PROGRESS IN PEDIATRIC CARDIOLOGY最新文献

{"title":"When free rolls aren't free: Incentive asymmetry and the hidden costs of transparency in pediatric cardiac care","authors":"Mohamed Abozaid,&nbsp;Murad Almasri,&nbsp;Joshua Daily","doi":"10.1016/j.ppedcard.2026.101946","DOIUrl":"10.1016/j.ppedcard.2026.101946","url":null,"abstract":"<div><div>In behavioral economics, a “free roll” describes a decision with potential gain and no meaningful downside risk. In rare, extreme-risk congenital cardiac cases, families may perceive intervention as a clinical analog of a free roll because mortality is certain without treatment, while survival remains possible with it. For clinicians, however, attempting the same intervention is not without downside: publicly visible outcome reporting assigns procedural deaths to surgical programs, creating professional and institutional consequences even in near-certain-fatality cases. Differences in reporting visibility across procedural domains create asymmetric downside exposure: high-risk interventions may carry institutional penalty in the surgical domain but function as effective free rolls in the catheterization domain. These structural pressures interact with predictable features of human judgment in both families and clinicians, amplifying their influence at the margins. This Perspective examines how reporting architecture shapes decision environments in near-certain-fatality scenarios and proposes targeted structural refinements, such as compassionate-use designations, contextualized reporting, and parallel learning registries, to preserve transparency while supporting patient-centered care for the sickest children.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"83 ","pages":"Article 101946"},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148554724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic and geographic factors are associated with lower prenatal diagnosis rates of congenital heart disease","authors":"Benjamin Ittleman,&nbsp;Waylon J. Howard,&nbsp;Kathryn Virk,&nbsp;Nicholas K. Brown,&nbsp;Elizabeth Caris,&nbsp;Jeffrey Conwell,&nbsp;Lindsay A. Edwards,&nbsp;Mark Lewin,&nbsp;Nelangi M. Pinto,&nbsp;Matthew Studer,&nbsp;Luciana Young,&nbsp;Bhawna Arya","doi":"10.1016/j.ppedcard.2026.101948","DOIUrl":"10.1016/j.ppedcard.2026.101948","url":null,"abstract":"<div><h3>Background</h3><div>Prenatal diagnosis (PND) of congenital heart disease (CHD) optimizes perinatal management and improves preoperative status; with survival benefit demonstrated for select lesions. Despite advances in fetal imaging, PND rates remain variable, with persistent disparities linked to socioeconomic, demographic, and geographic factors. However, these variables and their combined impact within a regional care network encompassing a large area of the Northwest United States have not been previously examined.</div></div><div><h3>Objective</h3><div>Evaluate the association between socioeconomic and geographic factors—including race, ethnicity, Area Deprivation Index (ADI), and distance from a regional surgical center—and PND of significant CHD, and to compare postoperative outcomes by PND status.</div></div><div><h3>Methods</h3><div>This single-center cross-sectional study included all patients with significant CHD requiring surgery within the first year of life and diagnosed between 2014 and 2022 at a regional referral center in the Northwestern United States. Socioeconomic and geographic variables were extracted, including race, ethnicity, insurance status, and address, which were used to determine state and national ADI rankings and distance to the surgical center. Postoperative outcomes were obtained. Group comparisons used nonparametric and categorical analyses.</div></div><div><h3>Results</h3><div>Among 929 patients, 736 (79.2%) were diagnosed prenatally. Higher state-level ADI (<em>p</em> &lt; 0.001), non-White race (<em>p</em> = 0.003), Hispanic ethnicity (<em>p</em> = 0.03), and greater distance from the surgical center (<em>p</em> = 0.009) were independently associated with lower PND rates. Prenatally diagnosed patients had higher 30-day mortality (<em>p</em> = 0.003) and reintubation rates (<em>p</em> &lt; 0.001), reflecting increased disease severity.</div></div><div><h3>Conclusion</h3><div>Socioeconomic disadvantage, non-White race, Hispanic ethnicity, and greater geographic distance were associated with lower PND rates. Mapping PND alongside regional deprivation indices may help identify underserved areas and guide targeted interventions.