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

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

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

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

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

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

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

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

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

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

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

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

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

Exercise capacity (VO2peak) predicts mortality in adult patients with CHD. There is a lack of paediatric exercise capacity data based on specific CHD lesions, limiting the ability to contextualise interpretation based on expected performance during testing. The primary aim of this study was to establish VO2peak percentiles for paediatric patients with repaired CHD undergoing treadmill-based cardiopulmonary exercise testing (CPET).

Retrospective analysis of CPET data from 2004 to 2022. CPETs were analysed for patients with CHD aged 6–18 years. Patients with repaired CHD were categorised based on their most haemodynamically significant CHD lesion. Percentiles and age-based trends were plotted for each group.

A total of 887 patients were included. CHD patients were divided into ten diagnostic subgroups. The mean percent expected VO2peak for each of the subgroups were as follows: Atrial and ventricular septal defect (94.5 ± 25.1%), pulmonary valve repair (88.1 ± 18.4%), aortic valve repair (92.7 ± 16.4%), tricuspid and mitral valve repair (81.3 ± 20.4%), coarctation of the aorta (93.6 ± 18.8%), transposition of the great arteries (90.5 ± 19.4%), double outlet right ventricle and truncus arteriosus (80.5 ± 16.2%), tetralogy of Fallot (85.6 ± 20.9%), left ventricle dominant Fontan (74.7 ± 18.3%), and right ventricle dominant Fontan (75.7 ± 16.7%).

There is a varying degree of reduced exercise capacity in paediatric patients with repaired CHD. Univentricular hearts and tricuspid and mitral valve repair have the lowest VO2peak. These CHD-specific percentiles may help providers risk-stratify and counsel patients with CHD.

Parental adverse childhood experiences have been associated with poorer health outcomes for children in the general population. This single-centre study examined the prevalence of parental adverse childhood experiences in a sample of young children with single ventricle CHD, the associations between parental adverse childhood experiences and child health outcomes, and the moderating effects of parental stress and social support on the relationship between parental adverse childhood experiences and child health outcomes.

Parents (N = 72) responded to questionnaires assessing demographic characteristics, parental adverse childhood experiences, social support, and stress. Child health outcomes (hospital admissions, length of stay, missed appointments) were assessed via parent-report and medical record review.

Half of parents (52.8%) endorsed exposure to at least one adverse childhood experience. In univariate analyses, children whose parents had a history of adverse childhood experiences were 1.78 times as likely to have more parent-reported hospital admissions (p = 0.002) and 2.22 times as likely to have more missed visits (p = 0.03) compared to children of parents without a history of adverse childhood experiences. Parental social support significantly moderated the relationship between parental adverse childhood experiences and total hospital length of stay (p = 0.03). Specifically, for each unit increase in parents’ social support total score, parents with a history of adverse childhood experiences were likely to have an 83% reduction in their child’s length of stay.

Parental adverse childhood experiences may be associated with poorer single ventricle CHD outcomes. Strengthening parental social support may improve health outcomes for children with single ventricle CHD in the setting of pre-existing psychosocial risk.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To investigate the variations of serum ghrelin levels in children with left-to-right shunt CHD, and analyse the correlation with the geometric structure of the heart. It may provide some clinical guidance for evaluating the early changes of cardiac structure and function in CHD children.

A total of 93 children with left-to-right shunt CHD who were hospitalised to Children’s Hospital of Soochow University from September 2021 to February 2023 were included in the CHD group (of which 58 were ventricular septal defect and 35 were patent ductus arteriosus). In addition, 57 cases (mainly inguinal hernia) were selected as the control group. The corresponding clinical data were recorded, and the fasting serum ghrelin levels of the two groups were detected by enzyme-linked immunosorbent assay on the day of admission. Then, the clinical data and serum ghrelin levels of the two groups were compared, and the Spearman correlation was analysed.

The serum ghrelin level in CHD group was higher than that in control group, and the difference was statistically significant (P < 0.05). Z score of weight for age and Z score of height for age in CHD group were lower than those in control group were statistically significant difference (P < 0.05). But there was no correlation between serum ghrelin and BMI, weight-for-age Z-score, and height-for-age Z-score (P > 0.05). Ghrelin in the enlarged heart group was lower than that in the non-enlarged heart group, and there were statistical significance of among those groups (P < 0.05). There were no significant differences in left ventricular ejection fraction and left ventricular fractional shortening among different cardiac load groups (P > 0.05). The left ventricular end-systolic diameter Z-scores, left ventricular mass Z-scores, left ventricular mass index, and left ventricular end-diastolic volume-scores in the cardiomegaly groupwere higher than those in the non-cardiomegaly group, and those two groups were significantly different (P < 0.05). The relative wall thickness and left ventricular remodelling index in the cardiomegaly group were lower than those in the non-cardiomegaly group, and the differences between the groups were statistically significant (P < 0.05). Serum ghrelin was negatively correlated with left ventricular end-diastolic diameter Z-scores, left ventricular end-systolic diameter Z-scores, and left ventricular end-diastolic volume Z-scores in cardiac indexes (P < 0.05), positively correlated with left ventricular remodelling index (P < 0.05), and had no correlation with relative wall thickness, left ventricular mass Z-scores, and left ventricular mass index (P > 0.05).

