Original Article
Intravenous prostaglandin E1 (alprostadil) bolus in ductus arteriosus-dependent CHD: valid or absolutely contraindicated?
- Jose L. Colín Ortiz, Angel Cruz Hernández, Jorge A. Silva Estrada, Roberto Maldonado Alonso, Carlos A. Corona Villalobos, Carlos González Rebeles Guerrero, Linda F. Pérez Pérez
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- Published online by Cambridge University Press:
- 05 July 2023, pp. 314-318
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The use of prostaglandin E1 is well documented in ductus arteriosus-dependent CHD or in neonatal pulmonary pathologies that cause severe pulmonary hypertension. The intravenous infusion is well established in loading infusion and maintenance with an onset of action of 30 minutes until 2 hours or even more. Our aim is to report three patients with pulmonary atresia that presented hypercyanotic spell due to a ductal spasm during cardiac catheterisation in whom the administration of a bolus of alprostadil reversed the spasm and increased pulmonary flow, immediately stabilising the condition of the patients allowing subsequent successful stent placement with no serious complications or sequelae after the administration of the bolus. More studies are needed to make a recommendation regarding the use of alprostadil in bolus in cases where the ductal spasm might jeopardise the life of the patient.
Do sports protect us from COVID-19? An evaluation of COVID-19 infection, vaccination status, and cardiac examination findings in children who exercise
- Nurdan Erol, Cigdem Erol
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- Published online by Cambridge University Press:
- 12 October 2023, pp. 771-775
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Aim:
The COVID-19 pandemic which has devastated the whole world for the past 3 years affects different patient groups differently. This study aims to evaluate the prevalence, symptoms, and severity of COVID-19 infection, vaccination status, and cardiac pathologies of children who exercise.
Material and methods:The records of the children and adolescents who applied to our paediatric cardiology outpatient clinic for preparticipation examinations between 01.01.22 and 31.12.2022 were scanned retrospectively, and information about their COVID-19 history, the severity of infection, symptoms during the infection, at the time of the examination, and vaccination status was obtained. The results were analysed using MS Excel 2016 software.
Results:The study consisted of 240 children [82 (34.17%) girls and 158 (65.83%) boys] whose mean age was 12.64 ± 2.64 years, mean weight was 50.03 ± 15.53 kg, mean height was 157 ± 15.09 cm, and mean body mass index was 19.65 ± 3.59. 129 cases had a COVID-19 history, 74 cases had no COVID-19 history, and 37 only had contact but no polymerase chain reaction positivity. 84 cases were mild, 19 were moderate, and 12 were asymptomatic. The most common symptoms were fatigue, malaise, headache, sore throat, and fever. 51 cases (35.15%) were vaccinated against COVID-19. No significant cardiac pathologies were detected in electrocardiography or echocardiography
Conclusions:This study shows that COVID-19 infections in children who exercise are generally mild and self-limiting. Our findings suggest that exercise may have positive effects on immunity.
Caregiver and provider attitudes toward family-centred rounding in paediatric acute care cardiology
- Dana B. Gal, Megan Rodts, Brittney K. Hills, Alaina K. Kipps, Danton S. Char, Colleen Pater, Nicolas L. Madsen
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- Published online by Cambridge University Press:
- 18 May 2023, pp. 67-72
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Family-centered rounding has emerged as the gold standard for inpatient paediatrics rounds due to its association with improved family and staff satisfaction and reduction of harmful errors. Little is known about family-centered rounding in subspecialty paediatric settings, including paediatric acute care cardiology.
In this qualitative, single centre study, we conducted semi-structured interviews with providers and caregivers eliciting their attitudes toward family-centered rounding. An a priori recruitment approach was used to optimise diversity in reflected opinions. A brief demographic survey was completed by participants. We completed thematic analysis of transcribed interviews using grounded theory.
In total, 38 interviews representing the views of 48 individuals (11 providers, 37 caregivers) were completed. Three themes emerged: rounds as a moment of mutual accountability, caregivers’ empathy for providers, and providers’ objections to family-centered rounding. Providers’ objections were further categorised into themes of assumptions about caregivers, caregiver choices during rounds, and risk for exacerbation of bias and inequity.
