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

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

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

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

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

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

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

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

CHDs, affecting 1.1% of newborns, are the most prevalent congenital anomalies. Improved survival rates expose children with CHD to long-term risks such as metabolic and acquired cardiovascular disorders. Despite physical activity’s benefits, participation is often limited by real and perceived safety concerns. This study evaluates awareness and practice of physical activity among Omani children with CHD.

To quantify physical activity levels and identify influencing factors in Omani children with CHD.

This cross-sectional study, conducted at major Omani paediatric cardiology centres, surveyed parents of children aged 5–18 years with CHD attending clinics from January 2019 to January 2023. A validated questionnaire assessed activity levels and influencing factors. Children with recent surgery (<3 months), single ventricle, cardiomyopathies, or without parental consent were excluded.

Among 412 children, mean weekly physical activity was 2.18 hours. Parental participation in sports (β = 0.42, p < 0.001) and cardiologist encouragement (β = 0.38, p < 0.001) significantly increased activity levels. Children in houses (64% participation) were more active than those in apartments (34%, p = 0.004). Acyanotic CHD was associated with higher participation (66%) than cyanotic CHD (45%). Gender, parental education, and surgical history were not significant predictors.

Omani children with CHD engage in insufficient physical activity. Parental involvement and cardiologist guidance are critical drivers. We recommend targeted educational programmes and routine exercise counselling to enhance participation.

This study aimed to evaluate the results of interstage home monitoring program and its impact on outcomes after initial univentricular palliation.

Patients with univentricular hearts who survived the initial palliation and were discharged from the hospital between 2013 and 2022 were included. The interstage outcomes in patients who received home monitoring program were evaluated, and survival was compared with those who did not.

Among 207 patients included, initial palliation consisted of 117 Norwood procedures, 58 aortopulmonary shunts, 28 ductal stents, and 7 pulmonary artery bandings. Home monitoring program was feasible in 187 (90.3%) patients. Survival after hospital discharge was higher in patients with home monitoring program compared to those without (93.0 vs. 82.9% at 180 days, p = 0.012). In 187 home monitoring program patients, events occurred in 98 patients (52.4%), including 77 low oxygen saturations (41.2%), 22 infections (11.7%), 10 stagnations of weight gains (5.3%), 6 hypoxaemic attacks (3.2%), and 4 side effects of vaccinations (2.1%). Additionally, 62 patients (37.1%) needed an unplanned hospital readmission. They were more frequent after ductal stent than other procedures (22.6 vs. 10.5%, p = 0.034) and had a lower weight at the time of bidirectional cavopulmonary shunt (5.0 vs. 5.4 kg, p = 0.021). Among them, 32 patients (47.1%) needed catheter interventions, and 10 (14.7%) underwent additional surgical procedures prior to bidirectional cavopulmonary shunt. Survival after bidirectional cavopulmonary shunt was similar between the groups (94.4 vs. 96.6% at 360 days, p = 0.807).

Home monitoring program improved interstage survival between stages I and II. However, unanticipated readmissions were frequent during this period, and various catheter and surgical interventions were mandatory before bidirectional cavopulmonary shunt.

Infants with single ventricle CHD commonly experience gross motor delays due to physiological and environmental factors, including increased risk for white matter injury, reduced aerobic capacity, restrictive post-operative protocols, and limited movement opportunities. These delays persist in adolescence, affecting physical and social development. This study examines a quality improvement initiative within the National Pediatric Cardiology Quality Improvement Collaborative to enhance gross motor development.

Fifteen centres participated. Gross motor skills were assessed using the Ages and Stages Questionnaires, Third Edition, at 6 and 12 months. A key driver diagram, Plan-Do-Study-Act cycles, baseline data, and ongoing process measures were collected. Interventions were implemented, including education, therapy support, and mobilisation protocols. Control charts were used to evaluate the data.

Scores from the Ages and Stages Questionnaires indicated delays in gross motor skills at baseline, with improvement over time. Participating centres showed a centerline shift from 41% to 89% of infants achieving on-target or improved motor scores, compared with 54% to 68% of infants at non-participating centres. Establishment of customised infant developmental plans increased from 62% to 74% for participating centres and from 53% to 61% for non-participating centres. Interventions included establishing processes for consistent screening, developmental plan administration, review of prone positioning, access to therapies, and early intervention referrals.

This targeted quality improvement project increased the use of inpatient practices to support gross motor development for infants with single ventricle CHD. Collaborative, interdisciplinary efforts remain critical for addressing neurodevelopmental challenges in this high-risk population.

The KONAR-MF™ occluder, with its flexible medium-profile design, has broadened the feasibility of transcatheter closure of muscular ventricular septal defects, particularly in infants.

