CHDs, affecting 1.1% of newborns, are the most prevalent congenital anomalies. Improved survival rates expose children with CHD to long-term risks such as metabolic and acquired cardiovascular disorders. Despite physical activity’s benefits, participation is often limited by real and perceived safety concerns. This study evaluates awareness and practice of physical activity among Omani children with CHD.

To quantify physical activity levels and identify influencing factors in Omani children with CHD.

This cross-sectional study, conducted at major Omani paediatric cardiology centres, surveyed parents of children aged 5–18 years with CHD attending clinics from January 2019 to January 2023. A validated questionnaire assessed activity levels and influencing factors. Children with recent surgery (<3 months), single ventricle, cardiomyopathies, or without parental consent were excluded.

Among 412 children, mean weekly physical activity was 2.18 hours. Parental participation in sports (β = 0.42, p < 0.001) and cardiologist encouragement (β = 0.38, p < 0.001) significantly increased activity levels. Children in houses (64% participation) were more active than those in apartments (34%, p = 0.004). Acyanotic CHD was associated with higher participation (66%) than cyanotic CHD (45%). Gender, parental education, and surgical history were not significant predictors.

Omani children with CHD engage in insufficient physical activity. Parental involvement and cardiologist guidance are critical drivers. We recommend targeted educational programmes and routine exercise counselling to enhance participation.

Childhood-onset cardiomyopathies are rare and not well characterised. This study aimed to describe the clinical features of a paediatric cohort with primary cardiomyopathies, with a particular focus on aetiology and both short- and long-term outcomes.

A retrospective descriptive study was conducted, including patients diagnosed with primary cardiomyopathies before the age of 18. Clinical presentation, aetiology, and outcomes were analysed for each morphological subtype of cardiomyopathy.

A total of 76 patients met the inclusion criteria. Dilated cardiomyopathy was the most common subtype (48.6%), followed by hypertrophic (31.5%), left ventricular non-compaction (10.5%), restrictive (5.2%), and arrhythmogenic cardiomyopathy (3.9%). The mean age at diagnosis was 6.3 ± 5.6 years, with a slight female predominance (56.6%). The rate of genetic diagnosis was 25.6%; the most commonly identified pathogenic or likely pathogenic variants were in MYH7, FLNC, TTN, and MYBPC3, across different morphological subtypes. A total of 94.7% of patients received at least one cardiovascular medication, and 9.2% received intracardiac devices. The overall mortality rate was 22.3%, and the heart transplant rate was 15.7%.

These findings highlight the heterogeneous aetiology of paediatric cardiomyopathies and the variability in outcomes according to morphological, genetic, and clinical subtypes. The results underscore the importance of individualised evaluation and management for affected patients.

Systemic inflammation plays an important role in the pathophysiology of hypertension, contributing to endothelial dysfunction and target organ damage. This study aimed to evaluate the diagnostic and predictive value of the systemic immune inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein-albumin ratio in children with primary hypertension by comparing them with healthy controls, assessing their association with disease severity, and examining changes after treatment.

This retrospective study included 49 paediatric patients with newly diagnosed primary hypertension and 50 age- and gender-matched healthy controls. Complete blood count derived indices and biochemical markers were analysed. Patients were stratified by hypertension stage, and post-treatment changes in inflammatory indices were evaluated.

The mean age was 16.3 ± 1.9 years in the hypertension group and 15.8 ± 1.3 years in the control group. Systemic immune inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein-albumin ratio were significantly higher in children with hypertension than in controls (p < 0.05). Systemic immune inflammation index was markedly higher in stage 2 compared with stage 1 hypertension (p = 0.003) and decreased significantly after treatment (p < 0.001). Neutrophil-to-lymphocyte ratio and C-reactive protein-albumin ratio emerged as strong diagnostic markers, while systemic immune inflammation index, although less discriminative, was associated with disease severity and decreased significantly after treatment.

Neutrophil-to-lymphocyte ratio and C-reactive protein-albumin ratio provide robust diagnostic value in paediatric hypertension. Systemic immune-inflammation index, despite modest diagnostic accuracy, has prognostic significance by indicating disease severity and monitoring treatment effects. Collectively, these markers may serve as cheap and accessible tools for early diagnosis, risk stratification, and follow-up in children with hypertension.