Caregivers and providers in the paediatric acute care cardiology setting echoed some previously described attitudes toward family-centered rounding. Many of the challenges surrounding family-centered rounding might be addressed through access to training for caregivers and providers alike. Hospitals should invest in systems to facilitate family-centered rounding if they choose to implement this model of care as the current state risks erosion of provider–caregiver relationship.
Echocardiographic measured shunt velocity does not predict pulmonary blood flow in patients with Blalock–Thomas–Taussig shunt
- Sarah Tucker, Matthew Cornicelli, Rohit Loomba, Jeremy Fox, Eric Wald, Jamie Penk
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- 02 August 2023, pp. 535-539
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Introduction:
Catheterisation is the gold standard used to evaluate pulmonary blood flow in patients with a Blalock–Thomas–Taussig shunt. It involves risk and cannot be performed frequently. This study aimed to evaluate if echocardiographic measurements obtained in a clinical setting correlate with catheterisation-derived pulmonary blood flow in patients with a Blalock–Thomas–Taussig shunt as the sole source of pulmonary blood flow.
Methods:Chart review was performed retrospectively on consecutive patients referred to the catheterisation lab with a Blalock–Thomas–Taussig shunt. Echocardiographic parameters included peak, mean, and diastolic gradients across the Blalock–Thomas–Taussig shunt and forward and reverse velocity time integral across the distal transverse aorta. In addition to direct correlations, we tested a previously published formula for pulmonary blood flow calculated as velocity time integral across the shunt × heart rate × Blalock–Thomas–Taussig shunt area. Catheterisation parameters included pulmonary and systemic blood flow as calculated by the Fick principle.
Results:18 patients were included. The echocardiography parameters and oxygen saturation did not correlate with catheterisation-derived pulmonary blood flow, systemic blood flow, or the ratio of pulmonary to systemic blood flow. As the ratio of reverse to forward velocity time integral across the transverse aorta increased, the probability of shunt stenosis decreased.
Conclusion:Echocardiographic measurements obtained outside the catheterisation lab do not correlate with catheterisation-derived pulmonary blood flow. The ratio of reverse to forward velocity time integral across the transverse aortic arch may be predictive of Blalock–Thomas–Taussig shunt narrowing; this finding should be investigated further.
Proinflammatory indicators and the relevance of echocardiography in children with cystic fibrosis
- Ovgu Ozenli Yagci, Ayşe Sulu, Pelin Kosger, Gonca Kilic Yildirim, Hulya Anil, Birsen Ucar, Koray Harmanci
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- 19 May 2023, pp. 73-78
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As the life expectancy improves in cystic fibrosis, cardiac dysfunction is becoming an important risk factor for morbidity and mortality. Here, the association of cardiac dysfunction with proinflammatory markers and neurohormones between cystic fibrosis patients and healthy children was investigated. Echocardiographic measurements of right and left ventricular morphology and functions together with levels of proinflammatory markers and neurohormones (renin, angiotensin-II, and aldosterone) were obtained and analysed in a study group of 21 cystic fibrosis children aged 5–18 years and compared with age- and gender-matched healthy children. It was shown that patients had significantly higher interleukin-6, C-reactive protein, renin and aldosterone levels (p < 0.05), dilated right ventricles, decreased left ventricle sizes, as well as both right and left ventricular dysfunction. These echocardiographic changes correlated with hypoxia, interleukin-1 α, interleukin-6, C-reactive protein, and aldosterone (p < 0.05) levels. The current study revealed that hypoxia, proinflammatory markers, and neurohormones are major determinants of subclinical changes in ventricular morphology and function. While the right ventricle anatomy was affected by cardiac remodeling, the left ventricle changes were induced by right ventricle dilation and hypoxia. A significant but subclinical systolic and diastolic right ventricle dysfunction in our patients was associated with hypoxia and inflammatory markers. Systolic left ventricle function was affected by hypoxia and neurohormones. Echocardiography is a reliable and non-invasive method that is used safely in cystic fibrosis children for screening and detection of cardiac anatomical and functional changes. Extensive studies are needed to determine the time and frequency of screening and treatment suggestions for such changes.
