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.

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.

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.

Mahaim ablation poses a significant challenge among accessory pathway ablations. This study aims to present our findings on Mahaim ablation performed using a contact force catheter, emphasizing both the effectiveness and safety of this technique.

This is a single-centre retrospective cohort study. Twenty-two consecutive patients who underwent Mahaim pathway ablation procedures between January 2017 and January 2025 were included in the study. The EnSite Precision System (Abbott, St. Paul, MN, USA) was used to facilitate mapping and to reduce or eliminate the need for fluoroscopy. Ablation was performed using the TactiCath catheter.

The median age was 11 years (range: 7–18). Antidromic tachycardia was induced in all patients with the left bundle block. All patients underwent successful ablation with the TactiCath catheter. Ablation was performed via the jugular approach in 11 patients and via the femoral region in another 11 patients. Ablation procedures were performed under atrial pacing in four patients regarding catheter stabilization. Locations of the Mahaim signals were at the right anterolateral (n = 6), right lateral (n = 7), and right posterolateral (n = 9) tricuspid annulus. The acute success rate was 100% (22/22). Fluoroscopy was not used on any patient. The median procedure time was 132 minutes (range: 72–411). No major complications were observed. One recurrent patient who presented with a tachycardia attack one month later had Ebstein’s anomaly. An ablation procedure was successfully performed from the right lateral region.

In paediatric Mahaim tachycardia ablations, the use of a contact force catheter can be safe and successful.

Transcatheter closure of secundum atrial septal defects is well-established, but data on very large defects requiring 40–50 mm occluders remain limited. This multicenter retrospective study evaluated the safety and efficacy of percutaneous closure using large atrial septal occluders.

Patients undergoing atrial septal defect device closure with 40–50 mm occluders from June 2015 to May 2025 at two tertiary centres were analysed. Patients were grouped by device size: Group A (40–42 mm; n = 34) and Group B (44–50 mm; n = 28).

The cohort (n = 62) had a mean age of 42.07 years with female predominance (70.96%). Mean atrial septal defect size was 33.03 mm (thick-to-thick: 38.71 mm), with mean pulmonary artery pressure of 22.33 mmHg and left ventricular end-diastolic pressure of 12.59 mmHg. Aneurysmal septum with thin or deficient posteroinferior rim was common (77.4% and 19.4%, respectively). Procedural success was 93.5%. Device instability or residual flow led to surgical closure in three cases; one had intraprocedural embolisation. Procedural assistance (balloon/device, etc.) was needed in 93.5%. Fenestrated devices were used in four (6.5%) patients—due to severe pulmonary stenosis, diastolic dysfunction, or pulmonary hypertension. “Cobra” configuration and device bulkiness were noted in 9.7% and 6.5%, respectively. Arrhythmias occurred in 25.8%, mostly transient. One patient developed device-related endocarditis, and one late, unrelated death occurred due to intracranial haemorrhage. At a mean follow-up of 29.29 months, outcomes were satisfactory.

Transcatheter closure of large atrial septal defects with 40–50 mm devices is safe and effective with proper anatomical assessment, procedural planning, and vigilant follow-up in selected patients.

Ventricular perforation is a serious complication of percutaneous myocardial biopsy. Accurate orientation of the biopsy forceps toward the ventricular septum under fluoroscopy is essential to minimise this risk. However, in paediatric patients, variations in ventricular septal orientation complicate proper forceps alignment. No previous studies have addressed this variability in children.

We retrospectively analysed paediatric patients who underwent myocardial biopsy between January 2019 and June 2023. The angle of the ventricular septum relative to the sagittal plane was measured using cardiac CT. Biopsies were performed under fluoroscopic guidance, with individualised angles adjusted to align with the septum. Fluoroscopic images were used to calculate the angle between the biopsy forceps and the septum and the combined angle relative to the sagittal plane.

Sixteen patients underwent a total of 85 biopsies; only the first biopsy per patient was included in the analysis. The mean angle of the septum was 54.3° (range: 30.0–75.0°), the mean angle between forceps and septum was 21.3° (range: 3.5–53.4°), and the combined angle relative to the sagittal plane was 75.6° (range: 45.0–115.7°). No cases of ventricular perforation were observed.