CHD affect approximately 1% of live births globally and are the most common congenital anomaly. Contemporary data on CHD risk in offspring of affected mothers remains limited. This study evaluated CHD incidence in offspring of mothers with CHD at a southeastern U.S. academic medical centre.

We conducted a retrospective review of patients with CHD who received prenatal care between 2015 and 2023 at a multidisciplinary Cardio-Obstetrics clinic. Patients with acquired heart disease, syndromic or inherited CHD, and deliveries at outside hospitals with missing delivery data were excluded. The primary outcome was infant CHD incidence, confirmed by postnatal echocardiography. Secondary outcomes were neonatal intensive care unit admission, early in-hospital cardiac surgery, and in-hospital infant mortality.

A total of 186 mothers with 195 pregnancies and 198 infants were included. CHD was diagnosed in 16 infants (8.1%), most commonly ventricular septal defect. Of affected infants, none required early in-hospital surgery, and one experienced in-hospital mortality, though this infant had severe extracardiac anomalies concerning an underlying genetic syndrome.

The incidence of CHD among offspring of mothers with CHD in our cohort was higher than the general population; however, the majority of defects were non-critical and did not require early intervention. These findings offer important context for prenatal counselling and tailored fetal/neonatal echocardiography screening in this high-risk population.

Shone complex is a rare congenital cardiovascular anomaly characterized by multiple left-sided obstructive lesions. Adult presentation is uncommon and may result in atypical clinical manifestations, particularly when complicated by infective endocarditis. Coarctation of the aorta–associated infective endocarditis is especially rare and carries significant clinical risk.

We report a 25-year-old male with partial Shone complex consisting of a parachute mitral valve, mitral stenosis, and coarctation of the aorta. The patient presented with persistent high-grade fever and was diagnosed with methicillin-sensitive Staphylococcus aureus infective endocarditis based on positive blood cultures. Transthoracic and transesophageal echocardiography revealed obstructive left-sided lesions, mitral valve pathology, and moderate aortic regurgitation. Positron emission tomography demonstrated intense hypermetabolic activity at the coarctation site, consistent with active infection and confirming a saccular aneurysm. The patient underwent prolonged intravenous cefazolin therapy followed by surgical repair. The early postoperative course was stable; however, seven months later he re-presented with recurrent fever. Repeat imaging demonstrated graft infection, vegetation on the prosthetic material, and a perforated mitral leaflet. A second course of intravenous antibiotics (cefazolin and rifampicin) was administered, followed by long-term suppressive oral therapy. Subsequent follow-up showed persistent moderate-to-severe mitral regurgitation with stable postoperative anatomy.

This case highlights a rare adult manifestation of partial Shone complex complicated by coarctation of the aorta-site methicillin-sensitive Staphylococcus aureus infection, saccular aneurysm formation, and recurrent graft-associated infective endocarditis. The clinical course underscores the importance of vigilant multimodality imaging, early multidisciplinary evaluation, and long-term follow-up in adults with complex CHD, particularly when infectious complications are present.

Aortopulmonary window is an uncommon CHD that often coexists with additional cardiovascular anomalies. Criss-cross heart, defined by rotation of the ventricular mass with crossed atrioventricular inflow streams, is exceedingly rare. The coexistence of aortopulmonary window and criss-cross heart is exceptional and markedly increases diagnostic and therapeutic complexity.

We report a full-term neonate with prenatal suspicion of aortopulmonary window. Postnatal echocardiography and CT demonstrated situs solitus, concordant atrioventricular and ventriculoarterial connections, rotational malalignment of the ventricles consistent with criss-cross heart, an inferior sinus venosus atrial septal defect, and a large type III aortopulmonary window. There was marked right-sided dilation and evolving right ventricular dysfunction, although no interrupted aortic arch was identified. At 17 days of life, the patient underwent early surgical repair with reconstruction of the aortic pathway. Despite anatomically successful correction, the immediate postoperative course was complicated by severe ventricular dysfunction and refractory low cardiac output syndrome, requiring venoarterial extracorporeal membrane oxygenation for haemodynamic stabilisation. Extracorporeal membrane oxygenation was discontinued on day nine, and follow-up imaging showed preserved biventricular systolic function and no residual aortopulmonary window.

