Pediatric Cardiology最新文献

{"title":"Largest Single-Center Experience Using the Micro Vascular Plug (MVP) for Transcatheter Closure of Premature Patent Ductus Arteriosus.","authors":"Peter Guyon, Dijana Popevski, Thomas Forbes, Brian Boe, Kak-Chen Chan, Larry Latson","doi":"10.1007/s00246-025-03832-6","DOIUrl":"https://doi.org/10.1007/s00246-025-03832-6","url":null,"abstract":"<p><p>Within the last 5 years, the FDA approved use of the Amplatzer Piccolo Occluder (Abbot Structural Heart, CA) for transcatheter patent ductus arteriosus (PDA) closure in premature infants. Other devices have been used off-label to successfully perform this procedure, including the Microvascular Plug, \"MVP\" (Medtronic, Minneapolis, MN). We report the largest single-center experience with PDA closure in premature infants using the MVP device. A retrospective review of transcatheter premature infant PDA closures at a single center was performed. Procedures performed using the MVP device were included; procedures using other devices were excluded. Descriptive statistics were performed using R version 4.4.0. From 4/2018 to 8/2022, a total of 74 cases were performed. The median gestational age was 24 (IQR 23-25) weeks and procedural weight was 1.17 kg (0.97-1.40); (82% ≤ 1.5 kg). The age at procedure was 44 days (34-54). PDA minimum diameter (by angiogram) was 2.85 (2.4-3.4) mm. There were no procedural or 30-day mortalities. There was one major Adverse Event (AE) (aortic arch obstruction; 1.3%). There were two minor AEs (2.6%; small pericardial effusion requiring no intervention, n = 1; and device malposition with uneventful retrieval and replacement of additional device within the same catheterization, n = 1). The left pulmonary artery peak gradient at most recent follow-up was 5.8 (3.4-8.9) mmHg; the aortic peak gradient was 0.77 (0.4-1.7). There is a median follow-up time of 63 days (32-310) post-procedure. The safety profile using the MVP is in line with or favorable compared to the contemporary literature of PDA closure in premature infants.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720882","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":"School Performance and Learning Challenges in Children and Adolescents with Congenital Heart Disease.","authors":"Zeina Al-Khalil, Jad Abdul Khalek, Mohamad Al Hajjar, Marc Barakat, Fadi Bitar, Mariam Arabi","doi":"10.1007/s00246-025-03835-3","DOIUrl":"https://doi.org/10.1007/s00246-025-03835-3","url":null,"abstract":"<p><p>Children with congenital heart disease are at risk for neurocognitive and neurodevelopmental challenges, learning disabilities, and psychosocial difficulties. Our narrative review draws literature-based evidence for the effect of congenital heart disease on school performance. We conducted a literature review and extracted relevant articles from Google Scholar, Medline, and PubMed. Evidence showcases that school performance is impacted directly by congenital heart disease. This seems to be underlined by different factors inherent to congenital heart disease, like inattention, language difficulties, and decreased fine and gross motor skills. Moreover, the operative and postoperative periods present various physical challenges that can hinder development, ultimately affecting daily activities and quality of life. The consequent stressors in childhood can have long-lasting effects, leading to an increased prevalence of anxiety and depression affecting patients as they transition into adolescence and adulthood and placing significant social and emotional burdens on their direct environment. Children with congenital heart disease face both direct and indirect challenges related to their disease. These challenges are most likely to be the source of poor school performance and learning, as suggested by the literature. Close monitoring, early interventions, and multidisciplinary care are essential to address these vulnerabilities and improve educational outcomes in children with congenital heart disease.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701153","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":"Beyond the Evidence: Psychological and Institutional Factors Shaping Patent Ductus Arteriosus Stent Adoption.","authors":"Stephen T Dalby, Daniel Fiedorek, Joshua A Daily","doi":"10.1007/s00246-025-03837-1","DOIUrl":"https://doi.org/10.1007/s00246-025-03837-1","url":null,"abstract":"<p><p>In infants with ductal dependent pulmonary blood flow (DDPBF), clinicians face a critical choice between two interventions to secure stable pulmonary circulation: the Blalock-Taussig-Thomas (BTT) shunt and patent ductus arteriosus (PDA) stenting. While the BTT shunt has long been the standard palliative procedure, its risks have prompted interest in less invasive alternatives. This manuscript explores the psychological and institutional factors contributing to the growing preference for PDA stenting over surgical shunting in the management of DDPBF. Cognitive biases, public reporting of surgical outcomes, and family preferences significantly influence clinicians' procedural decisions. Understanding these influences is essential to align clinical decisions with evidence-based practices, ensuring optimal care for patients while maintaining transparency and equity in procedural evaluation.