To assess feasibility, safety, techniques, and outcomes of muscular ventricular septal defect closure using the KONAR-MF™ occluder in a multicentre paediatric cohort.

A retrospective review was conducted at three tertiary paediatric cardiac centres (2018–2024). Patient demographics, ventricular septal defect characteristics, procedural approaches, and follow-up outcomes were analysed. Device implantation was performed via retrograde, antegrade, transseptal, or hybrid approaches under fluoroscopic and echocardiographic guidance.

Fifty patients (54 devices) were included (median age: 48 months [interquartile range 12–96]; weight: 12 kg [interquartile range 7.5–23]), including 14 infants (9 < 7 kg). Indications were failure to thrive (46%), heart failure (28%), recurrent infections (12%), and postoperative residual ventricular septal defect (14%). The mean ventricular septal defect size was 5.8 ± 2 mm. Median fluoroscopy time was 18 minutes (range: 3–71). Residual shunts were present in 18% immediately, reducing to 9% at one week and resolving by three months. Mild, transient tricuspid regurgitation occurred in 14%. Over a median 9-month follow-up (range 1–60), no cases of heart block or haemolysis occurred. One embolisation required surgical retrieval. Pulmonary artery pressure decreased significantly (37 ± 13.4 to 19 ± 3.8 mmHg, p < 0.001).

Transcatheter closure of muscular ventricular septal defects with the KONAR-MF™ occluder is safe, effective, and versatile across paediatric age groups, including infants and postoperative cases. High success rates, minimal complications, and favourable short- to mid-term outcomes support its use in routine practice.

Cardiopulmonary bypass-induced inflammation is associated with poor postoperative outcomes. Bypass exposure has been associated with shifts in lymphocyte populations. This study aimed to describe two cytokine profiles associated with T and NK cells and their effects on clinical markers of postoperative cardiovascular dysfunction in children undergoing cardiac surgery with cardiopulmonary bypass.

Children from two major children’s hospitals undergoing corrective cardiac surgery with cardiopulmonary bypass were included. Plasma was collected pre-, 0 to 4 hours post- and 24 hours (when available) postoperatively. Plasma concentrations of cytokines were quantified using enzyme-linked immunosorbent assays. Delta cytokine concentrations were compared to vasoactive infusion score and percent fluid balance on postoperative day one. Vascular reactivity was assessed in a subset of the cohort. Confirmation of endothelial-specific effects of interferon-γ and interleukin-17A was performed in microvascular endothelial cells, assessing cytokine levels by enzyme-linked immunosorbent assays or trans-endothelial electrical resistance.

A total of 26 children were included in the analysis. Interferon-γ was inversely associated with vasoactive infusion score (p < 0.05), whereas interleukin-17A and interleukin-23 were associated with greater cumulative postoperative fluid balance (p < 0.01 and 0.03, respectively). Peak vascular reactivity is strongly associated with interferon-γ (p = 0.001), but not with circulating interleukin-17A. Human microvascular endothelial cell exposure to interferon-γ increased endothelial permeability and cytokine production.

Interferon-γ and interleukin-17A may be associated with cardiovascular dysfunction in children after exposure to cardiopulmonary bypass, albeit with differential clinical features. Interferon-γ may directly impact vascular measures, while the impact of interleukin-17A may relate to fluid accumulation.

As patients progress through single-ventricle palliation, changing haemodynamics and patient conditions can prevent progression to Fontan. We sought to determine the incidence of Fontan completion at our institution and to investigate the reasons for non-Fontan candidacy.

Patients who underwent superior cavopulmonary anastomosis from 2010 to 2020 at a single institution were included. Pre-Fontan testing was reviewed for all patients, and the primary reason for non-candidacy was determined based on a review of the electronic medical records.

Of the 427 patients included, 396 (93%) underwent Fontan or were referred for Fontan at the time of the study. Reasons for non-Fontan candidacy in the remaining 31 patients included cardiac reasons (n = 26), mainly univentricular dysfunction or atrioventricular valve regurgitation, respiratory conditions (n = 3), or miscellaneous reasons (n = 2). The patients who were non-Fontan candidates due to respiratory conditions and miscellaneous reasons are all alive without further palliation at the time of the study. There are 17 patients (17/31; 55%) in the non-candidacy group who had a heart transplant or were listed for transplant at the time of the study. Non-Fontan candidates had a higher incidence of moderate or severe atrioventricular valve regurgitation prior to superior cavopulmonary anastomosis.

