The Fontan Pathway: Change in Dimension and Catheter-Based Intervention over Time
AbstractAn unobstructed Fontan pathway is essential for optimal hemodynamics. We hypothesize that more extracardiac conduit (ECC) Fontan pathways develop obstruction compared to lateral tunnel (LT) Fontans and that the dilation typically observed in LTs results in similar mid-term clinical outcomes. A single-center, retrospective study was done including all Fontan cardiac catheterizations from 2006 to 2019. Angiography and medical records were reviewed to define Fontan pathway dimensions, interventions, and clinical outcomes. 232 patients underwent cardiac catheterization, where 60% were ECCs and 30% LTs. The minimum cros...
Source: Pediatric Cardiology - June 16, 2021 Category: Cardiology Source Type: research

Changes in Coronary Aneurysm Diameters After Acute Kawasaki Disease from Infancy to Adolescence
AbstractWe clarified the changes in coronary artery diameters based on the degree of coronary artery involvement immediately after acute Kawasaki disease (KD). Two hundred sixteen coronary arteries in 85 patients after KD examined by two-dimensional echocardiography were reviewed from 1995. The maximal internal diameters were measured at 2  months, 1 year, 3 years, 10 years and 15 years after KD. The coronary arteries were divided into five groups based on the absolute diameter at 2 months, as well as six groups based on the Z score at 2 months. The maximum diameters were compared at 2&nb...
Source: Pediatric Cardiology - June 16, 2021 Category: Cardiology Source Type: research

Contractile Differences Detected by Speckle Tracking Echocardiography in Pediatric Patients with Mitral Valve Prolapse
AbstractMitral valve prolapse (MVP) is the most common valvar dysfunction in children. There is emerging evidence that MVP is not always a benign entity, hence identification of underlying mechanisms is pertinent to clinical management. Our group previously identified a ventricular contraction abnormality named end-systolic basal eversion (ESBE) in adults that contributed to MVP. The aim of this study was to evaluate regional circumferential strain in pediatric patients with MVP and ESBE compared to normal controls. Left ventricular circumferential strain was assessed in 16 pediatric patients referred for clinical echocard...
Source: Pediatric Cardiology - June 16, 2021 Category: Cardiology Source Type: research

The Identification and Impact of Abnormal Spirometry Patterns on Exercise Capacity in Pediatric Patients with Fontan Palliation
AbstractReduced exercise capacity and restrictive lung physiology are common in patients after Fontan palliation (FP). However, there is paucity of data regarding the association between specific spirometry patterns and key exercise parameters in this population. This is a single-center, cross-sectional, study correlating pulmonary function and exercise parameters in children with FP. Patients who were  ≤ 18 years of age and underwent a comprehensive cardiopulmonary treadmill exercise stress test (CPT) and spirometry at the same time, were included. Patients were categorized as (i) normal or (ii) abno...
Source: Pediatric Cardiology - June 14, 2021 Category: Cardiology Source Type: research

Correlation Between Fragmented QRS and Ventricular Function from Cardiac Magnetic Resonance in Patients with Repaired Tetralogy of Fallot
This study aimed to analyze the correlations between fQRS and ventricular function parameters from cardiac magnetic resonance (CMR) images. A total of 54 patients with rTOF or repaired DORV, TOF type who had been investigated by CMR at Songklanagarind Hospital from January 2012 to August 2019 were retrospectively reviewed. Most of the patients (47 patients, 87%) were diagnosed with TOF and most of these (57.4%) were treated with a transannular patch (TAP) on the right ventricular outflow tract (RVOT). Forty-four patients (81%) had fQRS. The median time interval between EKG and CMR was 4.2  months (IQR 1.1, 6.9). Patie...
Source: Pediatric Cardiology - June 10, 2021 Category: Cardiology Source Type: research

Echocardiographic Screening for Postoperative Pericardial Effusion in Children
In conclusion, the majority of PE cases were detected within 7 days post-operatively, including all cases subsequently developing cardiac tamponade. Day 10 echocardiography infrequently detected a moderate or large effusion that had previously gone undiagnosed. A positive perioperati ve nasopharyngeal aspirate for a respiratory virus was associated with postoperative PE. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - June 4, 2021 Category: Cardiology Source Type: research