This case illustrates an exceptionally rare association between aortopulmonary window and criss-cross heart, underscoring the value of prenatal detection and detailed postnatal imaging to delineate complex anatomical relationships. Early surgical intervention was mandatory, and the need for extracorporeal membrane oxygenation highlights the high intrinsic risk of this anatomical combination. Reporting such cases expands the limited literature on rare congenital cardiac malformations and may inform future refinements in diagnostic evaluation and perioperative management.

This study aimed to evaluate the independent effect of parental smoking on early markers of atherosclerosis in children, specifically carotid intima-media thickness and epicardial adipose tissue thickness.

A total of 106 healthy children aged 6–16 years were enrolled, including 53 with parental smoking exposure and 53 unexposed controls. Participants underwent clinical evaluation, laboratory assessment, transthoracic echocardiography, and carotid ultrasonography. Data on parental smoking habits, sociodemographic characteristics, and children’s daily sleep duration were collected. Multivariable analyses were performed to assess the independent association between parental smoking and subclinical atherosclerotic markers.

Children exposed to parental smoking demonstrated significantly greater epicardial adipose tissue thickness and carotid intima-media thickness compared with controls (p = 0.014 and p = 0.001, respectively). Lipid parameters did not differ significantly between groups. Daily sleep duration was negatively correlated with epicardial adipose tissue thickness (r = –0.325, p = 0.018) and carotid intima-media thickness (r = –0.484, p < 0.001). Parental smoking remained independently associated with both markers after adjustment for relevant covariates.

Parental smoking is associated with early atherosclerotic changes in children, demonstrated by increased carotid intima-media thickness and epicardial adipose tissue thickness, independent of traditional cardiovascular risk factors.

This study aims to identify the factors affecting the development of complications and to present the necessary data to the literature in order to reduce the frequency of complications as a result of some measures that can be taken against them.

This retrospective study included 609 patients between the ages of 0 and 18 who underwent cardiac catheterisation between 2012 and 2020 by our Department of Paediatric Cardiology. The patient’s demographic data, cardiac catheterisation-related data, laboratory results, and all data in the post-procedure records are scanned and evaluated.

Of the patients aged between 0 and 216 months (mean 67.1 ± 55.8 months), 371 were female (60.9%). Interventional catheterisation was performed in 419 (68.4%) of the patients, and diagnostic catheterisation was performed in 193 (31.6%). Complications were detected in 39 patients (6.4%). The most frequent complications were vascular complications in 16 patients (41%), bleeding in 5 patients (12.8%), anaemia in 4 patients (10.3%), and arrhythmia in 3 patients (7.7%). Mortality occurred in 2 patients (0.3%). Risk factors for the development of complications were determined as <10 kg (p = 0.001) and <1 year of age (p = 0.002).

The most common complications were vascular complications, followed by bleeding and anaemia. Low body weight (<10 kg) and being under 12 months of age are risk factors for the development of complications. Considering that most studies only include certain age groups or certain types of procedures, our study will make a significant contribution to the literature as it includes a larger scale and different types of procedures.

Vasovagal syncope is the most common cause of syncope in children, and there is no satisfactory treatment currently. We evaluated the response to midodrine treatment in patients with vasovagal syncope who failed to benefit from conventional, non-pharmacologic treatments.

The study was a single-centre retrospective study. The data of 44 children between the ages of 6 and 18 years, who were diagnosed with recurrent vasovagal syncope, did not benefit from non- pharmacological treatments, and received midodrine treatment from 2015 to 2022 were enrolled in the study.

In total, 44 patients, 38 (86.4%) were girls, and 6 (13.6%) were boys. The primary outcome measure was the change in frequency of vasovagal syncope episodes from baseline to 6 months after treatment with midodrine. Patients received a midodrine treatment at an average of 2.5–5 mg/day and were followed for a median of 23.07 (8–72) months. The median number of syncope was 4.2 (3–9.8)/year prior to treatment and 1.2 (1–5)/year (p = 0.01) following the treatment. There was a significant improvement in syncope episodes in all patients.