Use of the advisor™ HD Grid mapping catheter in transcatheter ablation of atrial arrhythmias in palliated CHD and children without CHD
- Şevket Balli, Pınar Kanlioğlu, Hüsnü F. Altin
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- 12 October 2023, pp. 776-781
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Objective:
In this study, we describe our experience utilising Advisor™ High Density (HD) Grid mapping catheter in transcatheter ablation of intraatrial re-entrant and focal atrial tachycardias with or without CHD.
Methods:Forty-five consecutive patients with intraatrial re-entrant and focal atrial tachycardia who underwent a transcatheter ablation procedure by using Advisor™ HD Grid mapping catheter and high-density mapping system in our hospital from January 2017 to January 2023 were included into the study.
Results:The mean age of the patients was 14.2 ± 7.3 years (6–32 years), and the mean weight was 48.3 ± 16.2 kg (22–83 kg). Of the total 45 patients, 21 were intraatrial re-entrant tachycardia and 25 were focal atrial tachycardia. Of the 21 re-entrant circuits, 15 were classified as cavotricuspid isthmus-dependent and 5 were non-cavotricuspid isthmus-dependent. In one patient, two re-entrant circuits were identified. A transbaffle ablation was successfully performed from the left atrium in one patient. Of the 25 focal atrial tachycardia, 19 were from right atrium and 6 were from left atrium. A cryoablation was performed in only one patient and radiofrequency ablation in others. The mean procedure time was 180 ± 64 minutes. The mean follow-up period was 69.3 ± 35.3 months. Acute success was 95.5%. Recurrence was noted in two patients (4.4%).
Conclusion:Advisor™ HD Grid mapping catheter was found to be safe and achieved an acceptable success in transcatheter ablation of patients with intraatrial re-entrant tachycardia and focal atrial tachycardias.
Impact of overweight and obesity in the fetal cardiac function parameters in the second and third trimesters of pregnancy
- Alberto Borges Peixoto, Nathalie Jeanne Bravo-Valenzuela, Wellington P. Martins, Gabriele Tonni, Antonio Fernandes Moron, Rosiane Mattar, Rodrigo Ruano, Liliam Cristine Rolo, Edward Araujo Júnior
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- Published online by Cambridge University Press:
- 06 July 2023, pp. 319-324
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Objective:
To assess the impact of overweight and obesity in the second and third trimesters of pregnancy on fetal cardiac function parameters.
Methods:We performed a prospective cohort study of 374 singleton pregnant women between 20w0d and 36w6d divided into three groups: 154 controls (body mass index - BMI < 25 kg/m2), 140 overweight (BMI 25–30 kg/m2) and 80 obese (BMI ≥ 30 kg/m2). Fetal left ventricular (LV) modified myocardial performance index (Mod-MPI) was calculated according to the following formula: (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Spectral tissue Doppler was used to determine LV and right ventricular (RV) myocardial performance index (MPI'), peak myocardial velocity during systole (S'), early diastole (E'), and late diastole (A').
Results:We found significant differences between the groups in maternal age (p < 0.001), maternal weight (p < 0.001), BMI (p < 0.001), number of pregnancies (p < 0.001), parity (p < 0.001), gestational age (p = 0.013), and estimated fetal weight (p = 0.003). Overweight pregnant women had higher LV Mod-MPI (0.046 versus 0.044 seconds, p = 0.009) and LV MPI' (0.50 versus 0.47 seconds, p < 0.001) than the control group. Obese pregnant women had higher RV E' than control (6.82 versus 6.33 cm/sec, p = 0.008) and overweight (6.82 versus 6.46 cm/sec, p = 0.047) groups. There were no differences in 5-min APGAR score < 7, neonatal intensive care unit admission, hypoglycemia and hyperglobulinemia between the groups.
Conclusions:We observed fetal myocardial dysfunction in overweight and obese pregnant women with higher LV Mod-MPI, LV MPI' and RV E' compared to fetuses from normal weight pregnant women.
