Pediatric Cardiology最新文献

{"title":"Z-Score Calculators for Cross Sectional Area to Height Ratio of the Aortic Root and Ascending Aorta in Healthy Children.","authors":"Anila A Chaudhary, Alexis Z Tomlinson, Stacey Drant, Andrea L Jones","doi":"10.1007/s00246-026-04525-4","DOIUrl":"https://doi.org/10.1007/s00246-026-04525-4","url":null,"abstract":"<p><p>In pediatrics, echocardiographic measurements of the aorta are normalized using body surface area (BSA), which do not account for differences in body composition amongst children or as they grow. Height has been shown to have a linear relationship with measures of aortic size in pediatrics. Data from the Pediatric Heart Network (PHN) Echo Z-Score database was used to develop z-scores for cross sectional area to height ratio (CSA/ht) on 3215 healthy pediatric patients ≤ 18 years old. Aortic root and ascending aorta CSA/ht (cm²/m) were calculated. Linear regression was performed to assess the relationship between patient sex, age at echocardiogram, and CSA/ht of the aortic root. An interaction term was included to allow the effect of age to vary by sex. Estimates from the final regression model were utilized in the z-score calculator. An identical analysis was repeated for ascending aorta CSA/ht. Older children had larger aortic root CSA/ht (β = 0.10, p < 0.001) and ascending aorta CSA/ht (β = 0.08, p < 0.001). Male children had larger aortic root CSA/ht (β = 0.13, p < 0.001) and ascending aorta CSA/ht (β = 0.08, p < 0.001). There was a significant interaction of sex and age in the aortic root model (β = 0.015, p < 0.001), but not in the ascending aorta model (β = 0.003, p = 0.16). We created two z-score calculators for CSA/ht of the aortic root and the ascending aorta in normal children, ideally allowing for more accurate assessment of aortic size in children.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245824","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":"Aveir VR for Atrial Leadless Pacing in Young Patients.","authors":"Anirud Aiyer, Daniel Cortez","doi":"10.1007/s00246-026-04507-6","DOIUrl":"https://doi.org/10.1007/s00246-026-04507-6","url":null,"abstract":"<p><p>Atrial Leadless pacemaker implantspresent a new treatment for sinus node dysfunction in complex cardiac anatomies. The Aveir-VR single chamber pacemaker can be placed in the atrium to control atrial flutter, or in the ventricle to control bradycardia. In this case report, we present four cases of the implantation of the Aveir VR in the atrium of male pediatric patients to treat sinus node dysfunction. Retrospective review of patients with symptomatic sinus node dysfunction and atrially placed Aveir-VRs was performed at UC Davis between April 2024 and April 2026. Femoral access was the route of implantation for all 5 patients. Trans-esophageal echocardiography was used in all cases. The patients' ages ranged between 14-17-years and follow-up appointments were held between 1-23-months. Immediately post-procedure, impedances were 380-1460 Ohms, thresholds at 0.4 ms were 2.25-3.5 V, and P-waves were between 1.7-3 mV. Follow-up impedance was between 390-720 Ohms for the patients, thresholds were 0.5-1.25 V at 0.2-0.4 ms, P-waves were between 4.5-9.1 mV, and pacing percentages were between 12-69%. This case series demonstrates the successful implant of Aveir VR leadless pacemaker in five young patients for sinus node dysfunction.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245854","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":"Subclinical Myocardial Dysfunction in Children and Adolescents with Celiac Disease: A Cross-Sectional Case-Control Study.","authors":"Elpida Emmanouilidou-Fotoulaki, Maria Kavga, Michail Delis, Evangelia Farmaki, Charalampos Agakidis, Maria Fotoulaki, Kyriaki Papadopoulou-Legbelou","doi":"10.1007/s00246-026-04521-8","DOIUrl":"https://doi.org/10.1007/s00246-026-04521-8","url":null,"abstract":"<p><p>Celiac disease (CD) is recognized as a systemic disorder extending beyond the gastrointestinal tract, with evidence of subclinical cardiovascular involvement emerging even in childhood. We aimed to evaluate myocardial function in children with CD compared to healthy controls, and to investigate whether echocardiographic parameters differ according to gluten-free diet adherence. This cross-sectional case-control study included 142 children with CD and 120 healthy controls. Conventional and advanced echocardiography were performed in all participants. Multivariable linear regression adjusted for sex, age, and body mass index (BMI) z-score was used for all echocardiographic outcomes. Patients were stratified by anti-tissue transglutaminase IgA (anti-tTG IgA) into tTG-negative (n = 55), borderline (n = 13), and positive (n = 74) subgroups. Ejection Fraction (EF) and Fractional Shortening (FS) were modestly but significantly reduced in CD patients, while left ventricular (LV) dimensions and LV mass were not significantly different. All Tissue Doppler Imaging (TDI) parameters were significantly impaired in CD patients, including elevated Myocardial Performance Index (MPI) and E/e' ratios at both septal and lateral mitral annulus (p < 0.001). Myocardial function was impaired across all serological subgroups compared to controls, with no significant differences among celiac subgroups in multivariable analysis. ROC analysis demonstrated excellent discriminatory ability of MPI between celiac patients and healthy controls, after adjustment for age, sex and z-score BMI. Children with CD demonstrate significant subclinical myocardial dysfunction, detectable by TDI, independently of serological disease activity. Prospective longitudinal studies are needed to establish the long-term cardiovascular implications and the role of routine cardiac monitoring in this population.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149245804","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":"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}