Pediatric Cardiology最新文献

{"title":"Immediate Hemodynamic Effects of Pulmonary Artery Flow Restrictors in Univentricular Circulation: Hypothesis-Generating Insights from High-Fidelity Physiologic Streaming Data Using Machine-Learning.","authors":"Jeremy L Fox, Alan W Nugent, Conor P O'Halloran, Paul Tannous, Michael Evans, Rohit S Loomba","doi":"10.1007/s00246-026-04509-4","DOIUrl":"https://doi.org/10.1007/s00246-026-04509-4","url":null,"abstract":"<p><p>Hypoplastic left heart syndrome has been historically palliated with the surgical Norwood or hybrid procedures. Transcatheter placement of pulmonary flow restrictors (PFR) with prostaglandin to maintain an unobstructed ductus arteriosus has emerged as an option for single-ventricle patients that are poor surgical candidates. High-fidelity physiologic data has been used to predict outcomes in interstage patients. This study aimed to characterize the acute hemodynamic effects of transcatheter flow restrictors on pulmonary to systemic blood flow ratio using physiologic data. A single-center retrospective review of 10 patients who underwent transcatheter flow restrictor placement was performed. High-fidelity physiologic data (1-second resolution) from before, during, and after flow restrictor placement were utilized. Data were aggregated with the Sickbay Clinical Platform. An autoregressive integrated moving average model was used to compare variables of interest before, during, and after flow restrictor placement. A total of 10 patients were included in the study for a total of 123,509 patient seconds of monitoring. A statistically significant decrease in pulmonary-to-systemic blood flow ratio, systemic saturation, and renal oxygen extraction, and an increase in blood pressure, were observed during and after PFR placement. Flow restrictor placement is associated with an acute decrease in calculated pulmonary to systemic blood flow ratio and an increase in calculated renal oxygen extraction ratio (related to an increase in systemic oxygen delivery). More importantly, this study demonstrates that high-fidelity physiologic data platforms can be used for real-time assessment of the effect of pulmonary artery flow reducers. Eventually, clinical decision algorithms may be able to guide the pulmonary artery flow reducer strategy, both intra-procedurally and afterward.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transplantation for Congenital Heart Disease in Children-A Quest to Do Better.","authors":"Lisa-Maria Rosenthal, Devin Koehl, Ryan Cantor, Jessica Laks, Svetlana Shugh, Jameson Dyal, James Kirklin, Christoph Haller, Alyssa Power, Anne I Dipchand","doi":"10.1007/s00246-026-04515-6","DOIUrl":"https://doi.org/10.1007/s00246-026-04515-6","url":null,"abstract":"<p><p>Children with congenital heart disease (CHD) represent the largest group of pediatric heart transplant recipients but experience lower graft survival than those transplanted for cardiomyopathy. We evaluated post-transplant outcomes among CHD recipients at the Hospital for Sick Children (HSC) and identified predictors of graft loss. Pediatric patients (< 17 years) undergoing heart transplantation for CHD between 1993 and 2023 were analyzed using the Pediatric Heart Transplant Society registry. Outcomes of CHD recipients at HSC (CHD HSC) were compared with cardiomyopathy HSC recipients, CHD recipients at other centers (CHD Non-HSC), and a propensity score-matched (PSM) cohort adjusting for pre- and peri-transplant risk factors. Kaplan-Meier survival and multivariable Cox proportional hazards analyses were performed. Among 4,362 pediatric CHD transplant recipients, 152 underwent transplantation at HSC. Freedom from graft loss for CHD HSC at 5, 10, and 15 years was 71.8%, 63.0%, and 58.4%, lower than in Cardiomyopathy HSC recipients (p < 0.0001), but similar to CHD Non-HSC (p = 0.6043). Survival remained comparable in the PSM cohort (n = 140, p = 0.4599). Conditional survival beyond 1 year was similar between groups, suggesting early mortality drives differences. CHD HSC recipients demonstrated longer freedom from CAV (p = 0.0041) and infection (p = 0.0335). Predictors of graft loss included pre-transplant ECMO (HR 3.11), ICU admission (HR 2.39), PRA > 10% (HR 2.49), African American/Black race/ethnicity (HR 2.71), and longer waitlist duration (HR 1.06). Graft survival in CHD recipients at HSC remains lower than in cardiomyopathy recipients but comparable internationally. Optimizing pre-transplant care, sensitization management, and equity-focused interventions may enhance outcomes.