Echocardiographic findings in non-hospitalised children and adolescents following acute COVID-19
- Amanda M. McIntosh, Anmol Goyal, Carol Moser-Dungan, Brian Harvey, Howard J. Heching, Doaa G. Aly, Nitin Madan, Daniel Forsha
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- Published online by Cambridge University Press:
- 10 August 2023, pp. 540-546
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Background:
Although COVID-19 is known to have cardiac effects in children, seen primarily in severe disease, more information is needed about the cardiac effects following COVID-19 in non-hospitalised children and adolescents during recovery. This study aims to compare echocardiographic markers of cardiac size and function of children following acute COVID-19 with those of healthy controls.
Methods:This single-centre retrospective case–control study compared 71 cases seen in cardiology clinic following acute COVID-19 with 33 healthy controls. Apical left ventricle, apical right ventricle, and parasternal short axis at the level of the papillary muscles were analysed to measure ventricular size and systolic function. Strain was analysed on vendor-independent software. Statistical analysis was performed using t-test, chi-square, Wilcoxon rank sum, and regression modelling as appropriate (p < 0.05 significant).
Results:Compared to controls, COVID-19 cases had slightly higher left ventricular volumes and lower left ventricular ejection fraction and right ventricular fractional area change that remained within normal range. There were no differences in right or left ventricular longitudinal strain between the two groups. Neither initial severity nor persistence of symptoms after diagnosis predicted these differences.
Conclusions:Echocardiographic findings in children and adolescents 6 weeks to 3 months following acute COVID-19 not requiring hospitalisation were overall reassuring. Compared to healthy controls, the COVID-19 group demonstrated mildly larger left ventricular size and lower conventional measures of biventricular systolic function that remained within the normal range, with no differences in biventricular longitudinal strain. Future studies focusing on longitudinal echocardiographic assessment of patients following acute COVID-19 are needed to better understand these subtle differences in ventricular size and function.
Disparities in resource utilisation by families of children with cardiac conditions
- Francisca L. Chou, Denis J. Donovan, Rachel J. Weller, Michael A. Fremed, Julie S. Glickstein, Usha S. Krishnan
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- Published online by Cambridge University Press:
- 07 July 2023, pp. 325-333
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Objectives:
There are limited data documenting sources of medical information that families use to learn about paediatric cardiac conditions. Our study aims to characterise these resources and to identify any disparities in resource utilisation. We hypothesise there are significant variations in the resources utilised by families from different educational and socio-economic backgrounds.
Methods:A survey evaluating what resources families use (websites, healthcare professionals, social media, etc.) to better understand paediatric cardiac conditions was administered to caretakers and paediatric patients at Morgan Stanley Children’s Hospital. Patients with a prior diagnosis of CHD, cardiac arrhythmia, and/or heart failure were included. Caretakers’ levels of education (fewer than 16 years vs. 16 years or more) and patients’ medical insurance types (public vs. private) were compared with regard to the utilisation of resources.
Results:Surveys completed by 137 (91%) caretakers and 27 (90%) patients were analysed. Websites were utilised by 72% of caretakers and 56% of patients. Both private insurance and higher education were associated with greater reported utilisation of websites, healthcare professionals, and personal networks (by insurance p = 0.009, p = 0.001, p = 0.006; by education p = 0.022, p < 0.001, p = 0.018). They were also more likely to report use of electronic devices (such as a computer) compared to those with public medical insurance and fewer than 16 years of education (p < 0.001, p < 0.001, respectively).
Conclusion:Both levels of education and insurance status are associated with the utilisation of informative resources and digital devices by families seeking to learn more about cardiac conditions in children.
Mid-term outcomes after catheter ablation in patients with congenital heart disease
- Diogo Faim, Pedro A. Sousa, Carolina Saleiro, Andreia Palma, Andreia Francisco, Natália António, João Cristóvão, Luís Elvas, Lino Gonçalves, António Pires
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- Published online by Cambridge University Press:
- 13 October 2023, pp. 782-787
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Introduction:
Cardiac arrhythmias are a major concern in patients with CHD. The purpose of this study was to evaluate the long-term outcomes in patients with CHD submitted to catheter ablation.
Materials and Methods:Observational retrospective study of patients with CHD referred for catheter ablation from January 2016 to December 2021 in a tertiary referral centre. Acute procedural endpoints and long-term outcomes were assessed.
