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.

The 2025 Global Peace Index highlights that there are now 59 active state-based conflicts, the highest number since the Second World War, and overall levels of peacefulness are at their lowest since the index began. For children with CHD, this escalation means that more regions face disruption of surgical services, growing backlogs of untreated cases, and greater risks of displacement and loss to follow-up.

We aimed to conduct a narrative review mapping existing evidence on the provision, models, outcomes, barriers, and enablers of paediatric cardiac surgery in conflict-affected and disaster settings while identifying gaps to inform future research and practice.

Conflicts and disasters amplify the burden of both congenital and acquired paediatric heart disease, worsened by late presentation and progressive loss of operability. The collapse of hospital infrastructure, targeting of health workers, interruption of supply chains, and diversion of resources to trauma care severely limit the feasibility of surgery. Perioperative challenges, including the absence of paediatric intensive care, infection control difficulties, and disrupted follow-up, frequently compromise outcomes.

Conflict and disaster settings significantly exacerbate existing structural weaknesses in congenital cardiac care and may introduce additional system shocks that disrupt infrastructure, workforce stability, supply chains, and continuity of care. Future humanitarian health frameworks should explicitly include congenital and paediatric cardiac care within non-communicable disease response, supported by pre-positioned critical equipment, telemedicine, and long-term partnerships.

Arrhythmias after paediatric cardiac surgery occur frequently and contribute to postoperative morbidity and mortality. There is limited literature assessing the safety and efficacy of common antiarrhythmics administered in this population.

We systematically searched PubMed and EMBASE for literature on antiarrhythmic use in children <18 years of age after cardiac surgery from 2000 to 2024. Two reviewers independently screened abstracts and then reviewed full-text manuscripts to determine eligibility.

We identified 28 studies of 3,752 patients across 11 different antiarrhythmics: flecainide, procainamide, esmolol, landiolol, propranolol, amiodarone, sotalol, dexmedetomidine, digoxin, ivabradine, and magnesium. Most studies were small, with 17 enrolling fewer than 100 children. Only eight studies were randomised, 16 were retrospective, 12 were prospective, and one was multicenter. Safety and efficacy endpoints varied widely, limiting our ability to combine data for meta-analysis. Overall, evidence supporting the use of these drugs in children after cardiac surgery was limited.

Although antiarrhythmics are commonly used in children after cardiac surgery, randomised trials with standardised endpoints to guide choice of therapy are lacking. Pragmatic trials to generate real-world data should be considered to further evaluate the safety and efficacy of various antiarrhythmics in this population.

Left atrial enlargement is a surrogate marker for disease progression in congenital post-tricuspid left-to-right shunt lesions. Despite advanced imaging, a need persists for a more accessible modality like electrocardiography for early detection of left atrial enlargement. This study evaluates the diagnostic accuracy of established electrocardiography standards and a novel electrocardiography criterion (with altered position of chest leads) in identifying left atrial enlargement in children with post-tricuspid shunt lesions, enabling routine monitoring and timely referrals.

This cross-sectional observational study enrolled 227 children (1 month–18 years) with post-tricuspid shunts (ventricular septal defect, patent ductus arteriosus, and aortopulmonary window). Left atrial volume determined by 2D echocardiography was used as the reference standard to compare the diagnostic accuracy of electrocardiography parameters (negative P-terminal force at V1, P/PR segment, and bifid P wave) in detecting left atrial enlargement. The diagnostic accuracy of a novel method of measuring negative P-terminal force with lead V1 placed at the 2nd right intercostal space was compared with traditional electrocardiography parameters.

Electrocardiography parameters showed diagnostic accuracy of 52.9–61.5%, sensitivity of 32.5–90.8%, and specificity of 17.8–89.7% for left atrial enlargement. Novel P-terminal force in V1 at the 2ndintercostal space (>151.2 mm.ms) had 32.5% sensitivity, 89.7% specificity, and 59.5% accuracy. At the 4th Rt. Intercostal space (novel P-terminal force in V1 ≥40 mm.ms), it had 74.2% sensitivity, 42.1% specificity, and 59.0% accuracy.

Measurement of the terminal negative force of the P wave at 2nd intercostal space has improved the specificity in the detection of left atrial enlargement. Future studies with higher sample sizes in a heterogeneous population might characterise this as a potential tool in detecting left atrial enlargement.

