Cardiology in the Young最新文献

Textbooks continue to serve as essential central repositories of knowledge for postgraduate education in paediatric cardiology, despite the widespread availability of digital learning tools. Recent studies confirm that trainees still value textbooks for their structure, depth, and accessibility, while also requesting improved pedagogy and organisation. In preparing the 5th edition of Anderson's Pediatric Cardiology, our editorial team implemented several deliberate educational innovations. These included (1) re-focusing towards our target audience, the congenital cardiac trainee and practicing congenital cardiologist; (2) adoption of a consistent lesion-based framework, termed the "red line," linking anatomy, physiology, and clinical features; (3) expansion of concise visual elements such as tables, figures, algorithms, and flowcharts; and (4) incorporation of clear learning objectives throughout. These modifications were informed by feedback from trainees, educators, and practicing providers, balancing the desires and needs of the modern learner, and firmly grounded in principles of cognitive and educational science. This paper outlines the rationale, design, and pedagogical implications of these innovations within the broader context of modern medical education.

Purpose: There is currently no established normative data for cardiopulmonary exercise parameters in the semi-supine position. There is conflicting data regarding the impact of a semi-supine body position on the semi-supine recumbent ergometer on cardiopulmonary exercise parameters. The goal of the current study was to match semi-supine recumbent ergometer tests completed in children/adolescents with those completed on the cycle ergometer and treadmill to identify differences in cardiopulmonary exercise parameters between devices.

Methods: Maximal semi-supine recumbent ergometer tests were matched by demographics (age, race/ethnicity, sex, height, weight, and body mass index) to tests completed on the cycle ergometer and treadmill. Groups were compared with two-sample T-tests for numeric variables and Fisher's exact tests for categorical variables.

Results: There was no difference in demographics between groups. Peak cardiopulmonary exercise parameters (watts, oxygen consumption, heart rate, blood pressure, oxygen saturation, minute ventilation, respiratory exchange ratio, respiratory rate, and anaerobic threshold) were unchanged between semi-supine recumbent ergometer and cycle ergometer, but the ventilatory equivalent of carbon dioxide was higher on the cycle ergometer versus semi-supine recumbent ergometer. Anaerobic threshold, peak oxygen consumption, and peak minute ventilation were lower on the semi-supine recumbent ergometer than on the treadmill.

Conclusions: The uniformity in nearly all cardiopulmonary exercise parameters between the semi-supine recumbent ergometer and cycle ergometer suggests that normative data for the cycle ergometer are a reasonable surrogate for normative data on the semi-supine recumbent ergometer until semi-supine recumbent ergometer-specific normative data are developed.

Neonatal pulmonary artery thromboembolism is a rare, life-threatening condition associated with diagnostic and therapeutic challenges. Early diagnosis and intervention are critical to mitigate high morbidity and mortality. Our case underscores the importance of considering neonatal pulmonary artery thromboembolism in the differential diagnosis of a full-term neonate with unexplained acute respiratory distress and highlights a successful management approach in the absence of formal guidelines.

Objective: We analysed cardiac MRI and catheterisation variables during pre-Fontan evaluations for associations with major adverse cardiac events including Fontan takedown, mechanical circulatory support, heart transplantation, or death.

Methods: In this single-centre retrospective study, we gathered pre-operative MRI and catheterisation data for all patients who underwent Fontan operation at Children's Medical Center, Dallas, from April 2017 to November 2022. Patients were grouped according to the presence or absence of adverse events, and MRI and catheterisation parameters were compared between groups. We used the Mann-Whitney U Test for non-parametric data, Student's T-test for parametric continuous variables, and Fisher's Exact Test for categorical variables.

Results: Of the 119 combined evaluations, 81 proceeded with Fontan palliation. Adverse events were recorded in 10% of patients (n = 8). One had a Fontan takedown, one underwent transplant, one required mechanical circulatory support, and five died in a median 21-month follow-up. Factors significantly associated with adverse events included heterotaxy syndrome (p = 0.04), higher combined pulmonary vascular resistance (p = 0.03), and moderate-severe (≥30%) atrioventricular valve regurgitation (p = 0.046). While combined pulmonary vascular resistance calculated from both catheterisation and MRI data predicted outcome, pulmonary vascular resistance calculated using data solely from catheterisation showed no discriminative ability.

Conclusions: Post-Fontan major adverse cardiac events were associated with heterotaxy syndrome, higher combined pulmonary vascular resistance, and moderate-severe atrioventricular valve regurgitation identified on pre-Fontan MRI and catheterisation. Combined pulmonary vascular resistance using transpulmonary gradient from catheterisation data and effective pulmonary blood flow from MRI data may help predict outcome.

Background: CHD are structural cardiac anomalies which are a leading cause of childhood mortality and morbidity in India and have multifactorial aetiology. Compromised socioeconomic status augments several environmental stressors and is shown to have a positive association with CHD in offspring. The presented study is an institution-based case-control study to explore the same with CHD as the primary outcome.