Results:A total of 44 ablation procedures were performed in 36 CHD patients (55% male, mean age 43 ±3 years). Fifty-four arrhythmias were ablated: 23 cavotricuspid isthmus atrial flutters, 10 atrial re-entrant tachycardias, eight focal atrial tachycardias, eight atrial fibrillations, three atrioventricular re-entrant tachycardias, and two ventricular tachycardias. During a median follow-up time of 37 months (interquartile range 12–51), freedom from arrhythmia recurrence was achieved in 93%, with 1.2 procedures per patient (18% with anti-arrhythmic drugs). There were no adverse events related to catheter ablation. No predictors of recurrence were identified.
Conclusion:In patients with CHD, catheter ablation presents a high mid-term efficacy while maintaining a safe profile.
The epidemiology of CHD in Malta
- Victor Grech, Miriam Gatt, Neville Calleja
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- 10 August 2023, pp. 547-551
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Background:
CHD refers to structural cardiac abnormalities which comprise the commonest group of congenital malformations. Malta is a small island in the central Mediterranean with excellent diagnostic and therapeutic facilities. It is unique in the European population as termination of pregnancy is illegal. This study was carried out to ascertain patterns in CHD prevalence in comparison with EUROCAT data (European Surveillance of Congenital Anomalies).
Methods:Anonymised data were obtained from the EUROCAT website for 1993–2020.
Results:There were a total of 22,833,032 births from all EUROCAT Registries, of which 121,697 were from Malta. The prevalence rate for Malta CHD was 32.38/10,000 births (at the higher end of the range). Malta had a significant excess of commoner, comparatively non-severe CHDs. For most of the severe lesions analysed rates reported were higher than EUROCAT average, however, apart from Ebstein’s anomaly, they all fell within the ranges reported from the different registries.
Discussion:Wide variations in reported CHD prevalence are known, and the Malta rates may be higher for milder defects due to quicker pickup prior to spontaneous resolution. There may also be a higher pickup of milder forms of more severe conditions. For the more severe conditions, lack of termination may be the explanation. These factors may result in the higher neonatal mortality observed in Malta.
Development of the data registry for the Cardiac Neurodevelopmental Outcome Collaborative
- Anjali Sadhwani, Erica Sood, Andrew H. Van Bergen, Dawn Ilardi, Jacqueline H. Sanz, J. William Gaynor, Michael Seed, Cynthia M. Ortinau, Bradley S. Marino, Thomas A. Miller, Michael Gaies, Adam R. Cassidy, Janet E. Donohue, Amy Ardisana, David Wypij, Caren S. Goldberg
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- Published online by Cambridge University Press:
- 19 May 2023, pp. 79-85
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Children with congenital heart disease (CHD) can face neurodevelopmental, psychological, and behavioural difficulties beginning in infancy and continuing through adulthood. Despite overall improvements in medical care and a growing focus on neurodevelopmental screening and evaluation in recent years, neurodevelopmental disabilities, delays, and deficits remain a concern. The Cardiac Neurodevelopmental Outcome Collaborative was founded in 2016 with the goal of improving neurodevelopmental outcomes for individuals with CHD and pediatric heart disease. This paper describes the establishment of a centralised clinical data registry to standardize data collection across member institutions of the Cardiac Neurodevelopmental Outcome Collaborative. The goal of this registry is to foster collaboration for large, multi-centre research and quality improvement initiatives that will benefit individuals and families with CHD and improve their quality of life. We describe the components of the registry, initial research projects proposed using data from the registry, and lessons learned in the development of the registry.
Acute kidney injury in hypoplastic left heart syndrome patients following the comprehensive stage two palliation
- Tyler W. Cunningham, Shasha Bai, Catherine D. Krawczeski, John D. Spencer, Christina Phelps, Andrew R. Yates
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- 11 August 2023, pp. 552-558
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Background:
An alternative surgical approach for hypoplastic left heart syndrome is the Hybrid pathway, which delays the risk of acute kidney injury outside of the newborn period. We sought to determine the incidence, and associated morbidity, of acute kidney injury after the comprehensive stage 2 and the cumulative incidence after the first two operations in the Hybrid pathway.
