Pediatric Cardiology最新文献_第2页

4-Dimensional Right Ventricular Outflow Tract Segmentation to Evaluate Candidacy for Transcatheter Pulmonary Valve Replacement. 评估经导管肺动脉瓣置换术适应症的四维右心室流出道分割。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-07-24 DOI: 10.1007/s00246-024-03603-9

Hunter C Wilson, Sassan Hashemi, R Allen Ligon

引用次数: 0

Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot. 法洛氏四联症修复患者的心房面积差有助于舒张期充盈

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-05-28 DOI: 10.1007/s00246-024-03508-7

Martin Johansson, Erik Hedström, Katarina Steding-Ehrenborg, Misha Bhat, Petru Liuba, Håkan Arheden, Pia Sjöberg

{"title":"Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot.","authors":"Martin Johansson, Erik Hedström, Katarina Steding-Ehrenborg, Misha Bhat, Petru Liuba, Håkan Arheden, Pia Sjöberg","doi":"10.1007/s00246-024-03508-7","DOIUrl":"10.1007/s00246-024-03508-7","url":null,"abstract":"A hydraulic force aids diastolic filling of the left ventricle (LV) and is proportional to the difference in short-axis area between the left ventricle and atrium; the atrioventricular area difference (AVAD). Patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) have reduced LV filling which could lead to a negative AVAD and a hydraulic force impeding diastolic filling. The aim was to assess AVAD and to determine whether the hydraulic force aids or impedes diastolic filling in patients with rToF and PR, compared to controls. Twelve children with rToF (11.5 [9-13] years), 12 pediatric controls (10.5 [9-13] years), 12 adults with rToF (21.5 [19-27] years) and 12 adult controls (24 [21-29] years) were retrospectively included. Cine short-axis images were acquired using cardiac magnetic resonance imaging. Atrioventricular area difference was calculated as the largest left ventricular short-axis area minus the largest left atrial short-axis area at beginning of diastole and end diastole and indexed to height (AVADi). Children and adults with rToF and PR had higher AVADi (0.3 cm2/m [- 1.3 to 0.8] and - 0.6 [- 1.5 to - 0.2]) at beginning of diastole compared to controls (- 2.7 cm2/m [- 4.9 to - 1.7], p = 0.015) and - 3.3 cm2/m [- 3.8 to - 2.8], p = 0.017). At end diastole AVADi did not differ between patients and controls. Children and adults with rToF and pulmonary regurgitation have an atrioventricular area difference that do not differ from controls and thus a net hydraulic force that contributes to left ventricular diastolic filling, despite a small underfilled left ventricle due to pulmonary regurgitation.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1163-1170"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141160703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of Long-Term Clinical Outcomes and Costs Between Transesophageal Echocardiography-Guided and X-ray-Guided Percutaneous Atrial Septal Defect Closure in Children. 经食道超声心动图引导和 X 射线引导经皮儿童房间隔缺损封堵术的长期临床疗效和成本比较。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-06-17 DOI: 10.1007/s00246-024-03539-0

Qiuqing Ke, Guoxing Weng, Qi Xie, Jiayin Bao, Fuzhen Zheng, Jie Huang, Licheng Yan, Haiyu Chen