Preoperative Morphological Prediction of Early Reoperation Risk After Primary Repair in Tetralogy of Fallot: A Contemporary Analysis of 83 Cases
This study was conducted to investigate the pulmonary artery (PA) variations in tetralogy of Fallot (TOF) and preoperative morphological predictors for early reoperation. Eighty-three TOF patients and 20 children with normal PA were included. The TOF group was divided into two subsets according to whether or not reoperation was performed within 3 years postoperatively. Clinical information was obtained, along with computed tomography (CT)-based three-dimensional geometry of the PA. Morphological measurements of the length of the main PA branches, the angles between them, and the cross-sectional area of each segment of the ...
Source: Pediatric Cardiology - June 1, 2021 Category: Cardiology Source Type: research

Early Ventricular Septal Defect Closure Prevents the Progression of Aortic Regurgitation: A Long-Term Follow-Up Study
AbstractAccording to current short-term evidence, ventricular septal defect (VSD) closure should be performed as early as possible after aortic regurgitation (AR) diagnosis in pediatric patients to prevent AR progression. However, long-term follow-up data are lacking. Therefore, our aim was to evaluate the long-term follow-up ( ≥ 10 years) of patients who underwent VSD closure as early as possible after AR diagnosis and to evaluate whether early VSD closure prevents progression of AR. This was a retrospective cohort study of 42 patients with VSD and AR who had undergone VSD closure at a median age of 2.9&nbs...
Source: Pediatric Cardiology - May 31, 2021 Category: Cardiology Source Type: research

Transfusion Strategies for Pediatric Cardiac Surgery: A Meta-Analysis and Trial Sequential Analysis
This study aimed to compare the effects of restrictive and liberal red blood cell (RBC) transfusion strategies on pediatric patients undergoing cardiac surgery, including cyanotic and non-cyanotic children. A literature search of the MEDLINE, EMBASE, PubMed, and the Cochrane Library database was conducted. Meta-analyses were carried out comparing restrictive and liberal transfusion strategies. Subgroup analyses were performed based on the basis of cyanotic status. Five randomized controlled trials with a total of 497 children were included. There was no significant difference in the risk of in-hospital mortality between th...
Source: Pediatric Cardiology - May 28, 2021 Category: Cardiology Source Type: research

Considerations in the Surgical Management of Unicuspid Aortic Stenosis
AbstractUnicuspid aortic valve (UAV) stenosis is a rare condition accounting for 5% of non-rheumatic aortic stenosis. The diagnosis can be difficult to make prior to surgical intervention and transesophageal echocardiography has been demonstrated to be more accurate in making the diagnosis compared to transthoracic echocardiography. The presence of a posteriorly located aortic orifice on the short-axis views, with one or two visible raphe anteriorly; the absence of commissures (acommissural); or the presence of a lone commissure (unicommissural) between the left and noncoronary, or the left and right cusps suggests the dia...
Source: Pediatric Cardiology - May 28, 2021 Category: Cardiology Source Type: research

From Other Journals: A Review of Recent Articles by Our Editorial Team
AbstractIn this review we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) The impact of COVID-19 in individuals with congenital heart disease through the life span. Patients with a genetic syndrome and adults at advanced physiological stage were at highest risk for moderate/severe infection. (2) Echocardiographic findings of the multisystem inflammatory syndrome in children showing a high prevalence of myocardial injury and syst...
Source: Pediatric Cardiology - May 26, 2021 Category: Cardiology Source Type: research

Red Blood Cell Distribution Width as a Predictive Marker for Coronary Artery Lesions in Patients with Kawasaki Disease
Conclusion: RDW can be used as an independent predictive marker of CALs in patients with KD, but the type of KD should be considered. RDW-SD was an independent marker o f CALs in patients with complete KD, while RDW-CV was a predictor of incomplete KD. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - May 25, 2021 Category: Cardiology Source Type: research