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"83 ","pages":"Article 101948"},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148554727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are weight, age and faltering growth at surgery associated with surgical course and long-term weight recovery following ventricular septal defect closure?","authors":"Sharon Brosilow,&nbsp;Chen Wolfgor,&nbsp;Yishay Salem,&nbsp;David Mishaly,&nbsp;Zvi Adler,&nbsp;Salvatore Campisi-Pinto,&nbsp;Asaad Khoury","doi":"10.1016/j.ppedcard.2026.101953","DOIUrl":"10.1016/j.ppedcard.2026.101953","url":null,"abstract":"<div><h3>Background</h3><div>Earlier repair of large ventricular septal defects (VSDs) is more common; however, optimal timing and the extent to which age and anthropometric measurements predict morbidity and weight recovery remain uncertain.</div></div><div><h3>Objective</h3><div>To assess whether age, weight, weight-for-age percentile (WAP), and duration of preoperative growth impairment are associated with perioperative outcomes and postoperative weight recovery after VSD closure.</div></div><div><h3>Methods</h3><div>Retrospective review of infants undergoing surgical repair of large VSDs between 2017 and 2022. Anthropometric measurements at surgery were analyzed in relation to perioperative variables and postoperative growth outcomes.</div></div><div><h3>Results</h3><div>Eighty-seven infants were included (Average weight at surgery 4.93 kg ±1.35, median age at surgery 14 weeks [11.1, 24.5]). Major complication occurred in 4 infants. Infants weighing &lt;4 kg at surgery had longer pediatric intensive care unit (PICU) stay than those weighing ≥4 kg (6 [4, 8] vs 4 [3, 5] days, <em>p</em> = 0.03). Similarly, infants operated at age &lt; 9 weeks had longer PICU stay (6 [4, 7.2] vs 4 [3, 5], p = 0.03) and longer postoperative hospitalization than those operated at age ≥ 9 weeks (10 [7, 16.2] vs 6 [6, 8], <em>p</em> = 0.02). On multivariable analysis, younger age and lower weight were independently associated with prolonged postoperative hospitalization, while younger age was associated with longer cardiopulmonary bypass time. Infants with WAP below the 3rd percentile at surgery required longer to stabilize on a weight trajectory (44 [23.9, 57.2] vs 21 [8.7, 36.9] weeks, <em>p</em> = 0.02) and subsequently tracked along lower weight-for-age percentiles (25.5 [14.7, 55] vs 72 [53, 78.9], <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Lower operative weight and younger age were associated with longer PICU stay and postoperative hospitalization, while significant preoperative growth faltering was linked to delayed postoperative weight stabilization and lower subsequent weight-for-age percentiles.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"83 ","pages":"Article 101953"},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148641332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute myeloid leukemia in a patient with Fontan circulation – Case report","authors":"Danielle Strah,&nbsp;Mrinal Joshirao,&nbsp;Hari K. Narayan,&nbsp;Anusha Preethi Ganesan,&nbsp;Caitlin Carter,&nbsp;Jose Silva-Sepulveda","doi":"10.1016/j.ppedcard.2026.101955","DOIUrl":"10.1016/j.ppedcard.2026.101955","url":null,"abstract":"<div><div>Patients with single ventricle heart disease require a series of palliative surgeries, culminating in the Fontan, which results in passive pulmonary arterial blood flow after direct connection of the venae cavae to the pulmonary arteries [1]. Fontan circulation leads to complications impacting multiple organ systems; however, cancers outside of hepatocellular carcinoma are not reported frequently [1].</div><div>Anthracycline-based chemotherapeutic regimens, frequently used to treat pediatric cancers, carry a significant dose-dependent risk of cardiotoxicity. Protocols require monitoring of left ventricular ejection fraction to detect declines in cardiac function and guide treatment.</div><div>Monitoring cardiac function in Fontan patients with systemic right ventricle presents unique challenges due to limitations of echocardiography to assess right ventricular systolic function, lack of established values for quantitative measures of systemic right ventricular function, and limited applicability of heart failure regimens for systemic right ventricles [1]. Cardiac magnetic resonance imaging and computed tomography can better quantitate right ventricular systolic function; however, these modalities are limited by ferromagnetic artifacts from prior interventions and contraindicated with renal dysfunction, respectively [2].