{"title":"Comparison of Long-Term Clinical Outcomes and Costs Between Transesophageal Echocardiography-Guided and X-ray-Guided Percutaneous Atrial Septal Defect Closure in Children.","authors":"Qiuqing Ke, Guoxing Weng, Qi Xie, Jiayin Bao, Fuzhen Zheng, Jie Huang, Licheng Yan, Haiyu Chen","doi":"10.1007/s00246-024-03539-0","DOIUrl":"10.1007/s00246-024-03539-0","url":null,"abstract":"This study aimed to compare the long-term clinical outcomes and costs between using either transesophageal echocardiography (TEE) or X-ray fluoroscopy for Percutaneous atrial septal defect (ASD) closure in children. An analysis was conducted on clinical data from children undergoing TEE-guided (n = 168) and X-ray-guided (n = 139) percutaneous ASD closure. Demographic characteristics, technical indices, acute complications, follow-up outcomes, and costs were compared between the groups. The results are that TEE-guided closure demonstrated shorter surgical times (20.3 ± 7.6 min vs. 32.8 ± 7.9 min, P < 0.001) and lower procedural costs ($3093.3 ± 451.5 vs. $3589.1 ± 219.4, P < 0.001) compared to X-ray guidance. Initial successful closure rates were similar between the groups (TEE: 98.2%, XR: 97.1%, P = 0.691). TEE guidance also resulted in fewer acute complications and reduced radiation exposure. TEE-guided percutaneous ASD closure offers advantages in terms of shorter surgical times, lower procedural costs, and reduced radiation exposure compared to X-ray guidance. These findings support the preference for TEE guidance in pediatric ASD closure procedures, with potential implications for improving patient outcomes and reducing healthcare costs.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1227-1234"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331539","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}

引用次数: 0

Identification and Analysis of Atrial-Bronchial-Abdominal Disharmony in Patients with Isomeric Atrial Appendages. 识别和分析心房-支气管-腹腔异位患者的心房-支气管-腹腔不协调。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-06-18 DOI: 10.1007/s00246-024-03544-3

Pujitha Vidiyala, Niraj Nirmal Pandey, Saurabh Kumar Gupta, Thazhathu Veettil Sreelal, Mansi Verma, Sanjeev Kumar, Sivasubramanian Ramakrishnan, Priya Jagia

{"title":"Identification and Analysis of Atrial-Bronchial-Abdominal Disharmony in Patients with Isomeric Atrial Appendages.","authors":"Pujitha Vidiyala, Niraj Nirmal Pandey, Saurabh Kumar Gupta, Thazhathu Veettil Sreelal, Mansi Verma, Sanjeev Kumar, Sivasubramanian Ramakrishnan, Priya Jagia","doi":"10.1007/s00246-024-03544-3","DOIUrl":"10.1007/s00246-024-03544-3","url":null,"abstract":"Ideally, the morphology of atrial appendages should solely be used to identify and differentiate patients with isomeric right and left atrial appendages. However, in clinical practice, the segregation is often indirectly based on the arrangement of thoraco-abdominal structures. The correlation between thoraco-abdominal arrangement and atrial appendages, however, is imperfect. In this study, we sought to clarify the cardiovascular malformations in patients with isomeric atrial appendages with an emphasis on atrial-thoracic-abdominal disharmony. A retrospective review of all patients who underwent cardiac CT angiography between January 2014 and June 2023 and identified to have isomeric atrial appendages was performed. Of the 366 cases (median age: 2 years [interquartile range: 11 months-7 years]), 247 (67.5%) patients had isomeric right atrial appendages while 119 (32.5%) patients had isomeric left atrial appendages. In 316 (86.3%) patients, the thoraco-abdominal arrangement was as per atrial appendage morphology while the remaining 50 (13.6%) patients had disharmonious patterns. Compared to isomeric left atrial appendages, the disharmonious pattern was more frequent with isomeric right atrial appendages (5.9% vs. 17.4%; p 0.003). Irrespective of the type of isomerism, disharmony was mostly confined to the level of the abdomen. Not all patients with isomeric atrial appendages have a harmonious thoraco-abdominal arrangement. The atrial-bronchial-abdominal disharmony is more frequent with isomeric right atrial appendages and is mostly present at the level of the abdomen. A detailed sequential segmental analysis with an independent description of each organ system is, therefore, essential for the complete evaluation of patients with isomeric atrial appendages.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1262-1272"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420277","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}

引用次数: 0

A Prospective Randomized Controlled Trial Using Virtual Reality in Pediatric Pre-intervention Echocardiograms to Decrease Child Anxiety and Fear. 前瞻性随机对照试验：在小儿超声心动图干预前使用虚拟现实技术降低儿童焦虑和恐惧感