Acute rheumatic fever (ARF) with severe carditis remains a major cause of non-procedural pediatric cardiology admissions in low- and middle-income countries. Data describing the clinical profile and outcomes of children with severe carditis are limited.

This prospective study included 100 children admitted with ARF and severe carditis between 2015 and 2022. Clinical presentation, severity of shock, valvular involvement, ventricular function and management strategies were documented. Outcomes studied included requirement of inotropes, mechanical ventilation, duration of intensive care and hospital stay, intractable heart failure, mortality and need for surgery.

Children were categorized into three groups according to hemodynamic severity. The duration of anti inflammatory treatment was 12 weeks. Group A included 18 children with decompensated shock, severe regurgitation of at least two valves and biventricular dysfunction. These children received pulse methylprednisolone followed by oral prednisolone, inotropes, diuretics and afterload reduction. Intractable heart failure was noted in 9 (50%) with a mortality of 4 (24%) and 5 (28%) requiring emergency surgery. Group B included 32 children with compensated shock and preserved ventricular function. They were treated with oral prednisolone tapered with addition of aspirin. Group C included 50 children without shock or ventricular dysfunction and treated with aspirin. Sixteen and ten children underwent surgery during one year follow-up in groups B and C respectively.

Severe rheumatic carditis continues to cause substantial morbidity and mortality in children. Recurrent disease and multivalvular involvement are associated with poor outcomes. Early recognition, strict secondary prophylaxis and strengthened public health strategies are essential to reduce disease burden.

Feeding difficulties and prolonged reliance on enteral nutrition are common in children with CHD, often leading to tube dependency. Despite its clinical relevance, evidence-based recommendations for tube weaning remain limited.

This study prospectively evaluated outcomes of the “Graz Model of Tube Weaning” in 70 tube-dependent children with CHD (median age 1.67 years) treated between 2016 and 2024. Children participated either in a two-week on-site programme (“Eating School”) or a telemedical home-based programme (“Netcoaching”). Outcomes included weaning success, changes in growth parameters (weight-for-age z-score, height-for-age z-score, standards-z-values for body mass index), treatment duration, feeding-related adverse effects, and caregiver burden.

A total of 98.6% of children (n = 69) transitioned to full oral feeding. Both programmes were effective. Younger children more often enrolled in Netcoaching and required longer treatment durations (median 2.23 vs. 1.48 months, p < 0.05). Adverse effects from tube feeding were prevalent in 97.1% of cases, with oral aversion and vomiting being most common. Temporary but significant decreases in growth parameters were observed in both groups; infants under one year showed greater height reductions in the Eating School cohort. Caregiver burden remained substantial, particularly among mothers. Average treatment duration until tube feeding cessation was 29 days.

Both treatments offer safe, effective methods to help children with CHD transition from enteral to oral feeding. Early intervention with an interdisciplinary, hunger-based approach emphasising autonomy appears advantageous. Further research is needed on long-term growth, nutritional development, motor skills, social interactions, and speech after tube weaning.

Sacubitril/valsartan is widely used in adults with heart failure with reduced ejection fraction, but paediatric experience, especially across ventricular dysfunction phenotypes, remains limited.

To evaluate the efficacy and tolerability of sacubitril/valsartan in children with cardiomyopathy and compare outcomes in patients with predominantly right or left ventricular dysfunction.

This single-centre retrospective study included 33 patients aged 1 month to 18 years who received sacubitril/valsartan between October 2020 and October 2024. Diagnoses included arrhythmogenic right ventricular cardiomyopathy, left ventricular non-compaction, and dilated cardiomyopathy. Patients were stratified by predominant ventricular dysfunction. Echocardiographic parameters, N-terminal pro B-type natriuretic peptide, six-minute walk test, NYHA class, blood pressure, creatinine, and potassium were recorded at baseline and at 1, 3, and 6 months, and at final follow-up. Clinical outcomes included rehospitalisation, death, and heart transplantation or listing.