Fetal Diagnosis is Associated with Improved Perioperative Condition of Neonates Requiring Surgical Intervention for Coarctation
AbstractTo define the relative importance of fetal diagnosis and comorbidities in severity of preoperative compromise, outcomes and hospitalization in neonatal coarctation of the aorta (CoA). Retrospective comparison of preoperative condition and postoperative course of neonates prenatally (PreDxn = 48) or postnatally diagnosed (PostDxn = 67) with CoA. Congenital and non-congenital comorbidities were adjusted for. Postnatal diagnosis was associated with preoperative mortality (n = 2), and severe acidosis (lactate >  5 mM or pH 
Source: Pediatric Cardiology - May 14, 2021 Category: Cardiology Source Type: research

Changes in Provider Prescribing Behavior for Infants with Single Ventricle Physiology After Evidence-Based Publications
ConclusionsPrescribing behavior changed congruently after the publication of evidence-based studies, with decreased ACEI use and increased digoxin use at discharge following initial palliation of SV infants. Our findings suggest scientific findings were rapidly implemented into clinical practice. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - May 11, 2021 Category: Cardiology Source Type: research

High Output Cardiovascular Physiology and Outcomes in Fetal Diagnosis of Vein of Galen Malformation
AbstractVein of Galen aneurysmal malformation (VGAM) is a rare anomaly associated with poor outcomes from high output cardiac failure and neurologic complications. Studies addressing fetal cardiovascular status and outcomes in this population are limited. A single-center retrospective review was conducted on patients with a prenatal diagnosis of VGAM who underwent a fetal echocardiogram between January 2015 and July 2019. Fetal echocardiographic data, brain magnetic resonance imaging (MRI) findings and outcomes were collected. Nine fetuses [median gestational age at echocardiogram 34 (1.1) weeks] were included. All patient...
Source: Pediatric Cardiology - May 8, 2021 Category: Cardiology Source Type: research

QRS Duration During Follow-Up of Tetralogy of Fallot: How Valuable is it? Analysis of ECG Changes in Relation to Pulmonary Valve Implantation
In conclusion, when the decision for PVR in TOF patients is primarily based on RV volume and/or function threshold, QRS duration >  180 ms is rarely observed. In contrast with the significant increase of QRS duration before PVR, QRS length regression appears to be independent of the extent of RV dilation or QRS >  160 ms. Considering that the decision for PVR is based on mechanical RV characteristics, the utility of serial follow-up of QRS duration in contemporary operated TOF patients becomes questionable in absence of clinical arguments for ventricular arrhythmia. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - May 7, 2021 Category: Cardiology Source Type: research

Characteristics of Interstage Death After Discharge from Stage I Palliation
ConclusionsMost IM occurred in the outpatient setting, with non-specific preceding symptoms and unknown cause of death. These data indicate the need for research to identify occult causes of death, including arrhythmia. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - May 4, 2021 Category: Cardiology Source Type: research

Sizing Up Fontan Failure: Association with Increasing Weight in Adulthood
AbstractObesity has become increasingly recognized in adults with Fontan palliation, yet the relationship between weight changes in adulthood and Fontan failure is not clearly defined. We hypothesize that increasing weight in adulthood among Fontan patients is associated with the development of Fontan failure. Single-center data from adults with Fontan palliation who were not in Fontan failure at their first clinic visit in adulthood and who received ongoing care were retrospectively collected. Fontan failure was defined as death, transplant, diagnosis of protein losing enteropathy, predicted peak VO2 less than 50%, or new...
Source: Pediatric Cardiology - May 4, 2021 Category: Cardiology Source Type: research

Comparison of Del Nido and Blood Cardioplegia in Pediatric Patients Undergoing Surgical Repair for Congenital Heart Disease
AbstractThe aim of the study is to investigate the impact of two different cardioplegia solutions, the del Nido (dN) and blood cardioplegia (BC), on postoperative troponin concentrations, vasoactive-inotrope score, and length of hospital stay in pediatric patients undergoing cardiovascular surgery for CHD. 80 subjects aged between 1 and 120  months who were scheduled for surgical repair for a CHD were prospectively enrolled in this study. Study subjects were allocated to one of the study groups using simple randomization technique as follows: The del Nido cardioplegia group (n = 40, median age 8.5 [5.5&n...
Source: Pediatric Cardiology - May 3, 2021 Category: Cardiology Source Type: research