Ventricular septal orientation varies significantly in paediatric patients. Individualised adjustment of fluoroscopic angles based on pre-procedural CT measurements allows accurate positioning of biopsy forceps and may reduce the risk of severe complications.

This study compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD and identified predictors of special education or early intervention plan.

Data were analysed from the 2022 National Survey of Children’s Health using complex weighted survey data procedures. Chi-square tests compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD. Multivariate logistic regression identified predictors of the need for special education or early intervention plan.

11,097 National Survey of Children’s Health responses pertained to children aged 3–5 years. Children aged 3–5 years with CHD were more likely than heart-healthy peers to be born prematurely, have special healthcare needs, have parent-reported health as “fair” or “poor,” be diagnosed with anxiety, depression, or a developmental disorder, and receive special education or an early intervention plan. Children aged 3–5 years with CHD were less likely to have acquired communication, fine motor, personal social, and problem-solving skills than comparators at the time of the survey, even after adjustment for special healthcare needs. Having public plus private insurance, special healthcare needs designation, and a developmental disorder predicted children aged 3–5 years needing special education or an early intervention plan.

Children with predictors of receiving special education or an early intervention plan may benefit from early identification and support. Further research should investigate the impact of systemic disparities on developmental skill acquisition in children with CHD.

Patients with 22q11.2 deletion are known to have immune abnormalities. Data on the immune profile of non-syndromic patients with conotruncal heart defects are limited.

A prospective study evaluated the genetic and immunological profiles and early to mid-term postoperative outcomes of patients with conotruncal heart defects.

Infants with 22q11.2 deletion had low leukocyte counts, while low total lymphocyte counts were observed in all patients except infants without a genetic syndrome. Reduced CD3+, CD4+, and CD8+ cells were found in 22q11.2 deletion neonates and infants, as well as in infants without a genetic syndrome. Immunoglobulin G, M, and A abnormalities occurred across all groups. T cell receptor excision circle levels were lowest in patients with complex heart defects. Kappa-deleting recombination excision circle levels were increased in patients without a genetic syndrome. Early postoperative infections were frequent in all groups. Neonates with 22q11.2 deletion had longer ICU stay and higher need for antibiotics and hospital readmission at 3 and 6 months of follow-up.

Neonates and infants with conotruncal heart defects have low preoperative T lymphocyte counts, reduced T cell receptor excision circle and immunoglobulin levels, and high incidence of postoperative infections. Higher kappa-deleting recombination excision circle levels compensated the T cell disbalances in patients without a genetic syndrome. The presence of a 22q11.2 deletion with conotruncal heart defects was associated with prolonged mechanical ventilation, longer ICU length of stay, higher need for antibiotic treatment after discharge from the hospital, and readmission risk in neonates after cardiac surgery.

We analysed cardiac MRI and catheterisation variables during pre-Fontan evaluations for associations with major adverse cardiac events including Fontan takedown, mechanical circulatory support, heart transplantation, or death.

In this single-centre retrospective study, we gathered pre-operative MRI and catheterisation data for all patients who underwent Fontan operation at Children’s Medical Center, Dallas, from April 2017 to November 2022. Patients were grouped according to the presence or absence of adverse events, and MRI and catheterisation parameters were compared between groups. We used the Mann–Whitney U Test for non-parametric data, Student’s T-test for parametric continuous variables, and Fisher’s Exact Test for categorical variables.

Of the 119 combined evaluations, 81 proceeded with Fontan palliation. Adverse events were recorded in 10% of patients (n = 8). One had a Fontan takedown, one underwent transplant, one required mechanical circulatory support, and five died in a median 21-month follow-up. Factors significantly associated with adverse events included heterotaxy syndrome (p = 0.04), higher combined pulmonary vascular resistance (p = 0.03), and moderate-severe (≥30%) atrioventricular valve regurgitation (p = 0.046). While combined pulmonary vascular resistance calculated from both catheterisation and MRI data predicted outcome, pulmonary vascular resistance calculated using data solely from catheterisation showed no discriminative ability.