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-06-25 DOI: 10.1007/s00246-024-03555-0

Sarina K Behera, Rajesh Punn, Maria Menendez, Christine Be, Sandra Moon, Michelle Zuniga, Katie Jo Stauffer, Kelly Thorson, Nora Asi, Leo Lopez

{"title":"A Prospective Randomized Controlled Trial Using Virtual Reality in Pediatric Pre-intervention Echocardiograms to Decrease Child Anxiety and Fear.","authors":"Sarina K Behera, Rajesh Punn, Maria Menendez, Christine Be, Sandra Moon, Michelle Zuniga, Katie Jo Stauffer, Kelly Thorson, Nora Asi, Leo Lopez","doi":"10.1007/s00246-024-03555-0","DOIUrl":"10.1007/s00246-024-03555-0","url":null,"abstract":"Virtual reality (VR) as a distraction tool decreases anxiety and fear in children undergoing procedures, but its use has not been studied during transthoracic echocardiograms (TTEs). We hypothesized that VR in children undergoing pre-intervention TTEs decreases anxiety and fear and increases TTE study comprehensiveness and diagnostic accuracy when compared with standard distractors (television, mobile devices). Patients (6-18 years old) scheduled for pre-intervention TTEs at Lucile Packard Children's Hospital in 2021 and 2022 were prospectively enrolled and randomized to VR and non-VR groups. Patients completed pre- and post-TTE surveys using the Children's Anxiety Meter-State (CAM-S) and Children's Fear Scale (CFS). Patients, parents, and sonographers completed post-TTE experience surveys. TTEs were reviewed by pediatric cardiologists for study comprehensiveness and compared with electronic medical records for diagnostic accuracy. Among 67 enrolled patients, 6 declined VR, 31 randomized to the VR group, and 30 to the non-VR group. Anxiety (average CAM-S difference 0.78 ± 1.80, p = 0.0012) and fear (average CFS difference 0.36 ± 0.74, p = 0.0005) decreased in both groups. There was no difference between groups in the change in anxiety and fear pre- and post-TTE (p = 0.96-1.00). TTE study comprehensiveness and diagnostic accuracy were high in both groups. Procedure time (time in the echocardiography room) was less for the VR group (48.4 ± 18.1 min) than the non-VR group (58.8 ± 24.4 min), but without a statistically significant difference (p = 0.075). VR is similar to standard distractors and may decrease procedure time. Patients, parents, and sonographers rated the VR experience highly and encouraged its use with future procedures.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1340-1348"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446710","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}

引用次数: 0

Reducing Adverse Events Associated with Pediatric Cardiac Catheterization: A Quality Improvement Project Focusing on Decreasing Catheterization-Associated Blood Transfusions. 减少与小儿心脏导管术相关的不良事件：以减少导管插入术相关输血为重点的质量改进项目。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-06-25 DOI: 10.1007/s00246-024-03553-2

Michael Wilhelm, Jenna Torgeson, Connor Cook, Alexandra Erdmann, Juan Boriosi, Luke Lamers