Methods: A total of 2064 paediatric patients (1760 CHD cases and 304 controls with structurally normal hearts) were analysed. Demographic and socioeconomic status parameters were recorded using the Kuppuswamy scale. Statistical associations were examined using chi-square tests and odds ratios.

Results: Majority of all patients belonged to the upper-lower class. No significant association was found between socioeconomic status and CHD (p = 0.18). However, rural residence was significantly associated with a higher risk of CHD (χ² = 16.09, p = 0.0011; OR vs. urban = 1.59). A significant association was found between maternal education and CHD prevalence (χ² = 20.9, p = 0.0001), with uneducated mothers having higher odds of children with CHD. Joint family structure also showed higher odds of having a child with CHD (OR = 1.75, p < 0.001).

Conclusion: While socioeconomic status alone was not significantly associated with CHD in this cohort-likely due to universal free care at our institute-maternal education, rural residence and family structure emerged as critical determinants. These findings highlight the need for targeted public health initiatives focusing on maternal literacy, rural healthcare access, and awareness programmes to improve early CHD diagnosis and outcomes. Further population-based research is needed to elucidate socioeconomic status-CHD associations at a broader level.

Introduction: Idiopathic infantile arterial calcification is a rare autosomal recessive disorder characterised by extensive calcification and proliferation of the intimal layer of the large and medium sized arteries.

Methods and objectives: The diagnosis is usually made at autopsy or in the neonatal period, when there is cardiac failure. Prenatal diagnosis is possible in the latter half of pregnancy when there are hyperechoic vessel walls, hypertrophied ventricular musculature, and nonimmune fetal hydrops. The number of cases diagnosed before birth is low.

Results: This study presents a 27-week pregnant patient diagnosed with widespread calcification in the aorta and pulmonary arteries, severe pericardial effusion, and hydrops fetalis during fetal echocardiographic examination.

Conclusion: This case report reminds paediatric cardiologists, radiologists, and perinatologists that they should be familiar with widespread arterial calcification. It emphasises that idiopathic infantile arterial calcification, a very rare condition, should be considered among the etiologic factors when hydrops fetalis is detected on ultrasound.

Cardiac MRI confirmed ventricular dysfunction identified by echocardiography and additionally detected myocardial oedema and fibrosis in some paediatric patients with systemic lupus erythematosus, systemic scleroderma, and mixed connective tissue disease. These findings were followed by changes in immunotherapy in 3 of 11 patients, supporting the added diagnostic and clinical value of cardiac MRI in managing paediatric patients with rheumatologic disorders.

Objective: To explore the feasibility and effect of video-assisted minimally invasive surgery for combined heart valvular diseases through an intercostal incision.

Method: From July 2022 to April 2025, a total of 50 video-assisted minimally invasive combined heart valve surgeries were performed in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Anhui Medical University. Combined heart valve procedures include mitral and tricuspid valve surgery and mitral and aortic valve surgery, as well as large atrial septal defect repair combined with mitral and tricuspid valve surgery. The 4th right intercostal incision along the anterior axillary line was set as the primary access for the surgical procedure of combined mitral and tricuspid valves. The 3rd intercostal incision next to the sternum was set as the primary access for the surgical procedure of combined aortic and mitral valves. The 4th right intercostal incision along the midclavicular line was set as the primary access for the surgical procedure of combined mitral and tricuspid valves concomitant with a large defect of the atrial septal. The perioperative data of patients was collected.

Results: All patients underwent the video-assisted minimally invasive surgery completely. A total of 49 patients were discharged as expected except for only 1 older patient who was transferred into a local medical institution for extended rehabilitation due to delayed postoperative awakening. Postoperatively, excellent function of replaced prosthetic valves without paravalvular leaking has been confirmed. Moreover, there was no or less than mild regurgitation for repaired mitral and tricuspid valves. Also, postoperative complications, including III atrioventricular block, renal failure, and severe hypoxaemia, have not been found.

Conclusion: Video-assisted minimally invasive surgery for combined heart valves is safe and effective with a short-term satisfactory outcome.

Infants with single ventricle physiology are at increased risk of undernutrition, which can contribute to adverse outcomes. This is a retrospective case series examining factors associated with undernutrition in patients with single ventricle physiology at one year of age. It includes 56 infants from a single institution who underwent single ventricle palliation between 2003 and 2023. Undernutrition was defined as a weight-for-length z-score below -1, based on World Health Organization normative data. Independent variables included surgical interventions, cardiorespiratory factors, and nutritional interventions. Associations between these variables and nutritional status were assessed using Fisher's exact test. At one year, a total of nine infants (16%) were undernourished. Undernutrition rates significantly declined after 2013 (p = 0.02), demonstrating improvements in nutritional outcomes over our study period. Those who used supplemental oxygen or pulmonary medications were undernourished at lower rates, though this difference was not statistically significant. While the number of undernourished patients in the cohort may have limited the study's power, our findings suggest that early respiratory interventions may provide nutritional benefits in infants with single ventricle physiology.