Thirty-one patients (31/427; 7%) were not Fontan candidates at our centre. Our results demonstrate that the reasons for non-Fontan candidacy after completion of stage 2 are broadly due to echocardiographic findings and respiratory concerns. Predicting non-Fontan candidacy prior to superior cavopulmonary anastomosis remains difficult.

Infective endocarditis remains a serious condition. Patients with CHD are particularly susceptible due to structural abnormalities and repeated interventions. However, comparative data on infective endocarditis outcomes in patients with and without CHD stratified by age group remain limited.

We searched PubMed, Embase, and Cochrane for cohort studies comparing infective endocarditis outcomes in CHD versus non-CHD. Risk ratios with 95% confidence intervals were pooled using random-effects models.

We included six observational cohort studies encompassing 180,194 patients, of whom 176,882 were adults and 3312 were children. Overall, 65% of the population were male. Patients with CHD tended to be younger and carried a lower comorbidity burden. CHD was associated with lower in-hospital mortality risk in adults (RR 0.42; 95% CI 0.34–0.53; p < 0.01), whereas children with CHD demonstrated higher risk (RR 1.59; 95% CI 1.08 to 2.32; p = 0.02). Streptococcus infective endocarditis was more common in adults with CHD (RR 1.28; 95% CI 1.09 to 1.50; p < 0.01), while Staphylococcus aureus infective endocarditis was less common in both adults (RR 0.71; 95% CI 0.58 to 0.88; p < 0.01) and paediatric (RR 0.73; 95% CI 0.64 to 0.84; p < 0.01) CHD patients.

In this meta-analysis, mortality patterns in CHD varied by age, with lower mortality in adults and higher mortality in children. Streptococcus infective endocarditis was more common in adults with CHD, whereas Staphylococcus aureus was less frequent across CHD age groups. These results highlight the need for age-specific and individualised endocarditis management in CHD.

Non-code dose boluses of epinephrine are utilised in critically ill paediatric patients during periods of hemodynamic deterioration, often with the hopes of preventing a cardiac arrest. Data regarding the physiologic effects of these administrations are limited. The primary aim of this study was to use high-fidelity physiologic data to characterise the effects of intravenous non-code dose bolus epinephrine.

Paediatric patients in the cardiac ICU who received non-code dose bolus epinephrine were identified. Those who received fluid boluses or chest compressions within 2 minutes of bolus epinephrine were excluded. Autoregressive integrated moving average analyses with exogenous variables were conducted to characterise the time-dependent changes in hemodynamic indices. Cluster analyses were then conducted to determine patterns in hemodynamic changes associated with bolus epinephrine.

A total of 71 non-code dose bolus epinephrine administrations were included in the final analyses. Heart rate, blood pressure, and renal near infrared spectroscopy all demonstrated statistically significant changes after bolus epinephrine administration. Peak change in each was 40%, 52%, and 9%, respectively, with peaks occurring between 60 seconds and 120 seconds after administration. Three response-based clusters were identified.

Non-code dose bolus epinephrine is associated with a significant increase in heart rate, blood pressure, and systemic oxygen delivery. Cluster analysis using the peak change identified distinct clinical clusters.

Although acute type A aortic dissection (ATAAD) is a recognised complication of Turner syndrome, population-level data describing its prevalence and outcomes remain limited.

We queried the National Inpatient Sample (2002–2020) and generated three groups: TS + ATAAD+, TS + ATAAD−, and TS−ATAAD+ in our retrospective observational cohort study. Primary outcomes were ATAAD hospital admission rate and in-hospital mortality; secondary outcomes included length of stay. Sampling weights were applied to all analyses.

A total of 51,426 Turner syndrome hospitalisations were identified. Median ages were 40 years (interquartile range 31–50) for TS + ATAAD+ and 32 years (interquartile range 9–49) for TS + ATAAD− (p < 0.001). Overall, 0.27% of Turner syndrome hospitalisations presented with ATAAD. Compared with TS + ATAAD−, those with ATAAD had higher mortality (13.1% vs 2.1%, p < 0.001) and longer length of stay (median 8 vs 3 days, p < 0.05). Rates of bicuspid aortic valve (34.3% vs 3.5%, p < 0.001), hypertension (46.0% vs 25.7%, p < 0.05), and complete heart block (14.6% vs 0.8%, p < 0.001) were also higher. Multivariable analysis showed bicuspid aortic valve (adjusted odds ratio 24.31, 95% CI 8.8–67.3) and age (adjusted odds ratio 1.02, 95% CI 1.01–1.04) predicted ATAAD. Compared with TS−ATAAD+ patients, those withTS + ATAAD+ were younger (40 vs 68 years, p < 0.001), while mortality, length of stay, hypertension, and bleeding rates were similar.