Total Transcatheter Stage 1: A Word of Caution
AbstractFor patients with single ventricle physiology, being able to initially establish systemic blood flow and control pulmonary blood flow is critical to their long-term health. Recently, there have been descriptions in achieving this by a purely transcatheter approach with stenting of the ductus arteriosus and implanting pulmonary flow restrictors, a very appealing prospect. We review a case series of 6 patients who underwent a percutaneous modified stage 1 approach using modified Microvascular plugs (MVP) at our center between September 2019 and December 2019. The initial procedure was technically successful in all pa...
Source: Pediatric Cardiology - April 29, 2021 Category: Cardiology Source Type: research

Diagnosing Atrial Septal Defect from Electrocardiogram with Deep Learning
AbstractThe heart murmur associated with atrial septal defects is often faint and can thus only be detected by chance. Although electrocardiogram examination can prompt diagnoses, identification of specific findings remains a major challenge. We demonstrate improved diagnostic accuracy realized by incorporating a proposed deep learning model, comprising a convolutional neural network (CNN) and long short-term memory (LSTM), with electrocardiograms. This retrospective observational study included 1192 electrocardiograms of 728 participants from January 1, 2000, to December 31, 2017, at Tokyo Women's Medical University Hospi...
Source: Pediatric Cardiology - April 27, 2021 Category: Cardiology Source Type: research

Validation of Prenatal Aortic Arch Angle Measurements in the Diagnosis of Neonatal Coarctation of the Aorta
In conclusion, we validate that angle measures are superior to standard models of predicting CoA. An  optimized 3 variable model maintains accuracy of identifying CoA while eliminating false positives. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - April 26, 2021 Category: Cardiology Source Type: research

Conduction Properties and Ablation of Adenosine Sensitive Accessory Pathways in Children
AbstractBlock in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs  
Source: Pediatric Cardiology - April 23, 2021 Category: Cardiology Source Type: research

Long-Term Outcomes After Fenestration Closure in High-Risk Fontan Candidates
AbstractThe study aimed to assess the long-term outcomes after fenestration closure in patients at risk for Fontan failure. Of 119 patients who underwent Fontan operation between 1995 and 2004, fenestration was not created in 89 patients (NF group) and created in 30 patients with hypoplastic left heart syndrome, heterotaxy syndrome, high pulmonary arterial pressure, high systemic ventricular end-diastolic pressure, low ventricular ejection fraction, or atrioventricular valve regurgitation. All fenestrations were closed spontaneously or by catheter/surgical interventions, excepting two patients, and therefore, they were exc...
Source: Pediatric Cardiology - April 21, 2021 Category: Cardiology Source Type: research

A Deeper Understanding of Physics, Physiology, Experimental Methodology, and Statistics is Essential for Valid Comparison of USCOM 1A and cMRI
(Source: Pediatric Cardiology)
Source: Pediatric Cardiology - April 20, 2021 Category: Cardiology Source Type: research

Pediatric Cardiology Fellowship Training in Exercise Medicine: A General Needs Assessment
AbstractThe aim of this study was to improve understanding of exercise medicine training needs for pediatric cardiology fellows. A survey was sent via email to all (N = 63) pediatric cardiology training program directors in the United States to evaluate the perceived exercise training needs of pediatric cardiology fellows. The survey consisted of multiple-choice responses as well as a few open-ended responses. A 60% response rate was achieved. 74% of program s did not have a pre-existing exercise core program. This type of training was felt to be important or very important in 84%. A wide variability of time ...
Source: Pediatric Cardiology - April 20, 2021 Category: Cardiology Source Type: research