The levels of serum ghrelin are increased in CHD children, and serum ghrelin is negatively correlated with left ventricular end-diastolic diameter and left ventricular end-diastolic volume in cardiac geometric structure, and positively correlated with left ventricular remodelling index. Additionally, patients with cardiac enlargement present with a low serum ghrelin level. These findings collectively suggest that serum ghrelin may play a potential role in cardiac remodelling.

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

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

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

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

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

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

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

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

Renal replacement therapy is sometimes utilised after paediatric heart transplant, although current data on this are extremely limited. We sought to identify incidence of renal replacement therapy and patient characteristics, comorbidities, and outcomes when renal replacement therapy was needed around paediatric heart transplant.

The Pediatric Health Information System database was queried for paediatric intensive care patients who underwent a heart transplant from 2018 to 2021. Demographic and clinical data were analysed. Only patients admitted for heart transplant with heart transplant occurring on day 0 of admission were included to ensure that renal replacement therapy was postoperative.

A total of 235 patients who underwent heart transplant were included. Of these, 22 (9.3%) required renal replacement therapy. Mortality during admission was 3.8% in those without renal replacement therapy and 40.9% of patients requiring renal replacement therapy. Renal replacement therapy was associated with cardiomyopathy, infection, rejection, acute kidney injury, acute hepatic failure, and fluid overload.

Renal replacement therapy was utilised in 9.3% of paediatric heart transplant admissions and is associated with increased mortality. Postoperative need for renal replacement therapy is associated with increased mortality and adverse transplant outcomes.

Given the high prevalence of mental health challenges, the field of paediatric cardiology has increasingly recognised the need for integrated and embedded psychosocial programming in cardiology care. In response to this, the University of Michigan Congenital Heart Centre Psychosocial and Educational (M-COPE) Program was established in January 2020. This paper aims to describe the development, current structure, preliminary outcomes, and future directions of the M-COPE Program to inform similar programme development efforts.

Informed by a comprehensive needs assessment (group/individual interviews, patient surveys), the M-COPE Program mission centres on expanding (1) psychosocial clinical services, (2) psychosocial research, (3) mental health training for all learners, and (4) advocacy for improved psychosocial care for paediatric cardiology patients and families.

In its first five years, the M-COPE Program has expanded access to mental health care by increasing the number of psychosocial clinicians, embedding psychology/perinatal psychiatry in select cardiology clinics, and developing novel modes of service delivery through collaborative efforts across our multidisciplinary teams. Training initiatives have included the development of cardiac psychology fellowships and a mental health curriculum for cardiology physician fellows. Research is foundational to the programme, ranging from federally funded research to centre-specific quality improvement projects.

The M-COPE Program has become foundational to our heart centre. Future directions include enhancing psychosocial care at home for patients/caregivers, integration of a perinatal psychiatrist, and wider-scale launch of novel patient-focused initiatives. Continued study of programme impact will be ongoing with key metrics including referral patterns and patient/family outcomes.

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

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

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

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

To examine the accuracy of pulse oximetry in neonates by race and ethnicity.

We performed a single-centre retrospective cross-sectional study in neonates aged ≤ 7 days at Children’s Healthcare of Atlanta in the neonatal and cardiac ICU between 2010 and 2022. Eligible patients had pulse oximetry with arterial oxygen saturation measurements taken within 10 minutes. We evaluated the mean saturation bias, accuracy root mean square, and the frequency of occult hypoxaemia by race and ethnicity.

Of 1645 infants, there were 639 non-Hispanic Black infants (38.8%), 651 non-Hispanic White infants (39.6%), and 215 Hispanic infants (13.1%). The majority had no CHD (71.4%), required respiratory support (81.1%), and had oxygen saturation levels = > 90% (87.6%). The mean pulse oximetry and arterial oxygen measurement time difference was 0.8 minutes. The mean bias and accuracy root mean square were 8.7% and 13.7%, respectively, with no significant difference between the groups (p = 0.91). Occult hypoxaemia was found in 20.5% of infants. Compared to White infants, there were no differences in likelihood of occult hypoxaemia for either Black (adjusted prevalence ratio 1.13 (0.92–1.4), p = 0.24) or Hispanic (1.06 (0.77–1.45, p = 0.72) infants.