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Vitro Models to Study Fibroelastic Remodeling of the Endocardium in Congenital Heart Disease.","authors":"Julia Gaal, Cindy Zajac, Sophie C Doettl, Magnus von Piechowski, Kerstin Saraci, Viktoria Weixler, Daniel Diaz-Gil, Pedro J Del Nido, Ingeborg Friehs","doi":"10.1007/s00246-026-04503-w","DOIUrl":"https://doi.org/10.1007/s00246-026-04503-w","url":null,"abstract":"<p><p>Congenital heart defects (CHD) are characterized by pathological intracardiac blood flow, exposing the endocardium to disturbed shear stress. This contributes to the development of endocardial fibroelastosis (EFE), a restrictive fibrotic remodeling process associated with diastolic dysfunction. Despite the pathomechanistic role of the endocardium in CHD, EFE-derived endocardial endothelial cells (EdEECs) remain largely understudied. No standardized protocol exists for isolating and purifying them from human pediatric tissue. Tissue from N = 15 pediatric patients with (1) hypoplastic left heart syndrome, (2) pulmonary atresia with intact ventricular septum, and (3) pulmonary vein stenosis was included. Immunohistochemistry demonstrated endothelial-to-mesenchymal transition (EndMT). EdEECs were isolated from resected EFE tissue using CD144-based magnetic separation. Enrichment of the endocardial phenotype was evaluated by flow cytometry, immunocytochemistry and RT-qPCR. To mimic disease-like conditions, EdEECs were exposed to in vitro shear stress and transforming growth factor beta 1. EFE driven by fibrogenic activation of EECs through EndMT was observed in the left ventricle, right ventricle, and left atrium in patients with different CHDs. Magnetic CD144-based isolation provided a reliable, gentle approach to purify EdEECs from cardiac tissue, achieving > 95% purity while reproducibly preserving endocardial identity at both the protein and gene expression levels. Isolated EdEECs retained their intrinsic, disease-specific predisposition and vulnerability to EndMT under static, and high shear stress. Unlike healthy EECs (HEECs), physiological, low shear stress alone was not sufficient to restore the intrinsic fibrogenic vulnerability of EdEECs. EndMT-mediated EFE was observed across different CHD entities. A reproducible protocol for isolating and purifying EdEECs from EFE tissue preserves their endocardial phenotype and disease-specific characteristics. This provides a disease-mimicking in vitro model to study EdEEC-specific signaling pathways.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Feeding, Nutritional, and Procedural Outcomes in Infants with Ductal-Dependent Pulmonary Blood Flow Undergoing Surgical Systemic-to-Pulmonary Artery Shunt Versus Ductal Stenting.","authors":"Phuong Tran, Morgan MacBeth, Kelly Wolfe, Piyagarnt Vichayavilas, Kaitlin E Olson, Ryan Leahy, Matthew Stone, Megan SooHoo","doi":"10.1007/s00246-026-04519-2","DOIUrl":"https://doi.org/10.1007/s00246-026-04519-2","url":null,"abstract":"<p><p>Ductal stenting and surgical systemic-to-pulmonary artery shunting (surgical shunt) are alternative strategies to establish pulmonary blood flow in infants with ductal-dependent circulation. The impact of palliation strategy on feeding, nutrition, and neurodevelopment remains unclear. We conducted a single-center retrospective study of 100 infants with ductal-dependent pulmonary blood flow (2017-2024) undergoing surgical shunt (n = 57) or ductal stenting (n = 43). Outcomes included feeding, nutrition, hospital course, and neurodevelopment. Multivariable logistic regression evaluated factors associated with gastrostomy tube (GT) placement. Baseline demographics were similar except for cardiac anatomy. Ductal stent patients reached target enteral feeds post-procedurally sooner (3 vs. 6 days, p < 0.001), had higher discharge weight-for-age z-scores (- 1.30 vs. -1.98, p = 0.02), and smaller declines in growth during hospitalization (p = 0.007). GT placement was less frequent following ductal stenting (26% vs. 51%, p = 0.011), but palliation strategy was not independently associated with GT placement after adjustment (OR 0.43, 95% CI 0.14-1.24, p = 0.12). Oral feeding or breastfeeding within 5 days following palliation was independently associated with lower odds of GT placement (OR 0.24, 95% CI 0.06-0.81, p = 0.03). Ductal stent patients also had shorter mechanical ventilation and ICU stays and required less vasoactive-inotropic support. Total hospital length of stay, need for reintervention, suspected or diagnosed necrotizing enterocolitis, and mortality did not differ significantly between groups. Ductal stenting was associated with improved early post-procedural recovery, faster feeding progression, and better preservation of growth compared with surgical shunt palliation. Although GT placement was less frequent following ductal stenting in unadjusted analysis, palliation strategy was not independently associated with GT placement after adjustment. Early post-procedural oral feeding was independently associated with lower odds of GT placement but may also reflect feeding readiness and clinical recovery.