The apical impulse palpation is a key component of cardiac physical examination, which offers insights into ventricular size and function. Its diagnostic accuracy in detecting cardiac enlargement in infants is unknown.

This cross-sectional observational study was done in infants 1 month to 1 year of age visiting a tertiary care hospital. The apical impulse was palpated and marked in supine position and its location in terms of the intercostal space and distance from mid-sternal line was noted. Echocardiography was performed to assess cardiac chamber enlargement. Z score of echo parameters was calculated. z score > 2 was considered to be an enlarged cardiac chamber. The diagnostic accuracy of a displaced apical impulse in detecting ventricular enlargement was evaluated using echocardiography as the reference standard.

309 infants were enrolled in the study. 22 % of the study subjects had a structurally normal heart. A displaced apical impulse had a diagnostic accuracy of 71.5%. Using another definition to define a displaced apical impulse, namely, horizontal displacement of > 4 cm from the mid-sternal line (regardless of the level of intercostal space), increased the diagnostic accuracy to 79.0 % with sensitivity and specificity of 76.4% and 81.1 %, respectively.

Horizontal displacement of the apical impulse 4 cm or more from the mid-sternal line (regardless of the level of intercostal space) is a simple and fairly accurate method to identify left ventricular enlargement in infants.

Carditis, the main determinant of long-term morbidity in acute rheumatic fever, may be detected by echocardiography even in the absence of clinical signs. This study aimed to determine the prevalence of silent carditis in asymptomatic children with elevated antistreptolysin O titers and to evaluate associations with demographic and laboratory parameters.

In this cross-sectional study, 61 asymptomatic children with incidentally detected elevated antistreptolysin O titers between September 2020 and September 2021 were evaluated. Demographic characteristics, inflammatory markers, and standardised Doppler echocardiographic assessments based on World Heart Federation criteria were analysed.

Silent carditis was identified in 8 of 61 patients (13.1%; 95% confidence interval 6.9 to 23.3). In the silent carditis group, 75% were female, and the median age was 12 years (interquartile range 9 to 14). Echocardiographic findings showed isolated mitral regurgitation in four patients and combined mitral and aortic regurgitation in four. Erythrocyte sedimentation rate was the only parameter that differed significantly between patients with and without silent carditis (p = 0.001). Antistreptolysin O levels showed weak negative correlations with haemoglobin (rho = −0.322, p = 0.011) and left ventricular posterior wall thickness (rho = −0.270, p = 0.036).

Some asymptomatic children with elevated antistreptolysin O titers had echocardiographic findings consistent with silent carditis. However, antistreptolysin O levels and most inflammatory markers were not reliable predictors of valvular involvement. Echocardiography in selected cases may help detect subclinical cardiac involvement. Findings should be interpreted cautiously due to the limited sample size and cross-sectional design.

Echocardiography has become a crucial diagnostic tool for assessing heart diseases in children within low- and middle-income countries, where the burden of heart diseases remains substantial.

This study aimed to audit echocardiography (echo) reports by reviewing the trends in echocardiography, indications for echocardiography, and the frequency and pattern of paediatric heart diseases seen at the Paediatric Cardiology Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, over a five-year period.

A total of 1,155 echocardiography reports were reviewed using a structured proforma to extract relevant data. Statistical analyses were conducted using IBM SPSS version 25.

Male participants constituted 52.1% of the study population. Ages ranged from 9 hours to 18 years, with a mean ± SD of 3.24 ± 4.46 years. The most frequent indication for echocardiography was fast breathing (38.27%). Approximately 31.86% of the echocardiograms were normal. CHD accounted for 63.55% of diagnoses, with 67.17% classified as acyanotic CHD and 32.83% as cyanotic CHD. Ventricular septal defect (VSD, 15.26%) and tetralogy of Fallot (TOF, 14.99%) were the most common CHDs. Acquired heart diseases were found in 4.59% of cases, with rheumatic heart disease being the most prevalent within this group (35.85%).

CHDs remain the predominant paediatric heart diseases, occurring nearly 14 times more frequently than acquired heart diseases. Ventricular septal defect and tetralogy of Fallot were the most common acyanotic and cyanotic CHDs, respectively. Among the acquired heart diseases, rheumatic heart disease was the leading diagnosis.

Kawasaki disease is the leading cause of acquired heart disease in children. Coronary artery involvement determines long-term outcomes, yet early identification of patients at risk for severe disease remains challenging.

We conducted a retrospective, single-centre cohort study of 104 children diagnosed with Kawasaki disease between January 2009 and April 2025. Clinical, laboratory, treatment-related, and echocardiographic data were collected. Coronary artery Z-scores were calculated using standardized equations and classified according to the 2017 American Heart Association criteria. Severe Kawasaki disease was defined as a baseline coronary Z-score ≥ 5.0. Longitudinal coronary changes were analysed in severe cases. Univariable and restricted multivariable logistic regression analyses were performed to identify independent predictors.