{"title":"Reducing Adverse Events Associated with Pediatric Cardiac Catheterization: A Quality Improvement Project Focusing on Decreasing Catheterization-Associated Blood Transfusions.","authors":"Michael Wilhelm, Jenna Torgeson, Connor Cook, Alexandra Erdmann, Juan Boriosi, Luke Lamers","doi":"10.1007/s00246-024-03553-2","DOIUrl":"10.1007/s00246-024-03553-2","url":null,"abstract":"The objective of this study is to describe interventions and outcomes of a quality improvement (QI) project to reduce red blood cell transfusion (RBCT) within 72 h of pediatric cardiac catheterization. Using Plan-Do-Study-Act (PDSA) methodology, we applied interventions including (1). Intraprocedural-to reduce hemodilution, blood loss, and excessive anticoagulation, (2). Standardization of institutional transfusion criteria, and (3). \"Hard stop\" requiring QI team consultation prior to elective post-catheterization RBCT. Primary outcome measures were frequency of RBCT from IMPACT quarterly reports and cases between transfusions (CBT). Length of stay (LOS) was the primary countermeasure. Characteristics of patients who did and did not receive RBCT were compared. 698 pediatric cardiac catheterizations occurred between 4/2017 and 8/2023. Intraprocedural interventions did not alter frequency of RBCT or CBT. Standardized transfusion guidelines followed by the \"hard stop\" decreased RBCT frequency from 10 to 1.9% and increased CBT without increasing LOS. Patients requiring RBCT were younger (medians 0.31 vs 2.4 years), smaller (5.2 vs 11.8 kg), and had longer procedures (2.24 vs 1.57 h) all p < 0.001. Single ventricle patients were more likely to have RBCT than simple biventricular patients (14.1% vs 3.1%; RR = 4.57, 95% CI 2.29-10.4; p < 0.001). Procedure type (diagnostic vs. intervention) and starting hemoglobin concentration were comparable between groups. Programmatic adherence to standardized peri-procedural transfusion guidelines successfully decreased RBCT without compromising patient care or increasing LOS. Younger age, lower weight, procedure length, and single ventricle physiology were all associated with RBCT risk.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1320-1327"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446712","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}

引用次数: 0

Pediatric Electrocardiogram-Based Deep Learning to Predict Secundum Atrial Septal Defects. 基于深度学习的小儿心电图预测房间隔缺损

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-07-02 DOI: 10.1007/s00246-024-03540-7

Joshua Mayourian, Robert Geggel, William G La Cava, Sunil J Ghelani, John K Triedman

{"title":"Pediatric Electrocardiogram-Based Deep Learning to Predict Secundum Atrial Septal Defects.","authors":"Joshua Mayourian, Robert Geggel, William G La Cava, Sunil J Ghelani, John K Triedman","doi":"10.1007/s00246-024-03540-7","DOIUrl":"10.1007/s00246-024-03540-7","url":null,"abstract":"Secundum atrial septal defect (ASD2) detection is often delayed, with the potential for late diagnosis complications. Recent work demonstrated artificial intelligence-enhanced ECG analysis shows promise to detect ASD2 in adults. However, its application to pediatric populations remains underexplored. In this study, we trained a convolutional neural network (AI-pECG) on paired ECG-echocardiograms (≤ 2 days apart) to detect ASD2 from patients ≤ 18 years old without major congenital heart disease. Model performance was evaluated on the first ECG-echocardiogram pair per patient for Boston Children's Hospital internal testing and emergency department cohorts using area under the receiver operating (AUROC) and precision-recall (AUPRC) curves. The training cohort comprised of 92,377 ECG-echocardiogram pairs (46,261 patients; median age 8.2 years) with an ASD2 prevalence of 6.7%. Test groups included internal testing (12,631 patients; median age 7.4 years; 6.9% prevalence) and emergency department (2,830 patients; median age 7.5 years; 4.9% prevalence) cohorts. Model performance was higher in the internal test (AUROC 0.84, AUPRC 0.46) cohort than the emergency department cohort (AUROC 0.80, AUPRC 0.30). In both cohorts, AI-pECG outperformed ECG findings of incomplete right bundle branch block. Model explainability analyses suggest high-risk limb lead features include greater amplitude P waves (suggestive of right atrial enlargement) and V1 RSR' (suggestive of RBBB). Our findings demonstrate the promise of AI-pECG to inexpensively screen and/or detect ASD2 in pediatric patients. Future multicenter validation and prospective trials to inform clinical decision making are warranted.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1235-1240"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Five-Year Outcomes of Coarctoplasty with Stents in the Pediatric Population: Results from a Retrospective Single-Center Cohort with Centrally Adjudicated Outcomes. 小儿使用支架行冠状动脉成形术的五年疗效：回顾性单中心队列与中央裁定结果的结果。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-06-28 DOI: 10.1007/s00246-024-03551-4