Epidemiology of Pediatric Heart Failure in the USA –a 15-Year Multi-Institutional Study
This study aims to describe the characteristics and outcomes of inpatient pediatric HF patients with CHD, CM, and CHD with CM (CHD  + CM) across the USA. We included all HF patients with CM diagnoses with and without CHD using ICD 9/10 codes ≤ 19 years old from January 2004 to September 2019 using the Pediatric Health Information System database. We identified 67,349 unique patients ≤ 19 years old with HF, of which 87% had CHD, 7% had CHD + CM, and 6% had CM. Pediatric HF admissions increased significantly from 2004 to 2018 with an associated increase ...
Source: Pediatric Cardiology - April 19, 2021 Category: Cardiology Source Type: research

Three Decades of Follow-up After Surgical Closure of Subarterial Ventricular Septal Defect
AbstractWe determined the occurrence of aortic regurgitation (AR), AR progression and risk factors in patients followed up for up to three decades after closure of subarterial VSD. We reviewed the outcomes of 86 patients categorized into three groups: group I comprised 37 patients without AR and had VSD closure alone, group II comprised 40 patients with AR and had VSD closure without aortic valvoplasty, and group III comprised 9 patients with AR and required both VSD closure and aortic valvoplasty. Patients were followed up for 18.9  ± 7.3 years (median 19.5 years, range 3.5–36.6). At l...
Source: Pediatric Cardiology - April 19, 2021 Category: Cardiology Source Type: research

Perioperative Opioid Consumption is Not Reduced in Cyanotic Patients Presenting for the Fontan Procedure
AbstractAdequate pain control is a critical component of the perioperative approach to children undergoing repair of congenital heart disease (CHD). The impact of specific anatomic and physiologic disturbances on the management of analgesia has been largely unexplored at the present time. Studies in other pediatric populations have found an association between chronic hypoxemia and an increased sensitivity to the effects of opioid medications. The purpose of this retrospective study was to examine perioperative opioid administration and opioid-associated adverse effects in children undergoing surgical repair of CHD, with a...
Source: Pediatric Cardiology - April 19, 2021 Category: Cardiology Source Type: research

Upcoming Events in Pediatric Cardiology Pediatric Cardiology 42 –2
(Source: Pediatric Cardiology)
Source: Pediatric Cardiology - April 19, 2021 Category: Cardiology Source Type: research

Status of Multidisciplinary Collaboration in Neonatal Cardiac Care in the United States
AbstractWhile outcomes for neonates with congenital heart disease have improved, it is apparent that substantial variability exists among centers with regard to the multidisciplinary approach to care for this medically fragile patient population. We endeavored to understand the landscape of neonatal cardiac care in the United States. A survey was distributed to physicians who provide neonatal cardiac care in the United States regarding (1) collaborative efforts in care of neonates with congenital heart disease (CHD); (2) access to neonatal cardiac training; and (3) barriers to the implementation of protocols for neonatal c...
Source: Pediatric Cardiology - April 18, 2021 Category: Cardiology Source Type: research

Impact of Regular Physical Activity on Aortic Diameter Progression in Paediatric Patients with Bicuspid Aortic Valve
AbstractPatients with bicuspid aortic valve (BAV) have an increased risk of aortic dilation and aortic dissection or rupture. The impact of physical training on the natural course of aortopathy in BAV patients remains unclear. The aim of this study was to evaluate the impact of regular physical activity on aortic diameters in a consecutive cohort of paediatric patients with BAV. Consecutive paediatric BAV patients were evaluated and categorized into two groups: physically active and sedentary subjects. Only the subjects with a complete 2-year follow-up were included in the study. To evaluate the potential impact of physica...
Source: Pediatric Cardiology - April 16, 2021 Category: Cardiology Source Type: research

Deployed Dimensions of the GORE ® CARDIOFORM ASD Occluder as Function of Defect Size
AbstractThe GORE ® CARDIOFORM ASD occluder (ASDO) is approved for closure of ASDs up to 35 mm diameter. With an adaptable central waist, each device size is suitable over a range of defect diameters. Understanding deployed dimensions across various defect sizes will assist operators. Therefore, this study investig ates the deployed dimensions of the ASDO as a function of defect size. A 2-mm-thick ASD model with circular defects ranging from 5 to 35 mm was 3D printed. Diameter, width, and left–right disc diameter were measured by fluoroscopy after ASDO devices were deployed in applicable defects. Linear ...
Source: Pediatric Cardiology - April 16, 2021 Category: Cardiology Source Type: research