Ten patients (9.6%) met the criteria for severe Kawasaki disease. Severe cases were younger and experienced longer diagnostic delays and prolonged fever before intravenous immunoglobulin administration. Baseline coronary Z-scores were significantly higher in the severe group (median 8.95 vs. 2.35, p < 0.001). Severe disease was associated with hypoalbuminaemia, anaemia, thrombocytosis, delayed inflammatory resolution, and increased treatment intensity. In multivariable analysis, delayed intravenous immunoglobulin treatment and baseline pericardial effusion independently predicted severe coronary involvement, while higher serum albumin levels were protective. Although coronary Z-scores declined during follow-up, persistent abnormalities were observed in 60% of severe cases.

Severe coronary involvement in Kawasaki disease is associated with delayed treatment and increased systemic inflammation. Baseline pericardial effusion and hypoalbuminaemia identify high-risk patients. Early recognition and timely treatment may improve cardiac outcomes.

Rheumatic heart disease is a systemic immune condition that develops from acute rheumatic fever. Rheumatic heart disease remains prevalent throughout the world, and this case highlights an unusual presentation of the disease.

An otherwise healthy 7-year-old Caucasian girl from a suburban Midwest United States community presents with several weeks of headaches, nausea, and vomiting. After an unremarkable initial evaluation, a systolic murmur was noted during a general paediatrics clinic visit. An echocardiogram revealed severe mitral regurgitation, and further findings suggested a diagnosis of rheumatic heart disease.

Rheumatic heart disease results from long-term damage to cardiac valves from an autoimmune reaction to Group A streptococcal pharyngitis. While various social determinants of health can contribute to the development of rheumatic heart disease, this case emphasises the importance of considering rheumatic heart disease in children without typical risk factors.

Right ventricular dysfunction is a major determinant of long-term outcomes after tetralogy of Fallot repair, particularly in the presence of chronic pulmonary regurgitation. Strain analysis may detect early right ventricular dysfunction more sensitively than conventional echocardiographic parameters.

This retrospective single-centre study included 63 patients after tetralogy of Fallot repair who underwent postoperative echocardiographic evaluation during mid-term follow-up. Right ventricular function was assessed using tricuspid annular plane systolic excursion, right ventricular systolic velocity, fractional area change, and right ventricular free-wall longitudinal strain. Pulmonary regurgitation severity was evaluated by colour Doppler, with pulmonary regurgitation jet width expressed as a ratio relative to the pulmonary annulus diameter. Associations between pulmonary regurgitation severity and right ventricular function were analysed using correlation and multivariable linear regression.

Conventional right ventricular systolic parameters were largely preserved, whereas right ventricular free-wall longitudinal strain worsened with increasing pulmonary regurgitation severity (p = 0.036). Pulmonary regurgitation jet width emerged as the sole independently associated determinant of impaired right ventricular strain (β = 0.132, p = 0.038). QRS duration was not independently associated. Pulmonary regurgitation jet width showed moderate discriminatory ability for impaired right ventricular strain (area under the curve = 0.67).

Right ventricular free-wall longitudinal strain is a sensitive marker of pulmonary regurgitation-related right ventricular dysfunction after tetralogy of Fallot repair. Pulmonary regurgitation jet width, expressed relative to the pulmonary annulus, appears to be the dominant determinant of right ventricular mechanical impairment and may complement conventional assessment during follow-up.

This study aimed to identify echocardiographic predictors of successful weaning from extracorporeal membrane oxygenation in paediatric and congenital heart disease patients.

We retrospectively analyzed pediatric patients who underwent venoarterial extracorporeal membrane oxygenation for cardiogenic shock or postoperative support between March 2018 and September 2023. Clinical and echocardiographic variables assessed at the time of weaning evaluation were compared between patients who were successfully weaned and those who were not.

Among the 46 enrolled patients, 31 were successfully weaned from extracorporeal membrane oxygenation. The mean age at extracorporeal membrane oxygenation initiation was 9.6 ± 13.9 years, and the mean duration of support was 12.3 ± 12.1 days. Patients in the successfully weaned group had significantly higher left ventricular ejection fraction (50.9 ± 16.4% vs. 27.3 ± 18.7%, p < 0.001) and higher velocity time integral at the left ventricular outflow tract (12.3 ± 8.0 cm vs. 4.1 ± 3.6 cm, p = 0.001) compared with the unsuccessfully weaned group. The cutoff values for predicting successful weaning were a left ventricular ejection fraction of 43.03% (sensitivity, 74.2%; specificity, 86.7%) and a velocity time integral of 4.45 cm (sensitivity, 92.0%; specificity, 66.7%).