Vasovagal syncope is the common cause of syncope in children, and its treatment has not yet been found satisfactory. Midodrine treatment was found to be effective and safe in paediatric patients with recurrent vasovagal syncope. However, further research is needed to determine the most effective treatment for this condition.

To compare the clinical efficacy and prognosis of Ozaki procedure and Ross procedure in the treatment of paediatric aortic valve disease.

According to the predetermined inclusion and exclusion criteria, relevant clinical studies were comprehensively searched in three databases, and relevant data were extracted for analysis and comparison.

This meta-analysis included four retrospective cohort studies with a total of 243 patients (117 undergoing Ozaki procedure and 126 undergoing Ross procedure). There were no significant difference in the in-hospital all-cause mortality [odds ratio = 1.38; 95% confidence interval: 0.38, 5.07, p = 0.63] and all-cause mortality during the follow-up period [odds ratio = 1.85; 95% confidence interval: 0.54, 6.32, p = 0.32] between Ozaki procedure and Ross procedure. The reoperation on the aortic valve [odds ratio = 10.48; 95% confidence interval: 2.22, 49.40, p = 0.003] was higher in the Ozaki procedure than in the Ross procedure. There were no patients who underwent pulmonary valve reoperation after Ozaki procedure [odds ratio = 0.21; 95% confidence interval: 0.03, 1.23, p = 0.08]. The cumulative reoperation rate after Ozaki procedure [odds ratio = 2.29; 95% confidence interval: 0.93, 5.66, p = 0.07] was higher than that of Ross procedure, but the difference was not statistically significant. The cardiopulmonary bypass time after Ozaki procedure [odds ratio = −32.09; 95% confidence interval:−45.05, −19.14, p < 0.00001] was shorter than that of Ross procedure. The incidence of postoperative complications [odds ratio = 0.24; 95% confidence interval: 0.04, 1.62, p = 0.14], aortic cross-clamping time [odds ratio = −20.39; 95% confidence interval: −43.68, 2.90, p = 0.09], ventilator assistance time [odds ratio = 1.71; 95% confidence interval: −42.70, 46.13, p = 0.94], and ICU time [odds ratio = −0.38; 95% confidence interval: −0.93, 0.16, p = 0.17] in Ozaki procedure was not statistically significant compared to Ross procedure.

In the treatment of children with aortic valve disease, there is no statistically significant difference between the Ozaki procedure and the Ross procedure in terms of freedom from reoperation and all-cause mortality.

Early post-operative arrhythmia is a frequent complication after paediatric cardiac surgery. Although usually transient, it contributes to considerable morbidity and may increase mortality. This study aimed to determine the incidence, predictors, and outcomes of early post-operative arrhythmia following paediatric open-heart surgery.

A single-centre retrospective cohort study was conducted on paediatric patients who underwent open-heart surgery for congenital or acquired heart diseases between January 2022 and December 2024. Pre-operative, intraoperative, and post-operative parameters were analysed to identify independent predictors using multivariate logistic regression.

Of 2,096 patients analysed, 220 (10.5%) developed early post-operative arrhythmias, mainly tachyarrhythmias. The most common were complete heart block (3.2%), accelerated junctional rhythm (2.8%), and junctional ectopic tachycardia (1.9%). Tetralogy of Fallot repair had the highest incidence (20.2%). Independent predictors included prolonged cardiopulmonary bypass (OR 1.005, 95% CI 1.002–1.009, p = 0.002), extended aortic cross-clamp time (OR 1.006, 95% CI 1.001–1.011, p = 0.011), and prolonged inotropic support (OR 1.035, 95% CI 1.009–1.063, p = 0.009). Serum magnesium ≥ 1.0 mmol/L was identified as a protective factor. Arrhythmia was associated with longer mechanical ventilation (median 4 vs. 2 days), ICU stay (8 vs. 4 days), and hospitalisation (20 vs. 12 days; all p < 0.001). Mortality was higher but not statistically significant (5.9% vs. 3.6%, p = 0.087).

Post-operative arrhythmia occurred in 10.5% of paediatric cardiac surgeries, most frequently after Tetralogy of Fallot repair. Prolonged bypass, aortic cross-clamp times, hypomagnesemia, and high inotropic support were independent risk factors associated with increased morbidity.