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693008","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":"Cost-Effectiveness of Implantable Cardioverter-Defibrillators in Surgically Repaired Tetralogy of Fallot.","authors":"Christopher W Follansbee, Laura A Navarro, Brian Feingold, Gaurav Arora","doi":"10.1007/s00246-025-03833-5","DOIUrl":"https://doi.org/10.1007/s00246-025-03833-5","url":null,"abstract":"<p><p>Implantable cardioverter-defibrillators (ICDs) are increasingly used in patients with congenital heart disease, most commonly in surgically repaired Tetralogy of Fallot (rTOF). Studies have examined patient outcomes after ICD implantation; however, the cost-effectiveness of ICDs in rTOF is unknown. We sought to evaluate the cost-effectiveness of typical medical management plus ICD (TMM + ICD) for primary prevention of sudden cardiac death (SCD) compared to typical management alone (TMM) in high-risk patients with rTOF. We created a Markov model to compare costs and quality of life (QOL) of TMM + ICD vs TMM for a hypothetical adolescent with rTOF and higher than average risk of SCD over 20 years. Model parameters were derived from the literature and institutional data. We assumed that SCD risk increased from 0.4%/year to 1.2%/year over 20 years, that the ICD was 99% effective in preventing SCD, and a frequency of ICD replacement of 11 years. We used sensitivity analyses to explore uncertainty around model assumptions. Costs were $62,895 for TMM + ICD and $19,004 for TMM. The incremental cost-effectiveness ratio for TMM + ICD was $53,386/quality-adjusted life-year (QALY) which is below threshold of $100,000/QALY that is usually considered cost-effective. The model was sensitive to SCD risk, costs of ICD implantation and management, cost of ICD replacement, and utilities of living with rTOF and of ICD implantation. Based on risk of SCD, cost of device implantation and management including complications, and our current understanding of the impact of ICD implantation on patient QOL, ICD therapy for primary prevention of SCD in rTOF can constitute a cost-effective strategy.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674386","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":"Comment on \"Contraception Use in Adolescents and Young Adults with Congenital Heart Disease\".","authors":"Syeda Samia Fatima","doi":"10.1007/s00246-025-03838-0","DOIUrl":"https://doi.org/10.1007/s00246-025-03838-0","url":null,"abstract":"<p><p>Contraceptive use among adolescents and young adults with congenital heart disease (CHD) is notably lower, influenced by multiple critical factors. This critique highlights three key determinants that warrant further investigation in future research. First, studies indicate that hormonal contraceptives, particularly estrogen-containing methods, may elevate the risk of thromboembolic complications, arrhythmias, and heart failure in CHD patients, especially those with Fontan circulation or transposition of the great arteries. Second, menstrual irregularities are prevalent among CHD patients, with a significant proportion facing contraindications to estrogen-based contraceptives, potentially discouraging their use. Lastly, inadequate disease-specific contraceptive counseling contributes to knowledge gaps, limiting informed decision-making regarding reproductive health. Addressing these determinants is essential to optimize contraceptive use and improve reproductive health outcomes in CHD patients.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677096","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":"Changes in Youth Cholesterol Screening Rates in an Academic Center During the COVID-19 Pandemic.","authors":"Jessica K Schwartz, Xiao Zhang, Amy L Peterson","doi":"10.1007/s00246-025-03831-7","DOIUrl":"https://doi.org/10.1007/s00246-025-03831-7","url":null,"abstract":"<p><p>Screening youth for hypercholesterolemia allows for detection of familial hypercholesterolemia that can predispose to premature heart disease, however guidelines provide conflicting recommendations regarding universal cholesterol screening. The COVID-19 pandemic and the perception of conflicting guideline recommendations (2011 National Heart, Lung, and Blood Institute guidelines and United States Preventive Services Task Force recommendations in 2016 and 2023) may have adversely affected youth cholesterol screening rates. This study examines screening rates during and after the COVID-19 pandemic and the most recent guideline update. Electronic health record data from a single academic institution was used to calculate Order Placement Rates (OPRs) for subjects aged 8 years 9 months-21 years from 3/18/2019 to 12/31/2023. Demographic data included subject sex, age, zip code, and primary provider's specialty. Zip codes were categorized as rural/urban and underserved/middle/advantaged. The study period was divided into five stages (pre-pandemic, mid-pandemic, late-pandemic, post-pandemic, and post-guideline). Relative to baseline OPR prior to 3/18/2019, study period OPRs decreased slightly in pre-pandemic (73.3%), mid-pandemic (70.9%), and late-pandemic (65.4%) stages, with sharper declines during post-pandemic (47.6%) and post-guideline stages (35.2%). OPR decreased more significantly for youth 9-11 years than 17-21 years (post-guideline OPR: 35.1% versus 46.9%). Urban underserved and urban advantaged had higher OPRs. OPRs for family medicine and pediatrics declined (p < 0.01), more significantly in pediatrics (post-guideline versus pre-pandemic OPR adjusted odds ratio [95% CI] = 0.03 [0.02-0.04] for pediatrics, 0.35 [0.30-0.40] for family medicine). Our institution showed decreases in cholesterol screening OPRs after both the COVID-19 pandemic and guideline update. OPRs dropped most significantly among youth aged 9-11 years and among pediatric providers. Urban youth were more likely to be screened than rural youth. Discrepancies persist among access to youth cholesterol screening.