Fenestration in the Fontan procedure was introduced to improve early postoperative outcomes by reducing systemic venous pressure and augmenting preload to the systemic ventricle. It is believed to decrease pleural drainage, shorten hospital stay, and reduce complications. However, fenestration may result in systemic desaturation and carries a potential risk of paradoxical thromboembolism. The benefits of routine fenestration remain controversial. This study aimed to evaluate whether adding a fenestration influences early postoperative outcomes.

Between March 2024 and November 2025, 52 patients underwent Fontan completion at our institution. Forty patients met the inclusion criteria and were prospectively divided into two equal groups: non-fenestrated (Group 1, n = 20) and fenestrated (Group 2, n = 20). Twelve patients were excluded due to a primary Fontan procedure, elevated pulmonary vascular resistance, increased transpulmonary gradient, or significant branch pulmonary artery distortion. Demographic and perioperative parameters, including ventilation duration, inotrope duration, chest drain duration and volume, ICU stay, and total hospital stay, were analysed.

Baseline demographic and intraoperative variables were comparable between groups. Duration of mechanical ventilation, ICU stay, total chest drainage, and cardiopulmonary bypass time were similar. Chest drain duration was shorter in the fenestrated group (8.1 ± 4.2 vs. 10.2 ± 5.3 days), but this difference was not statistically significant (p = 0.173). Discharge oxygen saturation was significantly lower in the fenestrated group (88.9 ± 5.6% vs. 93.3 ± 3.5%; p = 0.0072).

In the present cohort, fenestration was not associated with a statistically significant improvement in most early perioperative outcomes. Larger studies are needed to define its role.

Burnout and adverse mental health outcomes are increasingly reported by health professionals, affecting work engagement or collaboration, with negative effects on staff retention and healthcare quality. This cross-sectional study assessed the prevalence and correlates of work-related emotional exhaustion among health professionals in paediatric cardiac care.

Health professionals (153 nurses, 37 medical doctors, 22 allied and mental health professionals, 17 research/administrative staff; 55% response rate, 85% women) at a large quaternary paediatric hospital in Australia completed validated measures within the WithCare Health Professional Survey (June 2020–February 2021). Emotional exhaustion, depersonalisation, and personal accomplishment at work were measured using the Maslach Burnout Inventory. Hierarchical linear regression was used to identify correlates of tested emotional exhaustion, with calculation of 95% confidence intervals (CI).

Two-thirds (68%) of participants endorsed feeling “used up at the end of the workday,” while 65% felt “emotionally drained from work” at least a few times a month. Correlates of emotional exhaustion included higher anxiety (ß = 1.41, CI: 0.46, 2.35), greater avoidance-based coping (ß = 4.15, CI: 0.22,8.08), greater work–family conflict (ß = 0.55, CI: 0.38, 0.71), lower compassion satisfaction (ß = −0.55, CI: −0.81, −0.30), and lower approach-based coping (e.g., positive reframing or acceptance, ß = −3.44, CI: –6.24, −0.65). Demographics, clinical role characteristics, physical health, and psychosocial factors accounted for 62% of the variance in emotional exhaustion (p < 0.0001).

Health professionals providing paediatric cardiac care report emotional exhaustion, which can adversely affect both personal and professional well-being. Identification of correlates can inform the design of targeted initiatives to address mental health needs.

This study aimed to evaluate patients with beta thalassaemia major using the cardiac electrophysiological index of balance, a new electrocardiography parameter, and to predict ventricular arrhythmias.

In this study, 60 beta thalassaemia major and 60 healthy children were included. All patients were evaluated with echocardiography. P-wave dispersion, repolarisation times, repolarisation dispersion times, and cardiac electrophysiological balance index were measured using 12-lead electrocardiography. Heart rate variability parameters were evaluated with a 24-hour Holter electrocardiography.