The Influence of Bosentan on MicroRNA-27a/PPAR γ/ET-1 Signaling Pathway in Pulmonary Artery Hypertension
AbstractPulmonary artery hypertension (PAH) is a common and serious disease which is characterized by pulmonary vascular remodeling. Bosentan (BST) is the first approved oral targeted drug of endothelin-1 (ET-1) receptor antagonists for the treatment of PAH. MicroRNA-27a (miR-27a) and peroxisome proliferator-activated receptor γ (PPARγ) were found to be related to the pathogenesis of PAH. To further explore the signal transduction mechanism of BST in the treatment of PAH, we examined the effects of BST on endothelin receptors, miR-27a, and PPARγ. Meanwhile, the influence of miR-27a in the formation and de...
Source: Pediatric Cardiology - April 15, 2021 Category: Cardiology Source Type: research

Evaluating Left Ventricular Systolic Synchronicity with Real-Time 3D Echocardiography in Newborns
AbstractKnowing the normal values of left ventricular (LV) systolic synchronicity in the early neonatal period is very important for understanding myocardial function. This retrospective study analyzed data of 105 newborns who were examined using real-time 3-dimensional echocardiography (RT3DE). The time to the point of minimal regional systolic volume (Tmsv) was measured from volume –time curves in each segment. Standard deviation (SD) and maximal difference (Dif) of Tmsv were calculated from 16 (6 basal/6 mid/4 apical), 12 (6 basal/6 mid), and 6 (basal) LV segments with the corresponding parameters adjusted for the...
Source: Pediatric Cardiology - April 15, 2021 Category: Cardiology Source Type: research

The Outcomes of Surgical Separation in Thoracopagus Twins with Conjoined Hearts: An Analysis of the Literature
AbstractWe sought to perform a comprehensive review of reported cases of conjoined thoracopagus twins with cardiovascular conjunction to determine the overall survival after separation and factors that might be associated with survival. We performed a systematic review of cases of thoracopagus twins with conjoined cardiovascular systems reported in the English medical literature using Embase, PubMed, Web of Science, and Scopus. We employed standard statistical methods to analyze differences among groups. We identified 102 unique cases of thoracopagus twins (69% female) with some degree of cardiovascular conjunction who had...
Source: Pediatric Cardiology - April 15, 2021 Category: Cardiology Source Type: research

The Use of Virtual Reality Echocardiography in Medical Education
AbstractVirtual reality (VR) is a relatively new technology that allows an individual to experience a virtual world. This new immersive video type may be of particular usefulness in procedure-based healthcare settings. We hypothesized that VR echocardiography was non-inferior to live demonstration. Our aim was to assess the usefulness of a VR echocardiographic approach in teaching echocardiography to pediatric trainees compared to live demonstration. This was a single center, cross-sectional observational design. We used a Garmin VIRB® 360 and a head-mount display to record live echocardiography exams in a pediatric po...
Source: Pediatric Cardiology - April 15, 2021 Category: Cardiology Source Type: research

Rotational Position of the Aortic Root is Associated with Increased Aortic Dimensions in Marfan and Loeys –Dietz Syndrome
AbstractProgressive aortic dilation is common in Marfan syndrome (MFS) and Loeys –Dietz syndrome (LDS). Risk factors for progression are poorly understood. Normal variation in the aortic root (AoR) rotational position relative to the left ventricular base may impact this risk. We aimed to assess the relationship between the rotational position of the AoR and aortic dimensions in this population. Patients with a genetic diagnosis of MFS or LDS were included. AoR and ascending aorta (AAo) dimensions were measured from the first and most recent transthoracic echocardiogram. The AoR rotational angle was measured in the p...
Source: Pediatric Cardiology - April 13, 2021 Category: Cardiology Source Type: research

