Cardiology in the Young最新文献

Burkholderia cepacia is a rare cause of prosthetic valve endocarditis. We report an 18-year-old male with Tetralogy of Fallot and two sequential transcatheter pulmonary valves (Melody and Myval), presenting with persistent bacteraemia unresponsive to antibiotics. Surgical explantation of both valves with homograft replacement and tricuspid repair achieved complete recovery, emphasising surgery in refractory infections.

Introduction: Atrial septal defect is commonly considered a minor CHD, but morbidity and mortality are higher compared to the background population. Maternal pre-eclampsia is associated with CHD in the offspring in large registry-based studies. However, the association between pre-eclampsia and atrial septal defects might be subject to detection bias, as many atrial septal defects are asymptomatic or might remain undiagnosed until late in life.

Objectives: We investigated the association between maternal pre-eclampsia and the risk of atrial septal defects in a population-based cohort of neonates examined with echocardiography.

Materials and methods: Neonates included in the Copenhagen Baby Heart Study, who were examined using transthoracic echocardiography within 30 days of birth, were systematically assessed for atrial septal defects and patent foramen ovale using a standardised algorithm. Using log-linear binomial regression and polytomous logistic regression, we compared the risk of atrial septal defects in neonates exposed to maternal pre-eclampsia with the risk in neonates not exposed to pre-eclampsia.

Results: Our study cohort included 12,354 neonates (mean age, 11 days), including 462 exposed to maternal pre-eclampsia. Atrial septal defect was found in 5.9% (n = 732) of the study cohort and compared with unexposed neonates, neonates exposed to maternal pre-eclampsia had a modestly increased risk of atrial septal defects (adjusted risk ratio 1.19, 95% confidence interval 0.83, 1.64). Estimates were robust to various exclusions in sensitivity analyses.

Conclusion: There appears to be an association between maternal pre-eclampsia and atrial septal defect in the neonate in a population-based cohort of neonates.

Background: Scimitar syndrome is an uncommon congenital malformation of pulmonary venous drainage to the junction of the right atrium and inferior caval vein. Treatment is usually surgical, depending on the morphological variant. When there is dual drainage of the anomalous veins to the inferior caval vein and the left atrium, a transcatheter procedure may represent an alternative to surgery.

Methods: We report a series of four patients with the scimitar variant with dual pulmonary venous drainage treated with a transcatheter approach.

Result: All four patients (three children, one adult) had dual drainage of right pulmonary veins into the inferior caval vein and to the left atrium via a connecting vein. All patients underwent a successful catheter occlusion of the anomalous connection to the systemic vein without complication. Vascular plug devices were used in two patients: a left atrial appendage closure device in one patient and a ventricular septal defect closure device in one patient. All the procedures resulted in complete occlusion of the anomalous venous drainage to the inferior caval vein and unobstructed drainage to the left atrium.

US data from the National Health and Nutrition Examination Survey estimates that the prevalence of obesity among US adolescents (ages 12-19) has reached 22.9% of the paediatric population, with nearly 9% meeting criteria for severe obesity (body mass index ≥120% of the 95th percentile or ≥35 kg/m²). These alarming figures underscore the cumulative impact of paediatric obesity, including established associations with impaired cardiometabolic health. The study "Cardiac Geometry Alterations Following Bariatric Surgery in Severely Obese Adolescents: A One-Year Follow-Up Study of a Randomized Controlled Trial" advances this understanding by comparing lifestyle intervention alone versus lifestyle therapy in combination with the application of bariatric surgery (e.g. laparoscopic adjustable gastric banding). As the first prospective randomised trial to assess cardiac geometric and following adolescent metabolic and bariatric surgical intervention, the findings demonstrate significant improvements in cardiac geometry among surgical participants, suggesting partial reversal of obesity-related cardiac remodelling. While these short-term results are encouraging, durability remains uncertain given the study's small sample size and previous reports of significant weight regain and higher-than-expected complication rates following gastric banding. Considerations for future investigational designs should incorporate an expanded age range with regards to overall eligibility as well as bariatric procedures other than the gastric band, that offer long-term weight loss (i.e., vertical sleeve gastrectomy and gastric bypass). Longer-term and comprehensive follow-up will be critical to delineate the longitudinal cardiometabolic outcomes of surgical versus medical interventions for severe adolescent obesity.

