter closure was successfully performed with an Amplatzer Duct Occluder II. This case emphasizes considering aorto-atrial connections in pediatric syncope with continuous murmurs and highlights the efficacy of percutaneous closure.

Introduction: This study investigates the impact of patent ductus arteriosus (PDA) status and treatment response on myocardial adaptation in preterm infants by comparing serial echocardiographic trajectories across three groups: high-risk infants with treatment success, high-risk infants with treatment failure, and low-risk infants not requiring treatment.

Methods: In this prospective cohort study, preterm infants born < 29 weeks' gestation were stratified using the EL-Khuffash PDA Severity Score and subsequent response to medical therapy. Echocardiographic assessments were performed at three timepoints: day 2, 2 weeks, and 36 weeks corrected gestational age. A range of structural and functional parameters was analysed.

Results: Of 184 included infants, 58 were high risk with treatment success, 52 were high risk with treatment failure, and 74 were low risk. High-risk infants with treatment failure had persistent myocardial and haemodynamic alterations, including higher left ventricular wall thickness and lower coeliac artery velocities at follow-up. Treatment success was associated with improvements in strain metrics, systemic perfusion, and structural indices. Low-risk infants demonstrated spontaneous PDA closure and overall stable haemodynamics. Distinct differences in the evolution of myocardial trajectories between groups were apparent between day 2 and week 2 echocardiograms.

Conclusions: Serial echocardiographic assessments highlight the dynamic impact of PDA treatment response on myocardial adaptation. Persistent ductal patency despite treatment is associated with sustained structural and functional changes. Early definitive ductal closure may promote haemodynamic stability and mitigate maladaptive remodelling in a subgroup of high-risk infants.

Pulmonary arterial hypertension leads to dyspnoea, fatigue, and oxygen desaturation, limiting activities of daily living and functional capacity. This study aimed to evaluate the impact of pulmonary arterial hypertension on activities of daily living performance, functional capacity, peripheral muscle strength, oxygen dynamics, and energy expenditure. Eighteen adolescents and young adults with pulmonary arterial hypertension (10 females, 8 males; age 9-30 years) and 15 healthy controls (10 males, 5 females; age 9-30 years) were included. Peripheral muscle strength was assessed using a handheld dynamometer, functional capacity via the 6-minute walk test, and muscle oxygenation through near-infrared spectroscopy. Lower-limb endurance was evaluated with the 1-minute sit-to-stand test and activities of daily living performance with the Glittre Activities of Daily Living test. Compared to controls, the pulmonary arterial hypertension group had significantly lower 6-minute walk test distance (441.9 m versus 636.9 m; p < 0.001), reduced sit-to-stand repetitions (28 versus 42.1; p < 0.001), weaker peripheral strength, and lower minimum muscle oxygen saturation (24.9% versus 51.8%; p < 0.001). Glittre Activities of Daily Living test duration was longer (143 s versus 105 s; p < 0.001), with greater oxygen desaturation (-13% versus -1%; p < 0.001), higher dyspnoea scores using modified Borg scale (5 versus 1; p < 0.001), and blunted heart rate response (ΔHR [change in heart rate]: 32 versus 64; p = 0.011). These findings demonstrate that pulmonary arterial hypertension significantly impairs both cardiopulmonary and peripheral muscle function. Protecting muscle health and improving functional capacity should be prioritised to enhance quality of life in this population.

Objectives: This study aimed to identify echocardiographic predictors of successful weaning from extracorporeal membrane oxygenation in paediatric and congenital heart disease patients.

Methods: We retrospectively analyzed pediatric patients who underwent venoarterial extracorporeal membrane oxygenation for cardiogenic shock or postoperative support between March 2018 and September 2023. Clinical and echocardiographic variables assessed at the time of weaning evaluation were compared between patients who were successfully weaned and those who were not.

Results: Among the 46 enrolled patients, 31 were successfully weaned from extracorporeal membrane oxygenation. The mean age at extracorporeal membrane oxygenation initiation was 9.6 ± 13.9 years, and the mean duration of support was 12.3 ± 12.1 days. Patients in the successfully weaned group had significantly higher left ventricular ejection fraction (50.9 ± 16.4% vs. 27.3 ± 18.7%, p < 0.001) and higher velocity time integral at the left ventricular outflow tract (12.3 ± 8.0 cm vs. 4.1 ± 3.6 cm, p = 0.001) compared with the unsuccessfully weaned group. The cutoff values for predicting successful weaning were a left ventricular ejection fraction of 43.03% (sensitivity, 74.2%; specificity, 86.7%) and a velocity time integral of 4.45 cm (sensitivity, 92.0%; specificity, 66.7%).

Conclusions: Left ventricular ejection fraction and velocity time integral provide valuable echocardiographic information for predicting successful weaning from extracorporeal membrane oxygenation in pediatric patients and may support clinical decision-making during weaning assessments.