The Use of Chronic Total Occlusion (CTO) Wires for Perforation of Atretic Pulmonary Valve; Two Centers Experience
AbstractPulmonary valve atresia with intact ventricular septum (PA-IVS) can be treated either surgically or transcatheterly for eligible patients. Perforation of pulmonary valves using chronic total occlusion (CTO) guidewires has been reported as an alternative to radiofrequency (RF) perforation. We sought to report our experience with CTO guidewires for perforation of atretic pulmonary valves and subsequent balloon dilatation (with or without patent ductus arteriosus stenting) in patients with PA-IVS from two centers. A retrospective study was carried out on PA-IVS patients who underwent intervention between March 2014 an...
Source: Pediatric Cardiology - April 12, 2021 Category: Cardiology Source Type: research

Changes in Heart Rate and Heart Rate Variability During Surgical Stages to Completed Fontan Circulation
AbstractArrhythmia is related to heart rate variability (HRV), which reflects the autonomic nervous regulation of the heart. We hypothesized that autonomic nervous ganglia, located at the junction of the superior vena cava ’s entrance to the heart, may be affected during the bidirectional Glenn procedure (BDG), resulting in reduced HRV. We aimed to investigate changes in heart rate and HRV in a cohort of children with univentricular heart defects, undergoing stepwise surgery towards total cavopulmonary connection (T CPC), and compare these results with healthy controls. Twenty four hours Holter-ECG recordings we...
Source: Pediatric Cardiology - April 10, 2021 Category: Cardiology Source Type: research

Feasibility of P wave Centric Ambulatory Electrocardiogram Monitoring in Infants and Young Children
AbstractP wave centric ambulatory electrocardiographic (ECG) monitoring has emerged as an important tool aiding the diagnosis of arrhythmias. However, their efficacy and user experience in infants and young children are not well established. A retrospective study  was performed to detail clinical and user experience of ECG monitoring using the Carnation Ambulatory Monitor (CAM) patch (Bardy Diagnostics Inc., Seattle, WA) in patients less than 10 kg. Additionally, 2 different monitor locations (over the sternum and horizontal over the left axilla) were asse ssed to address the optimal placement in these patients. ...
Source: Pediatric Cardiology - April 10, 2021 Category: Cardiology Source Type: research

Authors ’ Response to a Letter to the Editor
(Source: Pediatric Cardiology)
Source: Pediatric Cardiology - April 9, 2021 Category: Cardiology Source Type: research

Impact of Valve Type (Ross vs. Mechanical) on Health-Related Quality of Life in Children and Young Adults with Surgical Aortic Valve Replacement
AbstractBackgroundThe impact of aortic valve replacement (AVR) type on health-related quality of life (HRQOL) in adolescents and young adults is unclear, but may vary depending on need for anticoagulation or re-intervention. We sought to determine the differences in HRQOL following AVR with either the Ross procedure or mechanical AVR in this young population.MethodsPatients 14 –35 years old and at least 1 year post-AVR were included. HRQOL was assessed using the Short Form-36 (SF-36). Valve-specific concerns regarding anticoagulation and reoperation were also assessed. Clinical outcome data were obtained by...
Source: Pediatric Cardiology - April 7, 2021 Category: Cardiology Source Type: research

Partial Anomalous Pulmonary Venous Connection Repair: Customized Approach and Outcomes
AbstractAlternative options for the correction of partial anomalous pulmonary venous connection (PAPVC) have been proposed. Each can be associated with variable risk for dysrhythmias, caval or pulmonary venous (PV) obstruction. A selective customized strategy to address PAPVC taking into account atrial shunt (AS) and growth potential was pursued. Between September 2014 and August 2018 21 PAPVC patients were identified. Two levels of reference determined the chosen repair strategy; azygous vein (AzV) and cavoatrial junction (CAJ). Six (Group-A) with PAPVC entering SVC cephalad to AV underwent a combined in-situ cavoatrial a...
Source: Pediatric Cardiology - April 2, 2021 Category: Cardiology Source Type: research

