We report a case of hypoplastic left heart syndrome and with subsequent aortopathy and then found to have hereditary haemorrhagic telangiectasia/juvenile polyposis syndrome due to a germline SMAD4 pathologic variant. The patient’s staged palliation was complicated by the development of neoaortic aneurysms, arteriovenous malformations, and gastrointestinal bleeding thought to be secondary to Fontan circulation, but workup revealed a SMAD4 variant consistent with hereditary haemorrhagic telangiectasia/juvenile polyposis syndrome. This case underscores the importance of genetic modifiers in CHD, especially those with Fontan physiology.

The Editorial Board of Cardiology in the Young has recently discussed the need for a Bioethics Forum and has given authorisation to proceed with its creation. Herein, we provide the organisational structure and launch process to introduce properly this interesting and timely endeavour. By this communication, we are establishing this Bioethics Forum of Cardiology in the Young. We hope to attract manuscripts concerning timely bioethical subjects and to offer the readership the opportunity to respond to these topics with supporting or opposing views as appropriate. New articles regarding timely topics will be written by the readership, as well as by invited authors, and these articles will be published. We hope to stimulate interactive discussion concerning the published manuscripts, and these manuscripts and the associated discussions will be open to all interested parties.

In this paper we present a high repetition rate experimental platform for examining the spatial structure and evolution of Biermann-generated magnetic fields in laser-produced plasmas. We have extended the work of prior experiments, which spanned over millimeter scales, by spatially measuring magnetic fields in multiple planes on centimeter scales over thousands of laser shots. Measurements with magnetic flux probes show azimuthally symmetric magnetic fields that range from 60 G at 0.7 cm from the target to 7 G at 4.2 cm from the target. The expansion rate of the magnetic fields and evolution of current density structures are also mapped and examined. Electron temperature and density of the laser-produced plasma are measured with optical Thomson scattering and used to directly calculate a magnetic Reynolds number of $1.4\times {10}^4$, confirming that magnetic advection is dominant at $\ge 1.5$ cm from the target surface. The results are compared to FLASH simulations, which show qualitative agreement with the data.

Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.

The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.

The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.

We present a new experimental platform for studying laboratory astrophysics that combines a high-intensity, high-repetition-rate laser with the Large Plasma Device at the University of California, Los Angeles. To demonstrate the utility of this platform, we show the first results of volumetric, highly repeatable magnetic field and electrostatic potential measurements, along with derived quantities of electric field, charge density and current density, of the interaction between a super-Alfvénic laser-produced plasma and an ambient, magnetized plasma.

Due to the limited availability of selective herbicides to control Sumatran fleabane after soybean emergence, it is essential to develop new options that provide effective control prior to planting. A new herbicide formulation containing diclosulam+halauxifen-methyl was evaluated for effectiveness at two Sumatran fleabane plant heights (5 to 10 cm, and 10 to 50 cm) and for soybean selectivity when applied at 7 or 3 d before planting. Combined results from the two sites showed that diclosulam+halauxifen, applied either alone or in a tank mixture with glyphosate, and the tank mixture of diclosulam+2,4-D amine+glyphosate are effective at all rates tested to control Sumatran fleabane in preplant applications. Crop response was observed with applications 7 days before planting at only one of the sites. A rate-dependent crop response was observed for pre-plant applications performed 3 days before soybean planting. However, crop yield was not significantly affected for either timing across all rates. All rates tested of diclosulam+halauxifen in this study were considered safe to soybean.

A 9-year-old boy who was born with bicuspid aortic stenosis underwent two unsuccessful aortic valvuloplasty interventions, and by 2 years of age he developed restrictive cardiomyopathy caused by left ventricular endocardial fibroelastosis and diastolic dysfunction. The attending cardiologist referred the patient to a high-volume, high-profile congenital cardiac surgical programme 1000 miles away that has a team with considerable experience with left ventricular endocardial fibroelastosis resection and a reputation of achieving good results. Owing to problems with insurance coverage, the parents sought other options for the care of their child in their home state. Dr George Miller is a well-respected local congenital and paediatric cardiac surgeon with considerable experience with the Ross operation as well as with right ventricular endocardial fibroelastosis resection. When talking with Dr Miller, he implied that there is little difference between right ventricular endocardial fibroelastosis and left ventricular endocardial fibroelastosis resection, and stated that he would perform the operation with low mortality based on his overall experience. Dr Miller stated that the local institution could provide an equivalent surgical procedure with comparable outcomes, without the patient and family having to travel out of state. A fundamental dilemma that often arises in clinical surgical practice concerns the conduct of assessing and performing new procedures, especially in rare cases, for which the collective global experience is scant. Although Dr Miller has performed right ventricular endocardial fibroelastosis resection, this procedure differs from left ventricular endocardial fibroelastosis resection, and he cannot be sure that he will indeed be able to perform the procedure better than the high-volume surgeon. This ethical situation is best understood in terms of the principles of respect for patient autonomy, beneficence, non-maleficence, and justice. The tension between the imperatives of beneficence and the obligation to respect the autonomy of the patient by acting only with the patient’s best interest in mind is discussed.