The cohort included 21 male patients (63.6%), and the median age was 8.6 years. Arrhythmogenic right ventricular cardiomyopathy was present in 45.5%, left ventricular non-compaction in 15.2%, and dilated cardiomyopathy in 39.4%. Left ventricular ejection fraction >45% increased from 39.4% to 72.7%. Mean N-terminal pro B-type natriuretic peptide decreased from 6309 to 3137 pg/mL (p < 0.001). NYHA class improved or remained stable in 93.3% of patients, with greater improvement in left ventricular dysfunction. During a median 17.3-months follow-up, rehospitalisation occurred in 42.4%, and 5 patients died or underwent heart transplantation/listing. Hypotension occurred in 18.2% but was manageable.

Sacubitril/valsartan was generally well tolerated and associated with improved ventricular function, biomarkers, and functional status in paediatric cardiomyopathy, particularly in left ventricular dysfunction.

Both untreated pain and opioid exposure impact neurodevelopment in critically ill infants. We aimed to describe and compare opioid exposure in neonates (30 days of age) post-cardiac surgery.

We conducted a secondary analysis of a single-centre retrospective cohort of all cardiac ICU surgical patients for 30 days. These findings also suggest the need for careful pain assessment and additional strategies to address pain in this vulnerable population.

Survivors of childhood cancer face an increased lifetime risk of cardiovascular disease related to cancer therapies. While paediatric and adolescent cancer cardio-oncology programmes have expanded in high-income settings, their implementation across Latin America remains poorly characterised.

To describe the current landscape of paediatric and adolescent cardio-oncology care in Latin America, focusing on workforce training, clinical infrastructure, diagnostic resources, follow-up strategies, and research capacity.

We conducted a cross-sectional survey of healthcare professionals involved in the care of paediatric and adolescent oncology patients across Latin America. The questionnaire assessed institutional resources, availability of specialised cardio-oncology services, diagnostic modalities, cardioprotective strategies, survivorship follow-up, and training and research activities. Descriptive analyses were performed.

A total of 177 complete surveys were analysed. Most respondents worked in public, tertiary-level institutions. Only 16.4% reported access to cardiologists with formal cardio-oncology training, and 26.0% had a structured cardio-oncology team. While baseline cardiac evaluation was widely performed (77.4%), advanced diagnostic tools such as myocardial strain imaging (35.0%) and cardiac magnetic resonance (22.0%) were infrequently available. Formal long-term cardiovascular follow-up programmes for cancer survivors were present in only 13.6% of institutions, and structured transition to adult cardiology care in 22.0%. Participation in multicentre research and formal training programmes was limited.

Paediatric and adolescent cardio-oncology care in Latin America is characterised by substantial heterogeneity and limited formal infrastructure. These findings highlight critical gaps and underscore the need for regional implementation strategies to improve cardiovascular care across the cancer survivorship continuum.

Pulmonary valve replacement may be required for patients with pulmonary valve disease. Exertional symptoms related to cardiovascular disease are an indication for pulmonary valve replacement; however, quantification of symptom improvement postoperatively is challenging, and previous studies have yielded mixed data. Accelerometry has the potential to remotely monitor changes in exercise tolerance following pulmonary valve replacement.

Individuals (n = 18) age >13 years scheduled for catheter-based or surgical pulmonary valve replacement were prospectively enrolled. Participants were instructed to wear two Link GT9X accelerometers, placed on dominant wrist and one ankle, for seven days and nights before pulmonary valve replacement and again 3–6 months after the procedure.

The cohort’s median age was 26.5 [16.0, 35.0] years old. Compliance of both wrist and ankle accelerometers had a median of 96% or greater at both timepoints suggesting adequate participation. Accelerometry showed stability between participants. Quantitative analysis using pre-and post-pulmonary valve replacement accelerometer-derived measures yielded no significant differences. There was a significant decrease in the average score for items “Shortness of Breath with Strenuous Activity,” “Extent Symptoms Impact Daily Activities,” and “Challenges with Activities of Daily Living.” Furthermore, all 9 individuals with baseline exertional intolerance had resolution of symptom in postoperative assessment.

Reliability of accelerometer-derived activity measurements supports usage of physical accelerometry as a remote outcome measure to reduce patient burden for onsite assessment. Mixed qualitative versus quantitative improvement in physical activity tolerance observed in this study aligns with previous studies on variable improvement in exercise tolerance following pulmonary valve replacement. This discrepancy suggests the need for a different quantitative mechanism to measure benefit.