Left ventricular ejection fraction and velocity time integral provide valuable echocardiographic information for predicting successful weaning from extracorporeal membrane oxygenation in pediatric patients and may support clinical decision-making during weaning assessments.

Right atrial appendage aneurysm, or giant right atrial appendage, is extremely rare, with very few cases reported in scientific literature. We sought to systematically review the published cases of right atrial appendage aneurysm in terms of age, sex, clinical presentation, electrocardiography, imaging (chest X-ray, echocardiography, CT/cardiac magnetic resonance), and outcome.

An electronic search for case reports, case series, and related articles published until March 2025 was carried out, and clinical data were extracted and analysed.

Forty-four cases of right atrial appendage aneurysm were identified with a clear male prevalence (68.2%) and commonly presenting in the third decade of life. Palpitation (27.3%) and dyspnoea (18.2%) were the most common clinical presentations, whereas 40.9% of right atrial appendage aneurysm patients were asymptomatic. Electrocardiography was done in 77.3% of the sample. It displayed an atrial arrhythmia (atrial fibrillation or flutter, atrial tachycardia, supraventricular tachycardia) in 31.8%. A chest X-ray was done in 65.9%. Echocardiography was the most common diagnostic modality (93.2%). Right atrial appendage aneurysm diagnosis was confirmed on CT and/or MRI in 79.5%. The mean size of the right atrial appendage aneurysm was 93 × 70 mm. In 12 patients (27.3%), an associated congenital cardiac abnormality was found, mostly in the form of an atrial septal defect/patent foramen ovale (22.7%). Half of the patients (50.0%) were treated surgically, whilst 47.8% were treated medically with close follow-up. One patient experienced right atrial appendage aneurysm reduction in size after atrial septal defect device closure. One death (2.3%) was reported also.

Although very uncommon, right atrial appendage aneurysm can be linked to considerable morbidity. Surgical removal is recommended for patients who are symptomatic.

To evaluate the right ventricle function by conventional echocardiographic methods and strain analysis in the long term after balloon pulmonary valvuloplasty. In addition, we investigated the relationship between pulmonary regurgitation, demographic data at the time of the procedure, and right ventricle dysfunction in late follow-up.

The records of patients submitted to balloon pulmonary valvuloplasty from 2001 to 2015 in a single centre were reviewed. From that sample, a revised cohort was formed, and the patients were submitted to clinical and echocardiographic evaluations.

The retrospective and the revised cohort analyses included 73 and 18 patients, respectively. In the follow-up, pulmonary regurgitation was observed in all patients, and there was a significant worsening of its magnitude over time (p < 0.001); the severity of pulmonary regurgitation was associated with balloon pulmonary valvuloplasty performed in patients with weight < 3 kg (p < 0.03), body surface area < 0.3 m2 (p < 0.04), and < 1 year of age (p < 0.006). Global longitudinal systolic strain of the right ventricle was abnormal in 8 of 18 patients, and conventional methods were abnormal in 2 of 18 patients (p = 0.001). There was a significant relationship between severe pulmonary regurgitation and right ventricle dysfunction detected only by strain evaluation (p = 0.01).

The severity of pulmonary regurgitation was related to the impairment of right ventricle function detected by strain. The predictors of pulmonary regurgitation severity in late follow-up were age < 1 year, weight < 3 kg, and body surface area < 0.3 m2.

Echocardiography is the preferred method for the visual assessment of bubble load in divers. This study evaluates the feasibility of a microteaching program for training combat medics to perform ultrasound measurements using echocardiography for self-monitoring decompression stress on the waterside.

A microteaching was provided to combat medics of the Netherlands Armed Forces. Participants used a handheld ultrasound device connected to a tablet. After two minutes practice time, medics performed and recorded videos on randomly assigned partners while being assessed by an anesthesiologist. Three outcomes were measured: (1) observer-assessed performance adapted from Objective Structured Assessment of Technical Skills (OSATS); (2) self-perceived procedure experience; and (3) video recording quality on a five-point scale.

All 21 combat medics completed the microteaching program. Three out of 21 video recordings were lost due to technical issues. All participants successfully obtained at least a partial cardiac view (median time: 61 seconds). Performance scores indicated near-competence across preparation, time-motion, and procedural flow. Image quality ratings by two reviewers showed near-perfect intra-rater agreement (κ = 0.904 and κ = 0.960) but substantial inter-rater variability (κ = 0.671); the assessor’s median scores were 2.75 and 3.0 out of 5.0, respectively. Most recordings received average scores of 3.0 or higher.

This study demonstrates that combat medics, following a brief microteaching session, were able to acquire cardiac ultrasound images partially suitable for assessing vascular gas emboli (VGE). These findings support microteaching as a feasible first step in echocardiography training for combat medics in austere environments.