Hojjat Mortezaeian, Elham Rezanejad, Yeganeh Pasebani, Raheleh Zamani, Yasaman Khalili, Hamidreza Ghaemi, Farshad Jafari, Mahshad Sabri, Jamal Moosavi, Bahram Mohebbi, Amir Abdi, Sara Montazeri Namin, Parham Sadeghipour, Stephan Haulon, Alain Fraisse

{"title":"Five-Year Outcomes of Coarctoplasty with Stents in the Pediatric Population: Results from a Retrospective Single-Center Cohort with Centrally Adjudicated Outcomes.","authors":"Hojjat Mortezaeian, Elham Rezanejad, Yeganeh Pasebani, Raheleh Zamani, Yasaman Khalili, Hamidreza Ghaemi, Farshad Jafari, Mahshad Sabri, Jamal Moosavi, Bahram Mohebbi, Amir Abdi, Sara Montazeri Namin, Parham Sadeghipour, Stephan Haulon, Alain Fraisse","doi":"10.1007/s00246-024-03551-4","DOIUrl":"10.1007/s00246-024-03551-4","url":null,"abstract":"Transcatheter stent implantation is a widely performed procedure for treating native coarctation of the aorta (CoA) in pediatric patients. However, data on mid- to long-term outcomes are limited. The aim of this study was to evaluate the mid-term safety and efficacy of transcatheter CoA stenting based on centrally adjudicated outcomes. This retrospective cohort study included patients aged 15 years or younger undergoing de novo stenting for CoA or recoarctation (reCoA) between 2006 and 2017. Immediate and 5-year outcomes were assessed. Immediate outcomes (procedural and in-hospital) were retrieved from electronic records. Rates of 5-year reCoA, stent fractures, aneurysmal/pseudoaneurysmal formation, and all-cause mortality were mid-term outcomes. The study included 274 patients (64% male and 36% female) with a median (interquartile range) age of 9 (6-12) years. Procedural success was achieved in 251 patients (91.6%). Procedural complications occurred in 4 patients (1.4%), consisting of stent migration in 1 (0.3%) and small non-expanding non-flow-limiting aortic wall injuries in 3 (1.1%). Major vascular access complications were observed in 18 patients (6.6%), acute limb ischemia in 8 (2.9%). In-hospital mortality occurred in 4 patients (1.4%). Five-year cumulative incidence rates of stent fractures, reCoA, and aortic aneurysmal/pseudoaneurysmal formation were 17/100 (17%), 73/154 (48%), and 8/101 (7.92%), respectively. Of 73 reCoAs, 47 were treated with balloon angioplasty, and 15 underwent a second stent implantation. Five-year all-cause mortality occurred in 4/251 (1.6%) patients. Coarctoplasty with stents was safe and effective in our pediatric population during a 5-year follow-up despite a high rate of reCoA.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1312-1319"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469942","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}

引用次数: 0

Persistent Valvular Regurgitation After Acute Rheumatic Fever: Early Predictors of Long Term Outcomes in a Pediatric Retrospective Cohort. 急性风湿热后持续性瓣膜返流：儿科回顾性队列中长期结果的早期预测因素

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-06-19 DOI: 10.1007/s00246-024-03547-0

Francesco Licciardi, Letizia Baldini, Francesco Del Monte, Alice Geranzani, Roberta Mulatero, Carlotta Covizzi, Giacomo Scaioli, Giuseppe Antonio Mazza, Davide Montin