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674381","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":"Tube Feeding Duration Associated with Socioeconomic Factors in Infants with Congenital Heart Disease: Single Center Study.","authors":"Juliana S Sherchan, Christine Oliver, Alexandra Krill, Alicia H Chaves","doi":"10.1007/s00246-025-03827-3","DOIUrl":"https://doi.org/10.1007/s00246-025-03827-3","url":null,"abstract":"<p><p>Infants with congenital heart disease are often discharged home with tube feeding after undergoing cardiac surgery. Clinical factors have been shown to impact tube feeding duration after cardiac surgery, but there is less information about how socioeconomic factors impact tube feeding duration. This retrospective cohort study was conducted among infants who underwent congenital heart disease surgery within 60 days of birth and were discharged from the hospital with tube feeding from 2016 to 2023 (N = 102). Tube feeding duration, neighborhood socioeconomic status (SES), self-reported race and ethnicity, and insurance type were collected. Neighborhood SES was calculated based on the previously published method by Diez-Roux and using the Childhood Opportunity Index. The median total tube feeding duration was 490.5 days, with 60.8% infants requiring tube feeding for greater than 1 year. Compared to other racial and ethnic groups, Hispanic/Latino patients had the highest median duration of tube feeding in days (1065). Longer length of stay, Hispanic/Latino ethnicity, and lower neighborhood SES score (ORs: 1.023-7.773) were associated with increased odds of needing a feeding tube for greater than 1 year. Further understanding of what is leading to these disparities is needed to guide improvement in equity.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664155","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":"Correction: Transitioning from the Safety of the Womb to the Outside World for Neonates with Life-Threatening Cardiovascular Conditions: The IMmediate Postpartum Access to Cardiac Therapy (IMPACT) Procedure.","authors":"Asif Padiyath, Jennifer M Lynch, Lisa M Montenegro, Susan C Nicolson, Olivia Nelson, Anita L Szwast, Amanda J Shillingford, Christine B Falkensammer, Jill J Savla, Julie Moldenhauer, Nahla Khalek, Jack Rychik","doi":"10.1007/s00246-025-03822-8","DOIUrl":"https://doi.org/10.1007/s00246-025-03822-8","url":null,"abstract":"","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657980","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":"Holodiastolic Flow Reversal in the Descending Aorta: A Marker of Concomitant Acute Myocarditis and Aortitis in Children-A Case Series.","authors":"Elaheh Malakan Rad, Hamidreza Pourlaiakbar, Mojtaba Gorji, Ziyad M Hijazi","doi":"10.1007/s00246-025-03810-y","DOIUrl":"https://doi.org/10.1007/s00246-025-03810-y","url":null,"abstract":"<p><p>This case series describes five pediatric patients with acute myocarditis presenting holodiastolic flow reversal in the descending aorta despite the absence of aortic run-off lesions. This Doppler finding highlights the role of aortitis or Concomitant Acute Myocarditis and Aortitis (CAMA). Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) confirmed myocarditis in three cases. Key findings included poor response to exogenous catecholamines, elevated troponin I, hyponatremia, low vitamin D, and frequent biventricular involvement. Outcomes included one successful cardiac transplantation, one requiring levosimendan, and three fatalities. Low diastolic blood pressure and flow reversal in the descending aorta are critical clues for diagnosing CAMA. Clinical implications, pathophysiology, and management are discussed.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657983","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":"Lung Density Measurement in Fontan Patients Using Zero Echo Time Sequences.","authors":"Alessia Callegari, Konstantinos Zeimpekis, Barbara E U Burkhardt, Emanuela R Valsangiacomo Buechel, Fraser M Callaghan, Jakob Usemann, Martin Hersberger, Christian J Kellenberger, Julia Geiger","doi":"10.1007/s00246-025-03825-5","DOIUrl":"https://doi.org/10.1007/s00246-025-03825-5","url":null,"abstract":"<p><p>Pulmonary complications are known to occur in patients after Fontan palliation. Cardiac MRI is performed in the follow-up of Fontan patients to assess single ventricular function, hemodynamics and potential collateral flow. To date, pulmonary function tests have been used to detect functional lung impairment, but lung MRI has not been integrated into imaging follow-up. In this study, we measured lung-to-background ratio (LBR) on zero echo time (ZTE) MRI sequences in 32 children with Fontan palliation. Patients were divided into 2 groups: LBR > 1.5 and < 1.5 and assessed for associations between LBR and ventricular function, fibrosis, hemodynamics as well as biomarkers, spirometry and previous catheter results. We observed significantly increased extracellular volume (ECV) and decreased tissue inhibitor of metalloproteinase 1 (TIMP-1), soluble suppression of tumorigenicity 2 (sST-2) and a trend towards decreased growth differentiation factor 15 (GDF-15) as well as decreased albumin and prothrombin time values in patients with elevated LBR, whereas the other cardiovascular and pulmonary parameters did not differ significantly. Moreover, patients with LBR > 1.5 had a history of increased pulmonary arterial pressure prior to the Fontan and Glenn procedures and interventional veno-venous collateral embolization. Monitoring lung density with ZTE MRI sequences may be helpful in the diagnostic workup to assess the outcome of patients after Fontan procedure.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657988","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}