Cardiology in the Young最新文献

Introduction: Dexmedetomidine is frequently used in paediatric anaesthesia. This includes use in patients with CHD, but detailed analysis of haemodynamics after administration in these patients has not yet been published. We performed a systematic review and meta-analyses examining haemodynamic changes immediately after dexmedetomidine administration in patients with CHD.

Methods: We conducted a systematic review of PubMed, Embase, and Medline from inception until May 31, 2024. Inclusion criteria were studies that contained children with CHD who received dexmedetomidine for a cardiac procedure and reported at least one haemodynamic variable before and after administration of dexmedetomidine. Exclusion criteria were studies of noncardiac procedures. We performed a meta-analysis on each haemodynamic variable that was reported by at least four studies.

Results: We screened 5383 abstracts. We included 85 studies for review, and 16 studies were accepted for four meta-analyses (heart rate, 16 studies, n = 408; systolic blood pressure, 11 studies, n = 280; diastolic blood pressure, 10 studies, n = 276; mean arterial pressure, 5 studies, n = 130). Analysis of heart rate, systolic blood pressure, and diastolic blood pressure showed a statistically significant reduction (p < 0.001), while there was no significant change in mean arterial pressure. The clinical difference was minimal with a decrease in heart rate of 11.3 beats per minute, and a decrease in systolic blood pressure/diastolic blood pressure of 5.9 and 6.2 mmHg, respectively. Heterogeneity was high in all analyses.

Discussion: Dexmedetomidine is associated with small changes in heart rate, systolic blood pressure, and diastolic blood pressure in children with CHD. Further study is warranted.

Coronary to pulmonary artery fistula is a rare malformation that can be detected incidentally because most cases are asymptomatic. Here, we present multiple micro coronary to pulmonary artery fistulas in a Fontan physiology adult patient, which leaded dyspnoea due to elevated pulmonary artery pressure and were successfully closed with vascular plugs from the pulmonary side.

Left atrial appendage aneurysms are uncommon cardiac anomalies often discovered incidentally, with potential to cause arrhythmias or thromboembolic events, prompting surgical correction. Herein, we present the successful surgical treatment of a left atrial appendage aneurysm identified in a 7-year-old asymptomatic patient.

Clinicians in paediatric cardiology have unique exposure to different pathologies and treatment based on geographic location and resource availability. "Cardiology Across Continents" is a virtual, case-based discussion series aimed at knowledge sharing across a variety of practice and resource settings. We report on a recent case discussion highlighting a rare cause of new-onset heart failure in a teenager, which is more frequently seen among African and Asian populations.

The peer review process is fundamental to academic publishing, guaranteeing the integrity and quality of the research upon which we depend. However, it is also infamous for its sluggishness-occasionally excruciatingly so. For numerous authors, the prolonged wait for feedback on their articles might seem interminable, particularly when they are enthusiastic about disseminating innovative discoveries to the public. But why exactly does peer review take so long? The reasons are complex and multifaceted, involving challenges faced by editors, reviewers, and authors alike. By understanding these challenges, we can start to see the bigger picture and work towards solutions that might speed things up."Patience requires knowing not just the cost of delay, but also the benefit of delay""The two most powerful warriors are patience and time."-Leo Tolstoy"Lost time is never found again." - Benjamin Franklin.

Isolated atrioventricular discordance with ventriculoarterial concordance, or ventricular inversion, is a rare congenital cardiac anomaly that produces transposition-like physiology. We report a case of prenatally diagnosed ventricular inversion presenting with profound systemic hypoperfusion secondary to a large patent ductus arteriosus (PDA). Initial management included prostaglandin E1 to maintain ductal patency and balloon atrial septostomy to promote intracardiac mixing. Despite these measures, the patient developed significant pulmonary overcirculation and systemic steal, necessitating urgent transcatheter PDA closure. This intervention resulted in immediate hemodynamic improvement and stabilization, allowing for subsequent definitive repair with VSD closure and Senning atrial switch. The case underscores the importance of individualized hemodynamic assessment and the potential for transcatheter ductal closure to temporize systemic perfusion in select patients with ventricular inversion prior to anatomic correction.

The combination of a right aortic arch with a vascular ring and coarctation of the aorta is a rare association, presenting a unique management challenge for the primary team. A thorough literature review revealed only seven published case reports, with three cases reported in the neonatal period with similar anatomy. This distinctive anatomy inspires inquiry into the development of coarctation in the context of a right aortic arch and vascular ring, as well as the best approach to surgical management. We encountered a similar case in a neonate with a combination of these malformations and a unique aortic arch branching pattern. Cardiac CT was instrumental in the diagnosis and surgical planning. This article reviews the variations in anatomy, clinical presentation, imaging findings, and management challenges encountered in the reported cases. This comprehensive review aims to assist the primary team in making informed decisions when treating these complex patients.

Double aortic arch is a congenital vascular ring with tracheal and oesophageal compression, potentially causing stridor and dysphagia. While some recommend early surgery, others favour observation. We present a 7-week-old female with mild symptoms and prenatally diagnosed double aortic arch who suffered cardiac arrest, highlighting the need for early surgery in patients with vascular rings and airway or oesophageal compression.

Background: This retrospective study aimed to investigate the prevalence of arrhythmia in patients presenting with palpitation to the paediatric emergency department of our hospital, which serves as an arrhythmia centre and to share the principles of their management.

Method: Patients presenting with palpitations were retrospectively reviewed. Those diagnosed with arrhythmias received appropriate emergency interventions. Cardiac electrophysiological studies and ablation were performed when indicated.

Results: Among 534 paediatric patients evaluated for palpitations, 140 (26.2%) were diagnosed with arrhythmias requiring antiarrhythmic treatment (Group 1). Within this group, 61 patients described palpitations lasting longer than one hour and/or heart rates too rapid to count, compared to only 35 patients in the not requiring antiarrhythmic treatment group (Group 2) (p < 0.001). Group 1 also demonstrated significantly higher rates of isolated palpitations (a single episode without accompanying symptoms or recurrent occurrences), recurrent palpitations, and palpitations ongoing at the time of paediatric emergency department admission (all p < 0.001).

Conclusions: Our study supports that, as in adults, the probability of arrhythmia increases in children when palpitations persist for more than an hour, occur at an uncountable rapid rate, present as isolated or recurrent episodes, or continue at the time of admission. This data highlights the importance of taking a detailed medical history once again. To our knowledge, this is one of the few studies to comprehensively examine both the acute management and long-term outcomes of arrhythmia in children, including the role of ablation therapy, making it a potentially valuable contribution to the existing literature.

Since 2014, transcatheter paravalvular leak closure with the Occlutech Paravalvular Leak Device has been successfully accomplished in adults with high technical success. We describe the first successful use of the Occlutech Paravalvular Leak Device in the left atrio-ventricular valve in the United States in a 5-year-old child with a history of previously repaired atrio-ventricular septal defect.