{"title":"Persistent Valvular Regurgitation After Acute Rheumatic Fever: Early Predictors of Long Term Outcomes in a Pediatric Retrospective Cohort.","authors":"Francesco Licciardi, Letizia Baldini, Francesco Del Monte, Alice Geranzani, Roberta Mulatero, Carlotta Covizzi, Giacomo Scaioli, Giuseppe Antonio Mazza, Davide Montin","doi":"10.1007/s00246-024-03547-0","DOIUrl":"10.1007/s00246-024-03547-0","url":null,"abstract":"Describe the echocardiographic evolution of valvular regurgitation in patients with rheumatic carditis (RC) and to establish which features may predict long-term outcome, in the absence of acute rheumatic fever (ARF) relapse. Retrospective cohort study. 123 patients with confirmed RC, diagnosed at Turin Children's Hospital between 2010 and 2019. We reviewed the echocardiographic images recorded at diagnosis, after 6-8 weeks, after 6 months, then yearly, to assess which predictors at diagnosis are associated with the degree of improvement at 6 months. Secondly, we tested which variables predict the regression of pathological regurgitation of mitral (MV) or aortic valve (AV) during follow-up. At onset, 90.2% patients had MV regurgitation while 42.3% had AV involvement. 115 (93.5%) patients were treated with steroids and 70.8% experienced a downgrading of RC after 6 months. Steroids were associated with better outcomes at six months (p = 0.01). During follow-up (median 56.1 months), MV improved in 58.6% patients, AV in 46.2%. At multivariate analysis, erythrocyte sedimentation rate (ESR) was positively associated with regression of MV regurgitation (OR 1.02, p = 0.02), while higher degree of carditis at onset was negatively associated (OR 0.04, p < 0.01). Conversely, regression of AV regurgitation was more frequent in patients with bi-valvular involvement (OR 20.5, p = 0.03) and in absence of murmur at onset (OR 0.04, p = 0.01). This study indicates that valvular regurgitation improves overtime if there are no ARF recurrences during follow-up, especially when the MV is involved and in patients treated with steroids.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1289-1295"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420278","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}

引用次数: 0

Perioperative Hyper-coagulation and Thrombosis: Cost Analysis After Congenital Heart Surgery. 围手术期高凝状态和血栓形成：先天性心脏病手术后的成本分析。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2025-06-01 Epub Date: 2024-06-20 DOI: 10.1007/s00246-024-03554-1

Puja Dutta, Meena Nathan, Sitaram M Emani, Sirisha Emani, Juan C Ibla

{"title":"Perioperative Hyper-coagulation and Thrombosis: Cost Analysis After Congenital Heart Surgery.","authors":"Puja Dutta, Meena Nathan, Sitaram M Emani, Sirisha Emani, Juan C Ibla","doi":"10.1007/s00246-024-03554-1","DOIUrl":"10.1007/s00246-024-03554-1","url":null,"abstract":"Thrombosis, a major adverse event of congenital heart surgery, has been associated with poor outcomes. We hypothesized that in CHD patients undergoing cardiac surgery, increased perioperative use of pro-coagulant products may be associated with postoperative thrombosis in the setting of hyperfibrinogenemia, leading to greater hospital and blood product costs. Single-center retrospective study. Data from Boston Children's Hospital's electronic health record database was used in this study. All patients undergoing congenital heart surgery between 2015 and 2018 with postoperative fibrinogen levels above 400 mg/dl were reviewed. Of 334 patients with high plasma fibrinogen levels, 28 (8.4%) developed postoperative thrombosis (median age: one year, 59% male). In our cohort, 25 (7%) demonstrated evidence of baseline hypercoagulability by one or more panel test results. Thrombosis was associated with greater hospital and blood product costs, longer ventilation times, and longer hospital and ICU length of stays. Preoperative hypercoagulable state (odds ratio: 2.58, 95% CI [1.07, 9.99], p = 0.002), postoperative red blood cell transfusion (odds ratio: 1.007, 95% CI [1.000, 1.015], p = 0.04), and single ventricle physiology (univariate odds ratio: 2.94, 95% CI [1.09, 7.89], p = 0.03) were predictors of postoperative thrombosis. Preoperative hypercoagulable state and intraoperative platelet transfusion were predictors of hospital cost. Thrombosis was associated with worse in-hospital outcomes and higher costs. Preoperative hypercoagulable state and postoperative red blood cell transfusion were significant predictors of thrombosis. Risk prediction models that can guide thrombosis prevention are needed to improve outcomes of patients undergoing congenital heart surgery.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":"1328-1339"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0