Post-Fontan major adverse cardiac events were associated with heterotaxy syndrome, higher combined pulmonary vascular resistance, and moderate-severe atrioventricular valve regurgitation identified on pre-Fontan MRI and catheterisation. Combined pulmonary vascular resistance using transpulmonary gradient from catheterisation data and effective pulmonary blood flow from MRI data may help predict outcome.

There is currently no established normative data for cardiopulmonary exercise parameters in the semi-supine position. There is conflicting data regarding the impact of a semi-supine body position on the semi-supine recumbent ergometer on cardiopulmonary exercise parameters. The goal of the current study was to match semi-supine recumbent ergometer tests completed in children/adolescents with those completed on the cycle ergometer and treadmill to identify differences in cardiopulmonary exercise parameters between devices.

Maximal semi-supine recumbent ergometer tests were matched by demographics (age, race/ethnicity, sex, height, weight, and body mass index) to tests completed on the cycle ergometer and treadmill. Groups were compared with two-sample T-tests for numeric variables and Fisher’s exact tests for categorical variables.

There was no difference in demographics between groups. Peak cardiopulmonary exercise parameters (watts, oxygen consumption, heart rate, blood pressure, oxygen saturation, minute ventilation, respiratory exchange ratio, respiratory rate, and anaerobic threshold) were unchanged between semi-supine recumbent ergometer and cycle ergometer, but the ventilatory equivalent of carbon dioxide was higher on the cycle ergometer versus semi-supine recumbent ergometer. Anaerobic threshold, peak oxygen consumption, and peak minute ventilation were lower on the semi-supine recumbent ergometer than on the treadmill.

The uniformity in nearly all cardiopulmonary exercise parameters between the semi-supine recumbent ergometer and cycle ergometer suggests that normative data for the cycle ergometer are a reasonable surrogate for normative data on the semi-supine recumbent ergometer until semi-supine recumbent ergometer-specific normative data are developed.

Children with CHD are at risk for neurodevelopmental impairments, and though these are often mild, some children face severe developmental challenges. Both unalleviated pain and exposure to opioids in the neonatal period have detrimental effects on the developing brain.

We developed and implemented a Comfort Curriculum including a standardised sedation pathway, bedside non-pharmacologic reference, and holding guidelines. Our primary aim was to assess the effect of the Comfort Curriculum on opioid exposure. The secondary aim was to assess the effect of the Comfort Curriculum on pain scores in neonates in the first 5 days after surgery. A retrospective cohort study of all cardiac surgical patients ≤30 days of age at the time of their first operation was conducted before and at two points after implementation of the Comfort Curriculum (3 months and 15 months).

We found that initial and maximum opioid infusion rates significantly decreased between the pre-implementation and both post-implementation phases, while pain scores did not increase. The total cumulative opioid doses in the first five post-operative days showed a non-statistically significant decrease in both post-implementation phases compared to the pre-implementation phase, and median pain scores showed a trend towards decreasing in both post-implementation phases.

After implementation of the Comfort Curriculum, we found a significant decrease in the initial and maximum opioid doses and a signal towards a reduction in total opioid dose in the first 5 days after neonatal cardiac surgery.

Critical CHD often requires surgical intervention or results in infant mortality. We aimed to determine the association between critical CHD categories and exposure levels to pollutants.

A retrospective study of n = 1484 infants who underwent complex cardiac surgery in early infancy from 1996 to 2021. The association between critical CHD categories (compared to a reference category with chromosomal abnormality) and exposure levels during early pregnancy to nitrogen dioxide, ozone, fine particulate matter (<2.5 micrometers diameter), and air quality from smoke was determined. Spatial heterogeneity was accounted for using geographically weighted multinomial logistic regression.

For fine particulate matter exposure, 0.34% of locations displayed statistically significant negative associations with critical CHD categories, clustered in Saskatchewan and Manitoba. These regions exhibited small spatial extents. For ozone exposure, 15.1% of locations exhibited statistically significant negative associations with critical CHD categories, with the majority originating from Alberta and a smaller fraction in Saskatchewan. Differences in significant associations with locations were observed before and after spatial adjustment. Air quality from smoke and nitrogen dioxide exposure demonstrated no statistically significant associations with critical CHD categories.