Severe dilated cardiomyopathy in children may uncommonly be caused by abnormal loading conditions such as mid-aortic pathology and renal artery stenosis. Refractory hypertension and left ventricular dilatation with hypertrophy are important clues to reversible causes. We present a case of dilated cardiomyopathy in a child secondary to mid-aortic syndrome with renal artery stenosis.

This case underscores an uncommon presentation of Pulmonary artery hypertension which, to our knowledge, has limited neonatal data. Its atypical course reveals diagnostic pitfalls that, if unrecognized, may delay effective therapy. This report highlights options for early recognition and management. It serves as a reminder that clinicians should maintain vigilance for a simple respiratory distress, even in settings where it is not expected. Ultimately, this case adds to the limited literature and could influence practice by expanding differential diagnoses, refining diagnostic algorithms, or prompting guideline modifications in similar clinical scenarios.

Introduction: Although first performed several years ago, percutaneous total cavopulmonary connection has not yet become a widely adopted procedure in patients with univentricular circulation.

Methods and objectives: We describe a case involving a novel, modified technique for the percutaneous completion of the Fontan circulation using covered stents in a 12 kg patient.

Results: The transcatheter Fontan completion was successfully performed. Minimal surgical preparation included banding of the inferior vena cava during the preceding superior cavopulmonary connection. Using needle puncture to create the anastomosis and implanting covered stents, a total cavopulmonary connection with an intra-atrial tunnel was established. The patient recovered uneventfully.

Conclusion: Percutaneous total cavopulmonary connection is feasible and may represent a less invasive alternative for selected patients. However, data on this approach are currently very limited, and further studies are urgently needed.

The genesis and significance of epsilon waves still remains an enigma. In this case report, we document occurrence of epsilon waves in a neonate with left ventricular diverticulum and its disappearance after the surgical division of the diverticulum. We postulate that the presence of myocardial cells in the diverticulum was the cause for epsilon waves.

Hydatid cyst is an infectious disease that occurs in humans due to infection of Echinococcus granulosus larvae. Although cardiac hydatid cysts are rare, right atrial localisation is even rarer. The aim of this article is to emphasise the importance of always being alert and prepared for the risk of anaphylaxis developing due to cyst rupture in paediatric patients with isolated cardiac hydatid cysts, to initiate oral albendazole treatment immediately upon diagnosis, to underline the importance of surgical timing, and to discuss the role of clinical assessment and imaging methods in predicting of cyst rupture.

Objective: Patients with CHD are at risk for developing necrotising enterocolitis. Currently, no standardised approaches for identification, diagnosis, and treatment of necrotising enterocolitis exists, and there are varying rates and management strategies of necrotising enterocolitis across centres. We used the Paediatric Cardiac Critical Care Consortium to identify high- and low-performing centres based on necrotising enterocolitis rates and convened a necrotising enterocolitis working group. The aims of the group were to understand why variability exists, identify risk factors, and create a foundation for a prospective improvement project.

Methods: Nine centres participated, and collaborative learning sessions were held with multidisciplinary input. REDCap surveys were disseminated to centres to create consensus among site practices and recommendations.

Results: The following topics were discussed: diagnosis, risk factors, and management. Diagnosis consensus suggests (1) Diagnosis would benefit from a comprehensive scoring tool, and (2) ultrasound may serve as a highly sensitive diagnostic tool for those at high risk with the absence of other radiologic findings of necrotising enterocolitis. Risk factor consensus suggests (1) those with ductal-dependent systemic blood flow are the highest risk, and (2) vasopressors with splanchnic constriction should be used with caution. Management consensus suggests (1) breastmilk be used first-line for feeding, 2) resume feeds 24-48 hours after a necrotising enterocolitis rule-out, and 3) surgical deference to physical examination and laboratory evaluation above radiographic findings.

Conclusion: Variability exists in diagnosing necrotising enterocolitis and feeding approaches for at-risk patients. Opportunities exist for collaboration to standardise definitions, compare outcomes, identify risk factors, and create consensus on the management of necrotising enterocolitis.