There was not a systemic discrepancy in pulse oximetry between racial and ethnic groups as previously described in older children and adults. However, pulse oximetry significantly overestimated arterial oxygen saturation. Future prospective studies that objectively measure skin pigmentation may be able to overcome some of the limitations of our study.

The Fontan procedure enables survival in individuals with univentricular physiology but is associated with progressive circulatory failure. Identifying predictors of adverse outcomes is essential to improve long-term management. This study evaluated five-year outcomes and baseline predictors of major events in a previously characterised paediatric and young adult Fontan cohort.

This retrospective longitudinal study included 51 patients (median age 18 years, interquartile range 11) who underwent comprehensive evaluation between 2018 and 2019, including echocardiography with atrial strain analysis and cardiopulmonary exercise testing. The composite outcome comprised death, heart transplantation listing, hospitalisation for heart failure, or conduit thrombosis. Univariable and multivariable logistic regression identified predictors of adverse outcomes.

During a five-year follow-up, 7 patients (14%) met the composite outcome. Those with events had lower body mass index (19.8 kg/m2 [4.1] vs 16.9 [3.6]; p = 0.007), lower atrial conduit strain (10.95% [8.95] vs 2.8 [6.2]; p = 0.011), reduced peak oxygen uptake, and higher VE/VCO2 slope. In multivariable analysis, lower body mass index (OR 0.49, 95% CI 0.26–0.93; p = 0.028) and reduced atrial conduit strain (OR 0.70, 95% CI 0.51–0.96; p = 0.026) were independently associated with adverse outcome, with excellent model discrimination (AUC = 0.95).

Both nutritional status and atrial functional parameters demonstrated a strong association with the outcome. Reduced atrial conduit strain, reflecting diastolic dysfunction, and lower body mass index, possibly reflecting myopenia or cachexia, identified higher-risk patients and potential areas for intervention. Routine assessment of atrial function and nutritional status should be integrated into clinical surveillance and risk stratification of the Fontan population.

Utilisation of nicardipine in the neonatal and infant period has been historically avoided due to a concern for a more calcium-sensitive myocardium. The aim of this study was to characterise the association between nicardipine and systolic blood pressure in neonates and infants after cardiac surgery.

In this single-centre, retrospective study, patients under 12 months of age who underwent cardiac surgery and received nicardipine for at least one hour were included (September 2022 to January 2024). Patients were monitored with Etiometry. Variables of interest included haemodynamic parameters, ionised calcium, serum lactate, vasoactive infusion score, and nicardipine dose. A time series regression was conducted with each patient having 5 distinct time points.

One hundred and eighty-five time points were collected across 37 patients with a mean age of 3 months. Of these patients, 22% were neonates and 32% were functionally univentricular. With nicardipine utilisation, a decrease in systolic blood pressure of 14 mmHg after an 8-hour time period was noted (p = 0.017). Heart rate, diastolic blood pressure, cerebral and renal oxygen extraction, ionised calcium, serum lactate, and vasoactive inotrope score did not significantly change over the study period.

Nicardipine utilisation in neonates and infants after cardiac surgery was associated with decreased systolic blood pressure. Indirect markers demonstrate no change in cardiac function. Additional studies are needed to better elucidate nicardipine’s role in this patient population.

To evaluate car seat tolerance screening failure rate in infants with CHD, clinical factors associated with test failure, and the impact of a failed test.

Single-centre retrospective study of 193 infants with CHD discharged from a general cardiology service between November 2020 and November 2024. Characteristics were compared between patients who passed and failed car seat testing using Wilcoxon-Mann–Whitney tests for continuous variables, and chi-square or Fisher’s exact tests for categorical variables.

Car seat test failure rate was 6.2% (12 of 193 patients). Neither median birthweight (3.2 kg vs. 3.3 kg, p = 0.68) nor the rate of prematurity (13.8% vs. 16.7%, p = 0.68) differed significantly between passing and failing groups. There was no relationship between cardiac physiology and car seat test failure (p = 0.39). There were no differences in rates of seizure (p = 0.29), stroke (p = 1.00), gastroesophageal reflux disease (p = 0.84), vocal cord dysfunction (p = 1.00), or pulmonary hypertension (p = 1.00) between passing and failing groups. Infants who failed had significantly higher rates of DiGeorge Syndrome (25.0%) compared to those who passed (2.2%) (p = 0.006). Readmission within 30 days of discharge was not different between failing (16.7%) and passing (17.1%) groups (p = 1.00). A failed test delayed discharge by a median of 1.5 days [IQR: 1.0–2.5 days].

The car seat test failure rate of our CHD cohort is higher than the published failure rate for premature infants. There was no relationship between cardiac physiology and test failure. DiGeorge Syndrome was the only comorbidity associated with increased failure rate. Failed car seat tests delay hospital discharge.