Left ventricular functions were similar between the groups. Although repolarisation times (QT, JT, and JTp) were significantly lower in the beta thalassaemia major group, heart rate-corrected repolarisation times were similar. Except for Tpe/QT, which is one of the repolarisation dispersion parameters, the other parameters were similar. The heart rate-corrected cardiac electrophysiological index of balance ratio was significantly higher in the beta thalassaemia major group. QRS duration and QRS-dispersion duration (QRS-d) were similar between the groups. There was a correlation between blood ferritin levels and LVmass-i, Tpe/QT, Tpe/QTc, QTc/QRS ratio, and QT, JT, and JTp values.

Patients with beta thalassaemia major are at high risk for ventricular arrhythmia due to a high QTc/QRS ratio, despite normal left ventricular systolic, diastolic, and autonomic function in the early period. We believe that there is a moderate correlation between blood ferritin levels and the QTc/QRS ratio and that the QTc/QRS ratio can provide important information for the follow-up and evaluation of patients with beta thalassaemia major.

Despite normal early ventricular function in the beta thalassaemia major group, they were at high risk of ventricular arrhythmias.

This study aimed to identify echocardiographic predictors of successful weaning from extracorporeal membrane oxygenation in paediatric and congenital heart disease patients.

We retrospectively analyzed pediatric patients who underwent venoarterial extracorporeal membrane oxygenation for cardiogenic shock or postoperative support between March 2018 and September 2023. Clinical and echocardiographic variables assessed at the time of weaning evaluation were compared between patients who were successfully weaned and those who were not.

Among the 46 enrolled patients, 31 were successfully weaned from extracorporeal membrane oxygenation. The mean age at extracorporeal membrane oxygenation initiation was 9.6 ± 13.9 years, and the mean duration of support was 12.3 ± 12.1 days. Patients in the successfully weaned group had significantly higher left ventricular ejection fraction (50.9 ± 16.4% vs. 27.3 ± 18.7%, p < 0.001) and higher velocity time integral at the left ventricular outflow tract (12.3 ± 8.0 cm vs. 4.1 ± 3.6 cm, p = 0.001) compared with the unsuccessfully weaned group. The cutoff values for predicting successful weaning were a left ventricular ejection fraction of 43.03% (sensitivity, 74.2%; specificity, 86.7%) and a velocity time integral of 4.45 cm (sensitivity, 92.0%; specificity, 66.7%).

Left ventricular ejection fraction and velocity time integral provide valuable echocardiographic information for predicting successful weaning from extracorporeal membrane oxygenation in pediatric patients and may support clinical decision-making during weaning assessments.

This scoping review evaluates the physiological, neurodevelopmental, and psychosocial effects of reading interventions on critically ill infants and young children.

Critically ill children, including premature infants and those with critical CHDs, are at elevated risk for neurodevelopmental complications that may be exacerbated by noxious stimuli in hospital settings. Given the increased awareness of the significance of developmental care in the critical care environment and the well-established role of reading and literacy interventions in healthy children, a potential method to improve developmental outcomes for critically ill children is early promotion of literacy. We reviewed reading-based interventions in critical care settings using a scoping review framework.

Searches were performed in clinical literature databases for articles evaluating outcomes consequent to or co-occurring with any neonatal or paediatric intensive care setting intervention involving reading to a child. Data and textual content extracted included measures of child physiological status, length of stay, acuity, stress/pain, health status, quality of life, neurodevelopment, as well as parent psychosocial and emotional functioning.

This review identified multiple potential benefits of reading to critically ill children at the bedside, including improved physiological and early literacy outcomes for paediatric patients as well as heightened senses of self-efficacy and psychological well-being for parents. Due to the observed positive impact and lack of negative effects, current literature about reading interventions in critical care settings indicates that such programmes are likely to be a scalable, inexpensive option for facilitating neurodevelopment and bonding for children and their families.

Transcatheter completion of the extracardiac Fontan provides a minimally invasive option for selected children with single-ventricle physiology who have undergone staged preparation at the time of the bidirectional cavopulmonary connection.

We performed a retrospective single-centre review of consecutive patients treated between 2022 and 2025. Candidate selection, cross-sectional imaging, diagnostic catheterisation, procedural steps, early recovery, and follow-up outcomes were collected.