Since its introduction in the late 19th century, symmetry breaking has been found to play a crucial role in physics. In particular, it appears as one key phenomenon controlling hydrodynamic and acoustic instabilities in problems with rotational symmetries. A previous paper investigated its desired potential application to the control of circumferential thermoacoustic modes in one annular cavity coupled with multiple flames (Bauerheim et al., J. Fluid Mech., vol. 760, 2014, pp. 431–465). The present paper focuses on a similar problem when symmetry breaking appears unintentionally, for example when uncertainties due to tolerances are taken into account. It yields a large uncertainty quantification (UQ) problem containing numerous uncertain parameters. To tackle this well-known ‘curse of dimensionality’, a novel UQ methodology is used. It relies on the active subspace approach to construct a reduced set of input variables. This strategy is applied on two annular cavities coupled by 19 flames to determine its modal risk factor, i.e. the probability of an azimuthal acoustic mode being unstable. Since each flame is modelled by two uncertain parameters, it leads to a large UQ problem involving 38 parameters. An acoustic network model is then derived, which yields a nonlinear dispersion relation for azimuthal modes. This nonlinear problem, subject to bifurcations, is solved quasi-analytically. Results show that the dimension of the probabilistic problem can be drastically reduced, from 38 uncertain parameters to only 3. Moreover, it is found that the three active variables are related to physical quantities, which unveils underlying phenomena controlling the stability of the two coupled cavities. The first active variable is associated with a coupling strength controlling the bifurcation of the system, while the two others correspond to a symmetry-breaking effect induced by the uncertainties. Thus, an additional destabilization effect appear caused by the non-uniform pattern of the uncertainty distribution, which breaks the initial rotating symmetry of the annular cavities. Finally, the active subspace is exploited by fitting the response surface with polynomials (linear, quadratic and cubic). By comparing accuracy and cost, results prove that 5 % error can be achieved with only 30 simulations on the reduced space, whereas 2000 are required on the complete initial space. It exemplifies that this novel UQ technique can accurately predict the risk factor of an annular configuration at low cost as well as unveil key parameters controlling the stability.

The treatment of rare and expensive medical conditions is one of the defining qualities of paediatric cardiology and congenital heart surgery. Increasing concerns over healthcare resource allocation are challenging the merits of treating more expensive forms of congenital heart disease, and this trend will almost certainly continue. In this manuscript, the problems of resource allocation for rare and expensive medical conditions are described from philosophical and economic perspectives. The argument is made that current economic models are limited in the ability to assess the value of treating expensive and rare forms of congenital heart disease. Further, multi-disciplinary approaches are necessary to best determine the merits of treating a patient population such as those with significant congenital heart disease that sometimes requires enormous healthcare resources.

Respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical medicine. Legal tenets recognise the centrality of this principle and the inherent right of patients of sound mind – properly informed – to make their own personal medical decisions. In the course of everyday medical practice, however, challenging cases may result in ethical dilemmas for the patient, the physician, and society. Resolution of these dilemmas requires a thorough understanding of the underlying principles that allow the clinician to make informed decisions and to offer considered therapeutic options to the patient. We argue in this paper that there is also need for a transition of moral competency from understanding principles to attaining virtue in the classic Aristotelian tradition. Achieving moral virtue is based on a lifetime of learning, practising, and watching how others, who have achieved virtue, act and perform their duties. We further claim that learning moral virtue in medical practice is best realised by incorporating the lessons learnt during daily rounds where frank discussions and considered resolutions can occur under the leadership of senior practitioners who have achieved a semblance of moral excellence.

Anomalous aortic origins of the coronary arteries comprise approximately one-third of all coronary artery anomalies and are characterised by coronary arteries with anomalies of aortic origin involving abnormal courses, stenoses, and compression that can lead to myocardial ischaemia and sudden death. Operative techniques to treat these anomalies have not been standardised yet. Moreover, the management of potential complications has not been addressed. Common and rare forms of anomalous aortic origins of the coronary arteries are reviewed and understood standard techniques for an uncomplicated unroofing procedure are illustrated. Also noted are techniques that can be applied to unexpected anatomical findings and unwanted complications that could prove to be life-threatening. Several technical recommendations are offered.

We report on the composition of turn-off stars in the intriguing open cluster, NGC 6791, which is old, but super-metal-rich using Keck/HIRES spectra. We find [Fe/H] = +0.30 ±0.02[O/Fe]n −0.06 ±0.02,[Mg/Fe], [Si/Fe], [Ca/Fe], and [Ti/Fe] near solar and the two Fe-peak elements, Cr and Ni, are consistent with Fe.