Glucagon-like-peptide-1 (GLP-1) agonists are beneficial for glycaemic control, weight loss, and cardiovascular health. Because GLP-1 agonists may be a useful tool in the management of obesity in patients with congenital heart disease (CHD), we examined whether GLP-1 agonists are effective and safe for weight loss in adults with congenital heart disease (ACHD) and explored the effects of sex and CHD complexity.

We conducted a retrospective cohort study of ACHD patients who were prescribed a GLP-1 agonist from 1/1/2022–3/31/2024 at Yale New Haven Hospital. Patients were subdivided by CHD anatomic complexity. The primary outcome was the change in weight over time. Side effects were explored as a secondary outcome.

The moderate complexity ACHD group had the fastest weight loss during both the first 6 months and 12 months of treatment, but was comparable to the other two ACHD complexities in the full period of follow-up. Patients in the simple and great complexity groups required 12 months of treatment to reach meaningful weight loss. Females had a faster rate of weight loss compared to males across all ACHD complexity levels. The most common side effects reported were gastrointestinal, such as nausea, acid reflux, and diarrhoea.

This study provides evidence that GLP-1 agonists are effective for weight loss in ACHD patients, with the greatest weight loss in females and patients with moderate ACHD complexity. Moreover, GLP-1 agonists in the ACHD population have a reasonable side effect profile that is typical for these agents.

Developing the next generation of leaders in congenital cardiology is critical to advancing the field. Increasingly, it is recognised that earlier opportunities to establish professional networks, gain unique skills, and disseminate scientific work can be highly beneficial. While cross-institutional collaboration has been successful in supporting quality improvement, it has not been widely used in other areas. We describe our initial experience with a multi-centre congenital heart early-career exchange programme.

Faculty (<10 years from training) among five participating congenital heart centres were eligible to apply. Applications were reviewed and matched with host sites. Visits (typically 3–5 days) included topics spanning research and collaboration, unique clinical programmes/skills, networking, and presenting a formal lecture. All participants were invited to complete an anonymous post-visit survey, with descriptive results reported.

Overall, 20/28 (71%) applicants over the initial two years of the programme were selected for participation. The majority were assistant professors; 75% were <5 years from training. There was an equal distribution of males and females and a diverse range of clinical specialties/areas of interest. Post-visit survey responses (75% response rate) were highly favourable, with 92% indicating “strongly agree” regarding the value of the programme across domains and highlighting valuable exposure to unique clinical and research opportunities, networking, and mentorship.

Initial results from the congenital heart early-career exchange programme highlight the feasibility and positive impact of a collaborative approach to career development. Further efforts should be prioritised to foster broader engagement and impact.

In hypoplastic left heart syndrome with aortic atresia, the non-functional left ventricle may influence right ventricular performance. We evaluated serial changes in tricuspid and mitral valve diameters after the Norwood procedure and their relationship to right ventricular function.

Of 150 patients who underwent the Norwood procedure (2001–2020), 47 died before total cavopulmonary connection. Of the 103 survivors, 76 with sufficient serial echocardiographic data were analysed (1,399 examinations). Tricuspid and mitral valve diameters were measured, and right ventricular function was assessed. Right ventricular dysfunction was defined as any degree of impairment. Mixed-effects models were used to account for repeated measures.

Median follow-up was 4.6 years (IQR 2.4–11.8). Right ventricular dysfunction was observed in 15.9% of examinations. Patients with right ventricular dysfunction had significantly larger tricuspid valve diameters than those with normal function (24.3 mm vs 23.4 mm, p = 0.006), whereas mitral valve diameters showed no significant difference (7.6 mm vs 7.1 mm, p = 0.120). The mitral/tricuspid ratio was similar between groups (0.320 versus 0.324, p = 0.340). Mixed-effects modelling showed that the tricuspid valve diameter remained 0.618 mm larger in the dysfunction group after adjusting for growth over time (p = 0.029). Tricuspid valve diameter differences emerged at the bidirectional cavopulmonary shunt stage and accelerated through Fontan completion (p < 0.001).

In hypoplastic left heart syndrome with aortic atresia, right ventricular dysfunction is associated with progressive tricuspid valve enlargement but not with changes in the mitral/tricuspid ratio. While the stable ratio suggests proportional annular growth, a comprehensive volumetric assessment is needed to clarify ventricular-ventricular interactions.