Sinus venosus atrial septal defect is an uncommon congenital cardiac anomaly frequently associated with partial anomalous pulmonary venous drainage. The coexistence of this defect with anomalous hepatic venous drainage, cor triatriatum, and two arterial ductal connections is extremely rare and may create diagnostic and surgical challenges.

An eleven-month-old female infant with tachypnoea and growth retardation was found to have sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage and anomalous hepatic venous drainage to the coronary sinus on CT angiography. Cardiac catheterisation demonstrated a moderate left-to-right shunt and mildly elevated pulmonary artery pressure. Intraoperative assessment unexpectedly revealed two arterial ductal connections and cor triatriatum. Surgical management consisted of closure of the atrial septal defect, rerouting of pulmonary veins, and ligation of both arterial ductal connections. Hepatic venous drainage was left unaltered due to low flow and lack of hemodynamic effect. Postoperative recovery was uneventful.

This rare constellation of anomalies highlights the importance of advanced imaging, careful preoperative planning, and intraoperative vigilance for unanticipated findings in CHD.

Double outlet right ventricle is a heterogeneous congenital defect in which both great arteries arise predominantly from the right ventricle. Several operative strategies exist, but contemporary paediatric outcome data have not been systematically synthesised.

A systematic search of PubMed, Embase, Scopus, the Cochrane Library, and medRxiv (2000–2025) identified cohort studies and case series including ≥10 children undergoing biventricular repair strategies reported in double outlet right ventricle cohorts, including intraventricular rerouting procedures, root-based realignment techniques, and neonatal pathway operations such as the Yasui procedure. Two reviewers independently screened studies, extracted anatomical and operative data, and assessed risk of bias. Early mortality and 10-year survival were pooled using random-effects models with logit transformation.

Thirteen studies (413 children; median follow-up ∼7 years) met inclusion criteria. Early mortality ranged from 0% to 6.8%. Pooled early mortality was 2.7% for Rastelli, 3.6% for REV, and 5.8% for Nikaidoh/Bex operations. Ten-year survival exceeded 90% across all major strategies. Conduit replacement was frequent after Rastelli and Nikaidoh/Bex repair. REV avoided a conduit but required right ventricular outflow tract reinterventions in about one-quarter of patients. Nikaidoh/Bex procedures provided durable left ventricular outflow but showed 19–35% conduit failure. Yasui repairs achieved excellent neonatal survival but required frequent conduit replacement.

Contemporary double outlet right ventricle repair provides excellent long-term survival with early mortality <6%. Procedure selection should consider ventricular septal defect position, risk of postoperative left ventricular outflow tract obstruction, coronary anatomy, and patient size.

This study evaluated the safety and efficacy of individualised interventional strategies in paediatric pulmonary arterial hypertension, focusing on the outcomes of atrial septostomy, reverse Potts shunt, and partial ASD closure in patients unresponsive to medical therapy or with rapid right ventricular deterioration.

A retrospective analysis included 12 paediatric patients who underwent 18 interventional procedures between 2019 and 2024. Pulmonary arterial hypertension was confirmed by right heart catheterisation, and pre- and post-procedural clinical, echocardiographic, and haemodynamic data were compared.

Interventions included graded balloon atrial septostomy (n = 10), partial ASD closure (n = 2), and reverse Potts shunt via ductal stenting (n = 1). All surviving patients showed clinical improvement with significant reductions in heart rate (p < 0.01), NT-proBNP (p = 0.008), mean right atrial pressure (p < 0.001), and RV/LV end-diastolic diameter ratio (p = 0.014), along with improvements in six-minute walk distance (p = 0.002), WHO functional class (p < 0.001), and TAPSE (p = 0.028). One patient (8.3%) died within days following atrial septostomy due to nonadherence to medical therapy. Three patients required repeat atrial septostomy because of shunt restriction or spontaneous narrowing.

Individualised interventional strategies guided by comprehensive haemodynamic assessment can slow disease progression and improve quality of life in paediatric pulmonary arterial hypertension. Partial ASD closure, as a novel approach in this cohort, reduces excessive left-to-right volume load while preserving a controlled right-to-left shunt, thereby enhancing haemodynamic stability and optimising outcomes. Timely implementation of interventional strategies before disease progression may help reduce mortality.