Design:A single centre, retrospective study was conducted of hypoplastic left heart patients completing the second-stage palliation in the Hybrid pathway from 2009 to 2018. Acute kidney injury was defined utilising Kidney Diseases Improving Global Outcomes criteria. Perioperative and post-operative characteristics were analysed.
Results:Sixty-one patients were included in the study cohort. The incidence of acute kidney injury was 63.9%, with 36.1% developing severe injury. Cumulatively after the Hybrid Stage 1 and comprehensive stage 2 procedures, 69% developed acute kidney injury with 36% developing severe injury. The presence of post-operative acute kidney injury was not associated with an increase in 30-day mortality (acute kidney injury 7.7% versus none 9.1%; p = > 0.9). There was a significantly longer median duration of intubation among those with acute kidney injury (acute kidney injury 32 (8, 155) hours vs. no injury 9 (0, 94) hours; p = 0.018).
Conclusions:Acute kidney injury after the comprehensive stage two procedure is common and accounts for most of the kidney injury in the first two operations of the Hybrid pathway. No difference in mortality was detected between those with acute kidney injury and those without, although there may be an increase in morbidity.
The retirement years of Doctor Helen B. Taussig: an intersection of art and medicine
- Richard D. Mainwaring, Stephanie Mainwaring
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- 10 July 2023, pp. 334-347
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Dr Helen B. Taussig (1898–1986) worked a paediatric cardiologist at the Johns Hopkins University in Baltimore, Maryland from 1930 to 1963. Dr Taussig would become world-renowned for her contributions to the systemic-to-pulmonary artery shunt to treat congenital heart patients with cyanosis. This shunt would eventually be named after the surgeon/cardiologist as the Blalock–Taussig shunt. Dr Taussig’s name was also attached to the description of one form of double outlet right ventricle called the Taussig-Bing malformation. Dr Taussig ultimately received the Presidential Medal of Freedom in 1964 as a testimony to her life-long contributions to the field of congenital heart surgery.
In 1963, Dr Taussig retired from clinical practice but continued her teaching and academic pursuits at Johns Hopkins for another 14 years. Upon her “second retirement” in 1977, she moved to Kennett Square, PA. This paper will review the retirement years of Dr Helen Taussig and the curious intersection between art and medicine.
Correlation of n-terminal pro-brain-type natriuretic peptide levels with the severity of single mitral regurgitation or accompanied by mild aorta valve dysfunction in patients with rheumatic heart disease in Sanglah general hospital
- Ricky Saunders, Eka Gunawijaya, I Nyoman Budi Hartawan, I Gusti Ngurah Sanjaya Putra, Anak Agung Ngurah Ketut Putra Widnyana, Made Sukmawati
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- Published online by Cambridge University Press:
- 13 October 2023, pp. 788-792
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Background:
The most frequent abnormality of the valves involved in rheumatic heart disease is mitral regurgitation. A promising supportive diagnostic tool for rheumatic heart disease is the N-terminal pro-brain natriuretic peptide, which can identify mitral valve damage.
Objective:To prove a positive correlation between N-terminal pro-brain natriuretic peptide levels and the severity of mitral regurgitation or accompanied by mild aortic valve dysfunction in children with rheumatic heart disease.
Material and method:Children aged 1–18 years who had been identified as having rheumatic heart disease with a single mitral regurgitation or accompanied by mild aortic issues at Sanglah General Hospital, Denpasar, met the inclusion criteria for this cross-sectional study. Mitral regurgitation severity was determined using the parameters of vena contracta width, effective regurgitation orifice area, regurgitant jet area, and regurgitation volume. Bivariate analysis using the Spearman correlation test.
Results:From 36 research subjects, the mean age was 11.32 years. In this study, there was a moderate positive correlation between the levels of N-terminal pro-brain natriuretic peptide and the regurgitation jet area. N-terminal pro-brain natriuretic peptide levels also had a moderately positive correlation with the vena contracta width and a weakly positive correlation with the regurgitation volume. Effective regurgitation orifice area and N-terminal pro-brain natriuretic peptide levels did not significantly correlate.
Conclusion:There was a moderately positive correlation between N-terminal pro-brain natriuretic peptide levels and the severity of mitral regurgitation on regurgitation jet area, a moderately positive correlation with the vena contracta width, and a weakly positive correlation with regurgitation volume in rheumatic heart disease patients.