Five patients underwent transcatheter completion at a median age of 7 years (range 4–17). The interval between the preparatory operation and catheter procedure was 7 months (range 6–9). Median procedure time was 140 minutes (range 120–180). The ICU stay was 2 days (range 1–3), and the total hospital stay was 5 days (range 4–6). Minimal pleural effusions occurred in four patients, none requiring drainage. At a median follow-up of 28 months (range 4–36), all patients were clinically stable; resting oxygen saturation was 96% (range 94% to 97%). One late-presenting patient had biochemical evidence consistent with protein-losing enteropathy but remained asymptomatic without targeted therapy. No thromboembolic events occurred.

In a programme that couples surgical preparation with later catheter-based completion, the extracardiac Fontan can be performed safely and effectively in carefully selected candidates, with rapid recovery and stable mid-term clinical status. Larger studies are needed to define long-term outcomes and comparative effectiveness versus surgical completion.

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

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.

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.

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

Right ventricular outflow tract reconstruction frequently leads to long-term pulmonary failure and ventricular dilation. This study aims to investigate the dynamics of matrix metalloproteinase-2, matrix metalloproteinase-9, and procollagen type-1 N-terminal propeptide in predicting postoperative remodelling and to evaluate the “protective” potential of restrictive right ventricular physiology.

This prospective comparative cohort study included 20 patients undergoing right ventricular outflow tract reconstruction (Research Group) and 20 patients undergoing atrial or ventricular septal defect repair via transatrial approach (Control Group). Biomarker levels were measured using ELISA at preoperative, early postoperative (24–48 hours), and 6-month intervals. Right ventricular geometry was assessed with cross-sectional snapshots at 6 months and 10 years. Right ventricular dilation was defined as right ventricular end-diastolic volume index > 150 ml/m2 or diameter z-score > 2, while preserved geometry was defined as right ventricular end-diastolic volume index < 100 ml/m2 or diameter z-score < 1.5.

Early postoperative biomarker increases were similar (p = 0.310) but differed significantly at 6 months. In the study group, matrix metalloproteinase-2 (p < 0.001) and procollagen type-1 N-terminal propeptide (p = 0.001) levels remained significantly elevated, independent of pulmonary regurgitation severity (p > 0.05). Ten years later, restrictive physiology was observed in 10 patients (50%), representing a progression compared to the 8 patients identified at 6 months.

Persistent elevation of matrix metalloproteinase-2 and procollagen type-1 N-terminal propeptide reflects an active “remodeling” process. Restrictive physiology is associated with the “Biological Banding” mechanism. By increasing myocardial stiffness, this adaptive process is linked to protecting the right ventricle from irreversible dilation under chronic volume overload.

To evaluate left ventricular geometry, haemodynamic load, and inflammatory markers with multisystem inflammatory syndrome in children.

This retrospective study included paediatric patients with a prior diagnosis of multisystem inflammatory syndrome in children who underwent follow-up echocardiography, ambulatory blood pressure monitoring, and laboratory assessments.

Thirty patients (mean age 12.9 ± 5.0 years; 18 boys) were evaluated, including eight (26.7%) who had required an ICU stay during the acute phase. The median interval since the diagnosis of multisystem inflammatory syndrome in children was 48 months (interquartile range 47–50). Body mass index was positively correlated with left ventricular end-diastolic diameter (r = 0.577, p = 0.001), left ventricular end-systolic diameter (r = 0.522, p = 0.002), interventricular septal thickness (r = 0.565, p = 0.001), posterior wall thickness (r = 0.610, p < 0.001), and left ventricular mass (r = 0.594, p = 0.001). Body mass index z-score correlated with interleukin-6 (r = 0.415, p = 0.023), while lymphocyte count correlated inversely with left ventricular end-diastolic diameter (r = −0.559, p = 0.001) and left ventricular mass (r = −0.631, p < 0.001). Multivariate analysis identified lymphocyte count as the only independent predictor of left ventricular end-diastolic diameter [β = −0.492, 95% confidence interval = −0.589 to −0.078, p = 0.013].

Four years after multisystem inflammatory syndrome in children, ventricular enlargement appears to reflect physiological scaling rather than persistent hypertrophy, supporting the need for continued long-term surveillance in this population.

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.

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.

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).

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.