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Magnetic Resonance Predictors of Residual Pulmonary Regurgitation and Biventricular Recovery After Pulsta Valve Implantation.","authors":"Seung Min Baek, Chibum Ahn, Sang Yun Lee, Woo Young Park, Hong Gook Lim, Whal Lee, Jongmin Seo, Kuk Hui Son, Gi Beom Kim","doi":"10.1007/s00246-026-04510-x","DOIUrl":"https://doi.org/10.1007/s00246-026-04510-x","url":null,"abstract":"<p><p>Current recommendations for pulmonary valve replacement are based primarily on cardiovascular magnetic resonance (CMR)-derived right ventricular (RV) volume thresholds established in repaired tetralogy of Fallot. However, patients undergoing self-expanding percutaneous pulmonary valve implantation (PPVI) often have mixed pulmonary regurgitation (PR) and pulmonary stenosis with heterogeneous right ventricular outflow tract (RVOT) anatomy. We investigated CMR predictors of residual PR, residual RV enlargement (RVE), and residual biventricular imbalance (BVI) after Pulsta PPVI. We retrospectively analyzed 98 patients with paired pre- and post-procedural CMR. Residual PR was defined as post-procedural PR fraction (PRF) ≥10%, residual RVE as RV end-diastolic volume index (RVEDVi) ≥130 mL/m², and residual BVI as an RV/LV end-diastolic volume ratio ≥1.5. Multivariable regression and restricted cubic spline analyses identified predictors of post-procedural remodeling. Residual PR occurred in 40.8% of patients, residual RVE in 38.8%, and residual BVI in 40.8%. Pyramidal/convex main pulmonary artery morphology and higher baseline PRF independently predicted residual PR, whereas reverse pyramidal/concave morphology was associated with lower residual RVE risk. Higher pre-procedural RV/LV ratio independently predicted residual BVI. RVEDVi z-score remained independently associated with RVEDVi reduction after adjustment for baseline RVEDVi. Although RV volumes decreased substantially after PPVI, LV remodeling varied considerably, and both RVEDVi and LVEDVi change independently contributed to recovery of ventricular balance. After Pulsta PPVI, anatomical factors influence residual PR and RV remodeling. RVEDVi z-score and RV/LV ratio provide complementary information that may improve patient selection.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Cardiac Surgical Workforce Inequities Across 194 Countries: A Global Cross-Sectional Analysis.","authors":"Jeevan Francis, Antonio F Corno, Ed Peng","doi":"10.1007/s00246-026-04523-6","DOIUrl":"https://doi.org/10.1007/s00246-026-04523-6","url":null,"abstract":"<p><p>Congenital heart disease is the most common birth defect globally, yet access to surgery remains inequitable. The availability of congenital heart surgeons (CHS) relative to paediatric population needs is poorly defined. A cross-sectional study of the Cardiothoracic Surgery Network was conducted across 194 United Nations-recognised countries and 54 territories and dependencies (T&Ds). Of 248 countries and T&Ds analysed, 123 (49.6%) had ≥ 1 CHS. A total of 4,296 CHS were identified; 71 (37% of recognised) countries with 189.5 million children had none. Low-income countries had a median of 0.15 CHS per million children compared with 9.29 in high-income countries. CHS density was strongly correlated with gross domestic product per capita. Average CHS ratios per million children were: high-income country 9.3, upper-middle-income country 2.0, lower-middle-income country 1.1, and low-income country 0.2 (p < 0.0001), representing a 46-fold disparity between high-income countries and low-income countries. Regional analysis showed North America and Europe had the highest CHS ratios (≥ 9 per million), and Sub-Saharan Africa and East Asia and Pacific had medians of zero (p < 0.0001). Only 3 T&Ds reported at least one CHS. Our findings confirm that human resource levels are even more disproportionate than previously estimated. A significant proportion of children globally remain without access to cardiac surgery, representing a major and largely unquantified burden of preventable morbidity and mortality. Accurately quantifying this unmet need should be an urgent priority for future population-level and health systems research.