Effect of comprehensive nursing methods in postoperative ICU of children with CHD
- Shaoyan Lin, Qiong Gao, Xiaoxia He, Zhirong Zhao
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- 25 May 2023, pp. 86-91
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To explore effect of comprehensive nursing in postoperative ICU of children with CHD. The subjects were 50 cases of children with CHD treated in our hospital: 25 cases in the control group: routine nursing, and 25 cases in the observation group: comprehensive nursing intervention. The effective rate of 92.00% in the observation group was significantly higher. The serum-free calcium value (1.07 ± 0.11) mmol/L of the observation group on the first day after surgery was significantly lower, and the observation group’s creatine phosphate, the daily average dosage of creatine phosphate per unit body weight was significantly higher. 96.00% of patients in the observation group were significantly higher in nursing satisfaction. The complication rate of 8.00% in observation group was significantly lower. In order to successfully complete the operation schedule and improve the postoperative recovery effect of children, high requirements are placed on nursing staff. The comprehensive nursing method used in the postoperative ICU of children with CHD can reduce the incidence of postoperative complications and improve nursing satisfaction.
Kawasaki disease: patients’ transition journey and recommendations for adult care
- Nita Chahal, Janet Rush, Arnelle Lardizabal, Rita Nobile, Christian Delayun, Tanveer Collins, Sara Thorne, Brian W. McCrindle
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- Published online by Cambridge University Press:
- 13 October 2023, pp. 793-802
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Background:
Children who develop coronary artery aneurysms after Kawasaki disease are at risk for cardiovascular morbidity, requiring health care transition and lifelong follow-up with an adult specialist. Follow-up losses after health care transition have been reported but without outcome and patient experience evaluation.
Objective:The Theoretical Domains Framework underpinned our aim to explore the required self-care behaviours and experiences of young adults’ post-health care transition.
Methods:A qualitative description approach was used for virtual, 1:1 interviews with 11 participants, recruited after health care transition from a regional cardiac centre in Ontario. Directed content analysis was employed.
Results:Health, psychosocial, and lifestyle challenges were compounded by a sense of loss. Six themes emerged within the Theoretical Domains Framework categories. Participants offered novel health care transition programme recommendations.
Conclusions:The realities of health care transition involve multiple, overlapping stressors for young adults with Kawasaki disease and coronary artery aneurysms. Our findings will inform a renewed health care transition programme and will include outcome evaluation.
Using nomogram scores to predict the early regression of coronary artery aneurysms of Kawasaki disease
- Yunru He, Shuran Shao, Yanni Qiao, Nanjun Zhang, Xue Gong, Yimin Hua, Kaiyu Zhou, Yifei Li, Xiaoliang Liu, Chuan Wang
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- 10 July 2023, pp. 348-355
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Background:
Coronary artery aneurysms have been considered the most serious complication of Kawasaki disease. However, some coronary artery aneurysms do regress. Therefore, the ability to predict the expected time of coronary artery aneurysm regression is critical. Herein, we have created a nomogram prediction system to determine the early regression (<1 month) among patients with small to medium coronary artery aneurysms.
Methods:Seventy-six Kawasaki disease patients identified with coronary artery aneurysms during the acute or subacute phase were included. All the patients who met inclusion criteria demonstrated regression of coronary artery aneurysms within the first-year post Kawasaki disease diagnosis. The clinical and laboratory parameters were compared between the groups of coronary artery aneurysms regression duration within and beyond 1 month. Multivariate logistic regression analysis was used to identify the independent parameters for early regression based on the results from the univariable analysis. Then nomogram prediction systems were established with associated receiver operating characteristic curves.
Results:Among the 76 included patients, 40 cases recovered within 1 month. Haemoglobin, globulin, activated partial thromboplastin time, the number of lesions, location of the aneurysm, and coronary artery aneurysm size were identified as independent factors for early regression of coronary artery aneurysms in Kawasaki disease patients. The predictive nomogram models revealed a high efficacy in predicting early regression of coronary artery aneurysms.