Differences before and after geographic spatial adjustment underscored the importance of accounting for spatial heterogeneity to uncover patterns of association between environmental pollutants and critical CHD categories. The negative associations likely reflected pollution acting as a second hit to markedly increase the risk for critical CHD in those with genetic predisposition.

Our study aimed to explore risk factors for medium–giant coronary artery aneurysms in children with Kawasaki disease.

6,540 eligible children with Kawasaki disease who were diagnosed in Wuhan Children’s Hospital from January 2011 to December 2023 were retrospectively analysed. The clinical and laboratory data were compared between medium–giant group and non–medium–giant group.

A total of 6,540 patients with Kawasaki disease were included, and 162 (2.5%) developed medium–giant coronary artery aneurysms, of whom 56 (0.9%) were giant. Univariate analysis showed a statistically significant difference between the two groups in 22 variables (P< 0.05). The least absolute shrinkage and selection operator regression analysis revealed that intravenous immunoglobulin resistance, haemoglobin, platelet count, and albumin were the most significant risk factors for medium–giant coronary artery aneurysms. The result of binary logistic regression analysis showed that intravenous immunoglobulin resistance (OR = 6.474, 95%CI = 4.399 ∼ 9.528, P< 0.001), platelet count elevation (OR = 1.003, 95%CI = 1.002 ∼ 1.004, P< 0.001), and albumin reduction (OR = 0.912, 95%CI = 0.879 ∼ 0.946, P< 0.001) were independent risk factors affecting the occurrence of medium–giant coronary artery aneurysms, and the area under the curve of the regression model was 0.75, with a sensitivity of 62.3% and a specificity of 79.2%.

Intravenous immunoglobulin resistance, platelet counts elevation, and albumin levels reduction may be significant predictors of medium–giant coronary artery aneurysms and can serve as a reference for early diagnosis of medium–giant coronary artery aneurysms.

Impaired muscle function, aerobic capacity, and fatigue are common in individuals with Fontan circulation. Knowledge regarding the effects of strength training in this population is limited. Therefore, the study aimed to investigate the effects of strength training on dynamic muscle function, aerobic capacity, and fatigue in adults with Fontan circulation compared to matched controls.

In this pilot non-randomised controlled trial, nine patients with Fontan circulation (median age 28.9 years [IQR: 23.4–35.0], 44.4% women) and nine age- and sex-matched controls completed a 10-week strength training intervention. Dynamic muscle function was assessed through shoulder flexion, heel rise, elbow flexion, and knee extension tests. Aerobic capacity was evaluated using cardiopulmonary exercise testing, and fatigue using the questionnaire Multidimensional Fatigue Inventory. All assessments were conducted pre- and post-intervention. Within-group changes were analysed using the Wilcoxon signed rank test and between-group differences using the Mann–Whitney U test.

Patients showed improvements in all muscle function tests post-intervention (shoulder flexions 39.3% [IQR: 18.9–69.7], p = 0.008; heel rise 26.7% [IQR:17.5–58.1], p = 0.008; elbow flexions 57.1% [IQR: 50.0–173.8], p = 0.007; knee extensions 66.7% [24.3–92.9], p = 0.008). The improvements were at comparable levels to controls. Only controls reported reduced fatigue (–19.4% [IQR: –28.7, –10.5], p = 0.01), while patients showed no change (–5.9% [IQR: −25.5, 3.2], p = 0.1). Aerobic capacity remained unchanged. No severe adverse events occurred.

Strength training is safe and improves dynamic muscle function in patients with Fontan circulation, with changes comparable to those of healthy controls. However, the effect of strength training on fatigue and aerobic capacity requires further investigation.

ClinicalTrials.gov, ID: NCT05454254, https://clinicaltrials.gov.

Percutaneous device closure is the preferred method for closing patent ductus arteriosus (PDA), even in preterm infants. We report our experience using the new KONAR-MFO™ ventricular septal defect occluder for transcatheter closure of preterm patent ductus arteriosus as an alternative device in resource-limited centres.