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we Adhering to Guidelines for Follow-up Imaging in Neonates with Simple Congenital Heart Defects? What are the Healthcare Costs of Non-adherence?","authors":"Zein Al Abideen Hammad, Helen Coo, Haarini Suntharalingam, Shaam Alhamwi, Joshua Penslar, Mahmoud Alsalehi","doi":"10.1007/s00246-026-04518-3","DOIUrl":"https://doi.org/10.1007/s00246-026-04518-3","url":null,"abstract":"<p><p>Simple congenital heart defects (CHDs) are frequently identified via neonatal echocardiograms (\"echos\"). In 2020, the American Heart Association/American College of Cardiology issued guidelines for follow-up imaging of CHDs. In this retrospective study, we evaluated adherence to these guidelines at an academic health center in Southeastern Ontario. The cohort included neonates who had one or more simple CHDs diagnosed in the first 30 days of life between April 1, 2020, and March 31, 2024. We reviewed electronic medical records up to September 30, 2025 to examine (a) rates of non-adherence to guideline-recommended follow-up imaging; (b) factors that may contribute to non-adherence; and (c) the costs of excessive imaging. Among 248 patients, 376 echos were performed over the study period. Adherence status could be determined for 320. Follow-up for 39.7% of echos did not adhere to the guidelines, primarily because repeat echos were performed earlier than recommended. Non-adherence was substantially higher for lesions requiring surveillance imaging, as per guidelines, compared with lesions where follow-up imaging is not recommended or findings were normal (91.9% vs. 12.0%; OR = 83.4, 95% CI: 37.5-185.5). The pediatric cardiologist's recommendation was documented for 74.5% of echos, but only 48.9% of recommendations aligned with the guidelines. Non-adherence was higher when recommendations were not documented or deviated from the guidelines. Sixty-two echos were deemed excessive, corresponding to $13,339 in extra imaging costs. The high rate of non-adherence to guideline-recommended follow-up imaging for simple CHDs highlights an opportunity to reduce unnecessary healthcare costs through consistent documentation of guideline-aligned follow-up recommendations by pediatric cardiologists.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcome of Late Survivors Following the Classic Fontan Procedure.","authors":"Muneaki Matsubara, Jasmin Reyhaniye, Doris Kienmoser, Thibault Schaeffer, Jonas Palm, Christina Ruda, Nicole Piber, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1007/s00246-026-04513-8","DOIUrl":"https://doi.org/10.1007/s00246-026-04513-8","url":null,"abstract":"<p><p>Heart failure and multi-organ dysfunction develop insidiously in adults with a classic Fontan circulation. We evaluated late outcomes and risk factors for failing Fontan beyond 20 years after the classic Fontan procedure. Among 170 patients operated between 1978 and 1995, those surviving beyond 20 years without Fontan conversion were included. Clinical outcomes and risk factors were assessed. Sixty patients were included: tricuspid atresia in 37, double-inlet left ventricle in 14. Over 35.2 years' median follow-up, 13 (21.7%) died and 31 (51.7%) developed failing Fontan at a median of 30.8 years. Survival was lower with failing Fontan (70.2% vs. 95.2% at 35 years; P = .013) than those without. In multivariable analysis, double-inlet left ventricle (hazard ratio 2.42; P = .027) and ascites (hazard ratio 2.70; P = .007) were independent risk factors. At the last follow-up, the failing group had lower serum albumin (4.2 vs. 4.6 g/dL; P = .017) and higher N-terminal pro-B-type natriuretic peptide (774 vs. 404 pg/mL; P = .004); hepatic markers, total protein, and platelet count did not differ. After adjustment for the interval since diagnosis and exclusion of protein-losing enteropathy, only the natriuretic peptide association persisted. Peak oxygen uptake was also lower (P < .01). Late mortality and failing Fontan remained substantial beyond two decades. Double-inlet left ventricle and ascites were independent risk factors. Higher natriuretic peptide and reduced exercise capacity characterized the failing group, whereas lower albumin did not independently identify it. Regular assessment of these markers may aid surveillance.