ATAAD is highly lethal in patients with and without Turner syndrome. In Turner syndrome, ATAAD is associated with higher mortality, longer hospitalisation, and higher rates of bicuspid valve disease and hypertension.

Atrial septal defect is a common CHD, and transcatheter closure is now the gold standard treatment. In an atrial septal defect, left-to-right shunting increases pulmonary blood flow. This study aimed to evaluate early changes in pulmonary artery, pulmonary vein, and inferior vena cava flow parameters following transcatheter closure of an atrial septal defect.

This retrospective study included 31 paediatric patients with haemodynamically significant atrial septal defect (Qp/Qs ≥ 1.5) who underwent transcatheter closure between January 2023 and June 2024. Comprehensive echocardiography was performed 24 hours before and after the procedure. Pulmonary artery and pulmonary vein maximum and mean pressure gradients, velocities, velocity–time integrals, inferior vena cava maximum and minimum diameters, and the inferior vena cava collapsibility index were analysed at both time points using standard transthoracic echocardiographic techniques.

When the data obtained were evaluated, it was observed that pulmonary artery maximum-mean pressure gradient (p < 0.001), pulmonary artery maximum-mean velocity (p < 0.001), pulmonary artery velocity–time integral (p < 0.001), pulmonary vein maximum pressure gradient (p < 0.001), pulmonary vein mean pressure gradient (p < 0.05), inferior vena cava maximum and minimum diameters (p < 0.001) and inferior vena cava collapsibility index (p < 0.05) decreased statistically significantly after transcatheter closure compared to before.

The duration of remodelling in both the right and left atrial structures following transcatheter atrial septal defect closure depends on the extent of early changes in flow parameters. Our findings suggest that the inferior vena cava collapsibility index may serve as a simple, non-invasive indicator for closure criteria in future studies.

Following paediatric and congenital heart surgery, recognition of rehabilitation needs is variable. This study aims to identify rehabilitation needs and gaps in care for patients in a post-operative congenital heart clinic.

Retrospective review of all patients following congenital heart surgery requiring sternotomy attending their first post-operative clinic appointment between 1/21/2022 and 8/18/2023. Physical therapy evaluation included assessment of posture, mobility, and pain. Patient demographics and clinical data were reviewed. Descriptive and univariate statistics were applied.

Two hundred seventeen patients were identified: 88 (40%) infants (<12 months), 34 (16%) toddlers (1–3 years), 43 (20%) school aged children (4–12 years), and 52 (24%) teens/adults (13+ years). Twenty-one (10%) demonstrated no additional physical therapy needs. Eighty-two (28%) needed clarification of sternal precautions. Teens and adults had significantly higher incidence of impaired posture, difficulty sleeping, and pain. Seventy (32%) patients were referred to physical therapy at time of discharge. Among the 147 not referred, 89 (60%) were identified as needing outpatient physical therapy. Physical therapy assessment discovered previously undiagnosed developmental delay in 9 (4%) patients.

Significant physical therapy needs were identified in a congenital heart post-operative clinic, including needs not identified while inpatient. Integrating physical therapy in clinic improves timely access to rehabilitation care in the subacute phase of recovery.

The Family Adaptation study, ancillary to the Single Ventricle Reconstruction Trial, examined the prevalence of anxiety and its associations with stress, psychosocial factors, and quality of life measures in parents of infants who underwent the Norwood procedure.

Two hundred and fifteen parents (143 mothers and 72 fathers) of 146 infants completed state anxiety (State Anxiety Inventory), stress, psychosocial, and quality of life measures post-Norwood, post-Stage II, and at a final visit (median child age: 14 months).

A substantial proportion of parents reported severe anxiety symptoms following the Norwood surgery, with 61% of mothers and 43% of fathers affected, decreasing over time to 46% and 33% by the final visit, respectively. Mothers’ average STAI-S scores were significantly higher than fathers’ post-Norwood (47.7 ± 13.2 versus 43.5 ± 11.8, p = 0.03), declining to 42.1 ± 13.0 versus 39.0 ± 9.6 (p = 0.14) at the final visit. Stress related to parenting a child with a serious illness was a stronger and more consistent predictor of mothers’ anxiety over time (highest R2 = 0.49 for emotional distress), whereas insufficient coping and fewer protective factors were greater and more consistent predictors for fathers (highest R2 = 0.40 for mastery and health). Quality of life was a consistent predictor of state anxiety for both mothers and fathers.

Anxiety is elevated in parents of infants who underwent the Norwood procedure and is influenced by a complex interplay of stress, psychosocial factors, and quality of life. Addressing these factors is crucial for improving parents’ mental health, which in turn promotes the well-being of the entire family.