Case 1: A preterm baby with Down’s syndrome and tracheobronchomalacia was born at 29 weeks, weighing 1.68 kg with multiple cardiac defects, including a 4 mm PDA and a 6 mm mid-muscular ventricular septal defect (VSD), stuck on a ventilator. Case 2: Another preterm baby born at 35 weeks, weighing 1.89 kg, with anorectal malformation and a right inguinal hernia. The echocardiogram revealed a 4 mm PDA with severe PAH. In both cases, the patent ductus arteriosus was occluded using a 6 mm × 4 mm Konar MFO device on day 14 (case 1) and day 20 (case 2).

The baby (case 1) was weaned off the ventilator and discharged on the 28th postnatal day at 2.09 kg. As for case 2, the baby was weaned off the ventilator within 2 days and discharged on day 30 at 2.23 kg. A follow-up echocardiogram of both cases confirmed a well-positioned device with no obstructions. At 18 months, in the follow-up, both babies were gaining weight and thriving.

The KONAR MFO device is a safe and effective option for patent ductus arteriosus closure in preterm infants, even in resource-limited settings. Its versatility accommodates various duct sizes and morphologies, and its self-expandable design ensures easy deployment, addressing the anatomical challenges often seen in preterm infants.

Lung ultrasound findings in cardiac patients correlate with mortality, hospital length of stay, and rehospitalisation after surgery. We report a lung ultrasound protocol integrated with echocardiography and its ability to predict adverse events in children after discharge following congenital heart surgery.

A prospective, single-blinded observational trial was performed. Subjects were consecutively identified after Fontan or septal defect repairs. Performed by cardiac sonographers at discharge, lung ultrasound scores were based on the number of B-lines. The primary outcome was subsequent development of new pericardial (≥small) or pleural (>small) effusion.

A total of 86 subjects were identified with adequate imaging for enrolment. Median age was 53 months. Procedures included Fontan (n = 23) and atrial (n = 30), ventricular (n = 28), and atrioventricular (n = 5) septal defect repairs. Lung ultrasound score was correlated with hospital length of stay (ρ = 0.29, p = 0.0066), discharge diuretic score (ρ = 0.38, p < 0.001), and chest tube duration (ρ = 0.25, p = 0.021); score was not correlated with age or weight. Primary outcome occurred in 12 subjects (atrial septal defect = 4, Fontan = 8). A lung ultrasound score ≥3 had a negative predictive value of 93% and an odds ratio of 24.5 (95%CI 5.3–113, p < 0.0001) for the primary outcome. Subjects following Fontan with the lung ultrasound score ≥3 had an odds ratio of 8.3 (95%CI 1.2–59.0, p < 0.036).

Our results suggest that lung ultrasound during discharge echocardiography has encouraging prognostic value for post-operative complications in patients deemed suitable for discharge after congenital heart surgery. Further research is needed to discern how lung ultrasound can be used for goal-directed medical therapy.

Dynamic, data-driven predictors of perioperative mortality risks in preterm/early-term neonates with CHD undergoing cardiac surgery in the first 24 months of life are limited.

To identify risk factors of mortality in the first 24 months of life for pre/early-term neonates with CHD.

Retrospective cohort study of patients <39 weeks of gestation undergoing cardiac surgery within 24 months of life from 2013–2020 at a tertiary care centre. Independent risk factors of mortality within 24 months of life were determined by multivariable Cox regression analysis.

Among the 205 neonates, 33 (16.1%) died within 24 months. Multivariable analysis revealed that high-frequency ventilation (hazard ratio = 5.15; 95% confidence interval): 2.51, 10.6; p < 0.001), extracorporeal membrane oxygenation support (hazard ratio = 5.77; 95% confidence interval: 2.67, 12.5; p < 0.001), and CHD with a palliated circulation (hazard ratio = 6.07; 95% confidence interval: 2.84, 13; p < 0.001) were significant independent risk factors of mortality at any time during the index hospitalisation or the first 24 months of life.

Identifying and re-evaluating risk factors of mortality for preterm/early-term neonates with CHD at any time during the index hospitalisation or the first 24 months of life may guide resource allocation and therapeutic interventions.

Trial registration number and date of registration: IRB P00028833 5/2/2018. Retrospectively registered.