There has been a growing clinical application of ketamine for procedural sedation. This study aimed to determine its hemodynamic effects when utilized in patients in the pediatric cardiac intensive care unit.

In this single-center, retrospective study, patients who were admitted to the pediatric cardiac intensive care unit and received a single dose of intravenous ketamine were studied. Patients were monitored utilizing high-fidelity physiologic data. Variables of interest for the study included: heart rate, arterial saturation, respiratory rate, mean arterial blood pressure, central venous pressure, and renal near infrared spectroscopy These variables of interest were obtained 30 min prior to the administration of ketamine, through 30 min after, serving as the comparison arm. Secondary aims included unexpected apnea, need for a fluid bolus, vasoactive bolus, or cardiopulmonary resuscitation.

A total of 45 administrations of intravenous ketamine were included. Average dose was 0.8 mg/kg per dose. Average age was 8.1 months. After administration of ketamine, there was a statistically significant increase in heart rate, arterial saturation, renal near infrared spectroscopy and central venous pressure and a statistically significant decrease in respiratory rate and mean arterial blood pressure. No cardiopulmonary resuscitation or bolus vasoactive was required after ketamine administration.

Intravenous ketamine dosed from 0.5 mg/kg to 1 mg/kg per dose in the pediatric cardiac intensive care unit appears safe and is associated with minimal hemodynamic change, apnea, or hemodynamic collapse. This represents the first data related to a single dose of ketamine’s effect captured with a 1-s temporal resolution.

The superior sinus venosus atrial septal defect is situated immediately inferior to the junction of the superior caval vein (SCV) and the right atrium. It is usually associated with partial anomalous pulmonary venous drainage. Surgical correction used to be the only treatment option, but the transcatheter approach using a covered stent has recently evolved substantially.

This is a single-centre retrospective analysis of all patients who underwent transcatheter correction of sinus venosus atrial septal defect in our institution between January 2024 and January 2026. Data was collected from the Adult CHD multidisciplinary meeting records and patients’ medical records. The hospital records, including case notes and other electronic data, were reviewed.

Five patients were treated with transcatheter correction of sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage. All patients were adults with an age range of 30–61 years. Three were males. One patient received a 100-mm Optimus-CVS polytetrafluoroethylene (PTFE)-Covered Stent XXL, whereas all remaining 4 patients received an 80-mm stent. One patient received a second stent for a residual shunt. There were no mortalities or immediate adverse events. The follow-up period at the time of manuscript submission so far is 3–24 months, and no late complications have been observed.

Transcatheter closure of sinus venosus atrial septal defect is a feasible and safe procedure in selected patients with good results. The learning curve is still to be completed, and surgical options are not to be completely abolished.

Despite the effectiveness of the surgical or percutaneous treatment of coarctation of the aorta, the presence of hypertension in these patients remains a common and concerning issue. This study was undertaken to explore the relation between the severity of coarctation of the aorta and renal perfusion and to evaluate the role of renal scintigraphy as a predictive tool for clinical outcomes after percutaneous treatment of coarctation of the aorta.

Adult patients with coarctation of the aorta and concomitant arterial hypertension were enrolled in the study. Ambulatory 24-hour blood pressure monitoring, CT angiography, and a renal perfusion scan were performed, along with invasive pressure gradient measurements. Patients with invasive peak gradients ≥20mmHg and/or a difference of ≥50% in diameter between the isthmus and the descending aorta at the diaphragmatic level were selected for percutaneous stent implantation.

The mean time to peak change in renal scintigraphy after captopril did not significantly differ between the Medical group (−1.01 ± 2.526 min. for the left kidney and −0.19 ± 1.46 min. for the right kidney) and the Stent group (−0.59 ± 1.188 min. for the left kidney and −0.17 ± 1.461 min. for the right kidney) (p-values > 0.05). No statistically significant changes in renal perfusion were observed between pre-and post-stent implantation measurements.

In this pilot study, no clear association was found between the degree of aortic narrowing and renal perfusion, and no measurable reduction in renal perfusion was detected. Stent implantation did not result in significant short-term changes in blood pressure. These findings are exploratory and require confirmation in larger studies.