Objective: To evaluate car seat tolerance screening failure rate in infants with CHD, clinical factors associated with test failure, and the impact of a failed test.

Methods: Single-centre retrospective study of 193 infants with CHD discharged from a general cardiology service between November 2020 and November 2024. Characteristics were compared between patients who passed and failed car seat testing using Wilcoxon-Mann-Whitney tests for continuous variables, and chi-square or Fisher's exact tests for categorical variables.

Results: Car seat test failure rate was 6.2% (12 of 193 patients). Neither median birthweight (3.2 kg vs. 3.3 kg, p = 0.68) nor the rate of prematurity (13.8% vs. 16.7%, p = 0.68) differed significantly between passing and failing groups. There was no relationship between cardiac physiology and car seat test failure (p = 0.39). There were no differences in rates of seizure (p = 0.29), stroke (p = 1.00), gastroesophageal reflux disease (p = 0.84), vocal cord dysfunction (p = 1.00), or pulmonary hypertension (p = 1.00) between passing and failing groups. Infants who failed had significantly higher rates of DiGeorge Syndrome (25.0%) compared to those who passed (2.2%) (p = 0.006). Readmission within 30 days of discharge was not different between failing (16.7%) and passing (17.1%) groups (p = 1.00). A failed test delayed discharge by a median of 1.5 days [IQR: 1.0-2.5 days].

Conclusion: The car seat test failure rate of our CHD cohort is higher than the published failure rate for premature infants. There was no relationship between cardiac physiology and test failure. DiGeorge Syndrome was the only comorbidity associated with increased failure rate. Failed car seat tests delay hospital discharge.

Background: Critical CHD often requires surgical intervention or results in infant mortality. We aimed to determine the association between critical CHD categories and exposure levels to pollutants.

Methods: A retrospective study of n = 1484 infants who underwent complex cardiac surgery in early infancy from 1996 to 2021. The association between critical CHD categories (compared to a reference category with chromosomal abnormality) and exposure levels during early pregnancy to nitrogen dioxide, ozone, fine particulate matter (<2.5 micrometers diameter), and air quality from smoke was determined. Spatial heterogeneity was accounted for using geographically weighted multinomial logistic regression.

Results: For fine particulate matter exposure, 0.34% of locations displayed statistically significant negative associations with critical CHD categories, clustered in Saskatchewan and Manitoba. These regions exhibited small spatial extents. For ozone exposure, 15.1% of locations exhibited statistically significant negative associations with critical CHD categories, with the majority originating from Alberta and a smaller fraction in Saskatchewan. Differences in significant associations with locations were observed before and after spatial adjustment. Air quality from smoke and nitrogen dioxide exposure demonstrated no statistically significant associations with critical CHD categories.

Conclusion: Differences before and after geographic spatial adjustment underscored the importance of accounting for spatial heterogeneity to uncover patterns of association between environmental pollutants and critical CHD categories. The negative associations likely reflected pollution acting as a second hit to markedly increase the risk for critical CHD in those with genetic predisposition.

Introduction: Lung ultrasound findings in cardiac patients correlate with mortality, hospital length of stay, and rehospitalisation after surgery. We report a lung ultrasound protocol integrated with echocardiography and its ability to predict adverse events in children after discharge following congenital heart surgery.

Methods: A prospective, single-blinded observational trial was performed. Subjects were consecutively identified after Fontan or septal defect repairs. Performed by cardiac sonographers at discharge, lung ultrasound scores were based on the number of B-lines. The primary outcome was subsequent development of new pericardial (≥small) or pleural (>small) effusion.

Results: A total of 86 subjects were identified with adequate imaging for enrolment. Median age was 53 months. Procedures included Fontan (n = 23) and atrial (n = 30), ventricular (n = 28), and atrioventricular (n = 5) septal defect repairs. Lung ultrasound score was correlated with hospital length of stay (ρ = 0.29, p = 0.0066), discharge diuretic score (ρ = 0.38, p < 0.001), and chest tube duration (ρ = 0.25, p = 0.021); score was not correlated with age or weight. Primary outcome occurred in 12 subjects (atrial septal defect = 4, Fontan = 8). A lung ultrasound score ≥3 had a negative predictive value of 93% and an odds ratio of 24.5 (95%CI 5.3-113, p < 0.0001) for the primary outcome. Subjects following Fontan with the lung ultrasound score ≥3 had an odds ratio of 8.3 (95%CI 1.2-59.0, p < 0.036).

Conclusions: Our results suggest that lung ultrasound during discharge echocardiography has encouraging prognostic value for post-operative complications in patients deemed suitable for discharge after congenital heart surgery. Further research is needed to discern how lung ultrasound can be used for goal-directed medical therapy.