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental Systems Cardiology III: Measuring Adaptation Across the Lifespan.","authors":"Colin J McMahon, Joseph Rossano, Jeffrey Kim, Mark Lewin","doi":"10.1007/s00246-026-04516-5","DOIUrl":"https://doi.org/10.1007/s00246-026-04516-5","url":null,"abstract":"<p><p>Developmental Systems Cardiology (DSC) conceptualizes congenital heart disease as a lifelong adaptive process shaped by interactions among biological, developmental, psychosocial, environmental, and healthcare systems. As survival has improved, contemporary challenges increasingly include neurodevelopment, psychosocial wellbeing, educational participation, healthcare engagement, and long-term adaptation, requiring multidimensional assessment beyond traditional physiological outcomes. This third article in the DSC series proposes a measurement framework for operationalizing adaptation across the lifespan. Rather than introducing new measurement domains or replacing established assessment recommendations, DSC provides an integrative architecture for linking existing measures across genomics and epigenomics, prenatal exposures, developmental physiology, neurocardiac interactions, family and social determinants, environmental influences, digital phenotyping, and healthcare-system context. Longitudinal measurement serves as a cross-cutting principle for characterizing adaptive trajectories and identifying periods of vulnerability and opportunity. Within this framework, adaptation is a dynamic, measurable process emerging through interactions among individuals, families, healthcare systems, and broader environments. Measurement therefore encompasses developmental functioning, resilience, participation, quality of life, healthcare transitions, and implementation outcomes alongside biological and clinical indicators. Established domain-specific standards, including neurodevelopmental assessment recommendations, can populate this broader architecture. This approach emphasizes integration rather than instrument development, while preserving the specificity and utility of established measures within individual domains. By integrating validated measures across domains, developmental stages, and time, DSC may provide a common language for research, registries, quality improvement, implementation science, and lifespan care. Its proposed contribution lies in organizing multidimensional measurement to better understand how adaptive and maladaptive trajectories emerge and evolve across development.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Ventricular Function Assessed by Speckle Tracking Echocardiography in Patients Undergoing Transcatheter Pulmonary Valve Replacement.","authors":"Mehmet Kucuk, Cesar Gonzalez de Alba, Jenny Zablah, Ryan Leahy, Anne Taylor, Christopher Iskander, Benjamin Rajic, Gareth J Morgan","doi":"10.1007/s00246-026-04505-8","DOIUrl":"https://doi.org/10.1007/s00246-026-04505-8","url":null,"abstract":"<p><p>The effect of pulmonary valve replacement (PVR) on right ventricular (RV) function remains unclear. Cardiac magnetic resonance (CMR) is the gold standard for RV assessment but has practical limitations. Speckle tracking echocardiography (STE) may offer an alternative for evaluating RV systolic function. This study used STE to assess changes in RV systolic strain and right atrial (RA) strain following PVR. STE parameters including RV free-wall longitudinal strain (RVFWSL), RV four-chamber strain (RV4CSL), regional basal, mid-ventricular, apical RV strain, RA reservoir and contraction strain were assessed in 50 patients who underwent TPVR at pre-, post-operative day 1 and at six-month follow-up. RV systolic strain significantly improved after TPVR. RVFWSL increased from - 20.3 ± 5.1% at baseline to - 23.3 ± 5.2% (P < 0.001), and RV4CSL improved from - 18.5 ± 4.1% to - 21.3 ± 4.1% (P < 0.001). Regional RV strain also significantly improved at the basal, mid-cavity and apical levels (- 18.1 ± 4.3% to - 21.4 ± 5.5%, P < 0.001). RA reservoir and contraction strain, did not change significantly. Patients with RV end-systolic volume index < 80 mL/m² demonstrated greater improvement in RV4CSL than those with larger RV systolic volumes. Transcatheter PVR is associated with significant improvement in RV systolic strain at six months, with no significant change observed on postoperative day 1. This delayed recovery highlights the importance of longitudinal assessment, for which STE may serve as a feasible complementary tool to CMR in guiding follow-up imaging.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}