Conclusion:The size of coronary artery aneurysms, the number of lesions, and the location of aneurysms presented better predictive value for predicting coronary artery aneurysms regression. The nomogram system created from the identified risk factors successfully predicted early coronary artery aneurysm regression.
The effect of smartphone addiction on vessel wall thickness, which is a predictor of atherosclerosis
- Ibrahim Emre Erden, Gökhan Bektaşoğlu
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- 11 August 2023, pp. 559-562
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Aim:
The increasing global popularity of smartphone usage has increased concerns about the negative effects of smartphone addiction, such as lack of sleep, sedentary life, bad eating habits, anxiety, stress, and depression, especially among the young population. These problems caused by smartphone addiction are also well-known risk factors for atherosclerosis. However, according to our observation, there is no research in the literature that directly shows the relationship between smartphone addiction and subclinical atherosclerosis. In this study, carotid intima-media thickness, an important surrogate marker in demonstrating subclinical atherosclerosis, was used to examine the relationship between smartphone addiction and subclinical atherosclerosis.
Materials and method:This cross-sectional study was conducted on 96 high school students aged between 13 and 22 years. A smartphone addiction questionnaire consisting of 33 questions was applied to measure smartphone addiction. Along with the socio-demographic characteristics of the patients, factors such as eating habits, sleep patterns, and activity levels were also questioned. The mean carotid intima-media thickness was measured by an experienced sonographer according to the published and accepted methods.
Results:When we set the threshold for smartphone addiction at over 66 points, we discovered that the group with smartphone addiction had considerably thicker carotid intima-media (0.68 ± 0.2 versus 0.45 ± 0.1; p < 0.001). In addition, logistics regression analysis had shown that smartphone addiction level independently affects the carotid intima-media thickness (odds ratio:1.111; %95 GA:1.057–1.168, p < 0.001).
Conclusion:Smartphone addiction may help prediction of subclinical atherosclerosis via carotid intima-media thickness among teenagers.
Risk Factors for Adverse Outcomes in Term Infants with CHD and Definitive Necrotising Enterocolitis
- Anna M. Deitch, Katie Moynihan, Robert Przybylski, Kimberlee Gauvreau, Nancy J. Braudis, Bethany Farr, Biren Modi, Kimberly I. Mills, Meena Nathan, Philip T. Levy
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- Published online by Cambridge University Press:
- 25 May 2023, pp. 92-100
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Objectives:
To define the incidence of definitive necrotising enterocolitis in term infants with CHD and identify risk factors for morbidity/mortality.
Methods:We performed a 20-year (2000–2020) single-institution retrospective cohort study of term infants with CHD admitted to the Boston Children’s Hospital cardiac ICU with necrotising enterocolitis (Bell’s stage ≥ II). The primary outcome was a composite of in-hospital mortality and post-necrotising enterocolitis morbidity (need for extracorporeal membrane oxygenation, multisystem organ failure based on the paediatric sequential organ failure assessment score, and/or need for acute gastrointestinal intervention). Predictors included patient characteristics, cardiac diagnosis/interventions, feeding regimen, and severity measures.
Results:Of 3933 term infants with CHD, 2.1% (n = 82) developed necrotising enterocolitis, with 67% diagnosed post-cardiac intervention. Thirty (37%) met criteria for the primary outcome. In-hospital mortality occurred in 14 infants (17%), of which nine (11%) deaths were attributable to necrotising enterocolitis. Independent predictors of the primary outcome included moderate to severe systolic ventricular dysfunction (odds ratio 13.4,confidence intervals 1.13–159) and central line infections pre-necrotising enterocolitis diagnosis (odds ratio 17.7, confidence intervals 3.21–97.0) and mechanical ventilation post-necrotising enterocolitis diagnosis (odds ratio 13.5, confidence intervals 3.34–54.4). Single ventricle, ductal dependency, and feeding related factors were not independently associated with the primary outcome.
Conclusions:The incidence of necrotising enterocolitis was 2.1% in term infants with CHD. Adverse outcomes occurred in greater than 30% of patients. Presence of systolic dysfunction and central line infections prior to diagnosis and need for mechanical ventilation after diagnosis of necrotising enterocolitis can inform risk triage and prognostic counseling for families.