Hospital Survival After Surgical Repair of Truncus Arteriosus with Interrupted Aortic Arch: Results from a Multi-institutional Database
In conclusion, the addition of IAA to TA is associated with an increased post-operative LOS, but does not increase in-hospital mortality. (Source: Pediatric Cardiology)
Source: Pediatric Cardiology - March 30, 2021 Category: Cardiology Source Type: research

A Modified Approach with Caval Transection for Supracardiac Total Anomalous Pulmonary Venous Connection: Comparison Between Conventional and Sutureless Surgery in 173 Patients
This study aimed to compare the long-term outcomes between the conventional surgery and the sutureless technique with a modified approach in superior TAPVC. Between January 2008 and December 2018, 173 patients with supracardiac TAPVC underwent surgery either with the conventional procedure (n = 130) or the sutureless repair (n = 43). Multivariate analysis and competing-risk analysis were used to identify risk factors for early death and postoperative pulmonary venous obstruction (PVO), respectively. Among 173 patients who underwent repair of supracardiac TAPVC, 46 (28%) had preoperative PVO, and...
Source: Pediatric Cardiology - March 23, 2021 Category: Cardiology Source Type: research

Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality
AbstractMyelomeningocele (MMC) and congenital heart disease (CHD) are independent risk factors for increased morbidity and mortality in the newborn period and each can require significant operations shortly after birth. Few studies have examined the impact of these combined lesions. We sought to examine the incidence of CHD in patients with MMC, and to evaluate length of stay (LOS), hospital charges, and mortality. Using the Texas Inpatient Public Use Data File,  ~ 6.9 million newborn records between 1/1999 and 12/2016 were examined. Hospitalizations were classified as MMC without CHD (n = 3054)...
Source: Pediatric Cardiology - March 10, 2021 Category: Cardiology Source Type: research

Prognostic Significance of Myocardial Ischemia Detected by Single-Photon Emission Computed Tomography in Children with Hypertrophic Cardiomyopathy
AbstractMyocardial ischemia caused by microvascular dysfunction is an important pathophysiologic component of hypertrophic cardiomyopathy (HCM), promoting myocardial fibrosis, adverse left ventricular remodeling, and impacting on clinical course and outcome in HCM patients. The aim of study was to assess the prevalence and clinical significance of myocardial ischemia in children with HCM using 99mTc-MIBI single-photon emission computed tomography (SPECT). Ninety-one children with HCM, median age 13.6  years, underwent SPECT evaluation from 2006 to 2017. Imaging was performed at rest and after maximal exercise. Myocard...
Source: Pediatric Cardiology - March 9, 2021 Category: Cardiology Source Type: research

Longitudinal Changes in Exercise Capacity in Patients Who Underwent Ross Procedure and Mechanical Aortic Valve Replacement: Does the Type of Surgery Matter?
AbstractThe surgical options for significant aortic valve disease include either Ross procedure (RP) or aortic valve replacement (AVR). The exercise stress test is routinely performed in these patients to assess the objective functional capacity. This retrospective study was conducted to evaluate the differences and the longitudinal changes of exercise capacity in patients following the RP and AVR for aortic valve disease. This is an IRB approved retrospective study and included patients who had either RP or AVR performed for aortic valve disease and had at least one exercise stress test performed after the surgical proced...
Source: Pediatric Cardiology - March 8, 2021 Category: Cardiology Source Type: research

Accuracy of Fetal Echocardiography in Defining Pulmonary Artery Anatomy and Source of Pulmonary Blood flow in Pulmonary Atresia with Ventricular Septal Defect (PA/VSD)
AbstractPrecise delineation of central and branch pulmonary artery anatomy, patent ductus arteriosus, and major aorto-pulmonary collateral artery anatomy in the fetal diagnosis of pulmonary atresia with ventricular septal defect is challenging but important to prenatal counseling and postnatal management. We aimed to evaluate the accuracy of fetal echocardiography to determine these anatomical nuances in pulmonary atresia with ventricular septal defect. This was a retrospective, single-institution, 10-year chart review of consecutive prenatal diagnosis of pulmonary atresia with ventricular septal defect for assessment of p...
Source: Pediatric Cardiology - March 8, 2021 Category: Cardiology Source Type: research