Single ventricle pulmonary arteriovenous malformations are poorly understood and variably assessed in published literature. To improve our understanding of single ventricle pulmonary arteriovenous malformations and facilitate multi-centre studies, it will be necessary to have uniform clinical practice patterns among paediatric heart institutions.

The aim of this study was to assess paediatric interventional cardiologists’ clinical perspectives and practice patterns for diagnosing single ventricle pulmonary arteriovenous malformations.

We surveyed paediatric interventional cardiologists using the Congenital Cardiovascular Interventional Consortium listserv. A single survey was distributed electronically with two subsequent reminder emails. Voluntary participants completed the anonymous survey electronically via RedCap.

Among 253 Congenital Cardiovascular Interventional Consortium members, a total of 55 (21.7%) paediatric cardiology interventional attending physicians completed the survey. There was near unanimity (98%) that pulmonary arteriovenous malformations develop due to lack of hepatic vein blood flow to the lungs; however, there was wide variation among practice patterns. A minority (20%) of respondents perform bubble contrast echocardiograms (bubble studies) more than half the time pre-Fontan, whereas many (31%) almost never (< 5% of cases) perform bubble studies pre-Fontan. Most respondents reported that they did not perform bubble studies because results do not impact clinical decision making pre-Fontan (56%) or post-Fontan (60%). Many respondents (49%) do not have a typical volume of agitated saline that they inject for bubble studies.

Clinical practice patterns vary widely among paediatric cardiology interventionalists. A standardised clinical approach, new diagnostic tools, or both are needed to standardise our field’s approach to diagnosing, studying, and treating single ventricle pulmonary arteriovenous malformations.

With more than 1 million children in the United States living with a heart defect or condition, it is important to identify interventions that may minimise the long-term impacts of repeated medical surveillance and care. Thus, the purpose of this quasi-experimental study was to examine relationships between facility dog intervention and young children’s anxiety during outpatient echocardiogram.

Participants were seventy children aged 18 months to 8 years undergoing echocardiogram in a paediatric cardiology clinic. Child anxiety was scored by a trained nurse observer pre- and post-procedure using the modified Yale Preoperative Anxiety Scale. Facility dog intervention included individualised play, positioning, therapeutic conversation and touch, and emotional support throughout to promote coping and compliance. Parents and staff completed a post-procedural perceptions survey about their experiences.

Paired samples t-tests demonstrated child anxiety levels were significantly lower post-procedure compared to pre-procedure (Z = −3.974, p < .001). This direction held for nearly all participants; however, those with prior echocardiogram history demonstrated significantly higher anxiety levels at the pre-procedural timepoint (z = −2.442, p = .015). Caregivers (97.2%) and staff (87.9%) agreed or strongly agreed that facility dog intervention was helpful in this context.

Facility dog intervention was associated with a significant reduction in young children’s anxiety across procedural timepoints in outpatient echocardiography. The intervention was perceived as helpful by families and staff; no workflow changes or barriers were noted. Thus, facility dog intervention may be a well-received and promising care innovation for this vulnerable chronic population.

Congenital aortic valvar disease represents a heterogeneous population with suboptimal surgical repair or replacement outcomes. We assess our approach and short-term outcomes in this population using cardiac CT evaluation for personalised surgical planning and execution.

We assessed patients who underwent aortic valvar surgery from February 2022 to August 2024. Pre-surgical evaluation included cardiac CT with quantitative assessment of the leaflet geometry and measures of leaflet coaptation. A standardised approach towards surgical execution guided by this assessment was established and followed.

Seventy-three patients underwent surgery at a median age of 26.0 years (interquartile range 19–44), 65.8% males. Forty-eight patients (65.8%) underwent some form of aortic valvar repair, with 22 of these 48 patients undergoing a valve-sparing aortic root replacement. The remaining 25 patients (34.2%) underwent some form of aortic valvar replacement. Mean post-surgical follow-up was 4.2 ± 6.1 months. Moderate or greater aortic regurgitation was present in 45 patients (61.6%) pre-operatively versus 2 patients (2.7%) post-operatively (p-value < 0.001). The peak and mean gradient improved from 33.2 ± 31.3 mmHg and 16.9 ± 10.7 mmHg pre-operatively, to 16.9 mmHg±10.7 mmHg and 9.5 ± 6.4 mmHg post-operatively (p-value < 0.001).

The heterogeneity and complexity of the dysfunctional and/or dilated (neo-)aortic root encountered in those presenting for surgery necessitates a methodical, detailed three- and four-dimensional assessment. By applying such an approach, we have aimed to standardise not only the assessment, but also description and surgical execution in this challenging patient population. Excellent short-term results have been achieved, necessitating long-term follow-up to understand the potential benefits towards this personalised approach.