</div><div>We present a patient with Fontan physiology and systemic right ventricle, diagnosed with acute myeloid leukemia (AML) requiring multi-disciplinary management with a goal of curative treatment of AML while minimizing cardiac and nephrotoxicity.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"83 ","pages":"Article 101955"},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148641468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril/valsartan improves clinical, biomarker, and echocardiographic outcomes in pediatric heart failure: A systematic review and meta-analysis","authors":"I.R. Predeus ,&nbsp;M.Y. Sato ,&nbsp;M.D.W. de Souza ,&nbsp;G.C. Moraes ,&nbsp;R.F. Gomes ,&nbsp;J.P. Oliveira ,&nbsp;I.C.F. Carlos ,&nbsp;H.S. Azevedo ,&nbsp;J.R. Cardoso ,&nbsp;P.B. Cardoso ,&nbsp;A.B.N. Cunha ,&nbsp;C.O.F. Bacca ,&nbsp;E.S. Melo","doi":"10.1016/j.ppedcard.2026.101932","DOIUrl":"10.1016/j.ppedcard.2026.101932","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) in children remains a major cause of morbidity and mortality. Sacubitril/valsartan (S/V) is a cornerstone therapy in adult HF, but its role in pediatrics is less established, especially after the neutral results of the PANORAMA-HF randomized trial.</div></div><div><h3>Aim of the review</h3><div>To synthesize available evidence on the effects of sacubitril/valsartan (S/V) on clinical, biomarker, and echocardiographic outcomes in pediatric heart failure (HF).</div></div><div><h3>Key scientific concepts of review</h3><div>Systematic review and meta-analysis of 6 studies comprising 336 patients. Outcomes included NT-proBNP, left ventricular ejection fraction (LVEF), and NYHA functional class. Standardized mean change (SMC) was calculated for NT-proBNP, and mean difference (MD) for LVEF using random-effects models. S/V therapy was associated with a significant reduction in NT-proBNP (SMC −0.57; 95% CI −0.77 to −0.36; <em>P</em> &lt; 0.001; I² = 35%) and a significant increase in LVEF (MD +12.53%; 95% CI 10.06% to 15.01%; P &lt; 0.001; I² = 0%). The proportion of patients in NYHA class III/IV decreased from 63.9% at baseline to 29.1% after treatment. A post hoc analysis of PANORAMA-HF (Shaddy 2025) demonstrated that halving NT-proBNP was associated with a 52% risk reduction for clinical events. Adverse events included hypotension (2–10%) and renal dysfunction (2–12%). Limitations include a small number of studies, predominance of observational designs, and lack of control groups.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"82 ","pages":"Article 101932"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148184610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular features of Alagille syndrome in hospitalized pediatric patients: a tertiary center experience","authors":"Federico D'Antonio ,&nbsp;María Teresa Politi ,&nbsp;Ana Emilia Ruiz Mariani ,&nbsp;Mariana del Rosario Fernández ,&nbsp;Fausto José Ochoa Toro ,&nbsp;Gladys Haydee Salgado ,&nbsp;Diana Mariela Mouratian","doi":"10.1016/j.ppedcard.2026.101930","DOIUrl":"10.1016/j.ppedcard.2026.101930","url":null,"abstract":"<div><h3>Background</h3><div>Although several case series have been published, comprehensive data on the full spectrum of cardiovascular anomalies remain limited, particularly on a global scale.</div></div><div><h3>Objectives</h3><div>To describe the spectrum and severity of cardiovascular anomalies in patients with Alagille syndrome admitted to a pediatric tertiary care center.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study of pediatric patients with a clinical diagnosis of Alagille syndrome hospitalized between January 2014 and September 2024. Clinical data and cardiovascular imaging (echocardiography, computed tomography angiography, and cardiac catheterization) were reviewed and analyzed descriptively.</div></div><div><h3>Results</h3><div>Thirty patients were included (57% female; median age at diagnosis 3.0 months). Genetic confirmation with JAG1 mutation was available in 17%. Pulmonary artery branch stenosis was present in 83% of patients, predominantly bilateral and mild in severity. Additional structural anomalies were identified in 27%, including rare associations such as Scimitar syndrome, acquired aortic arch atresia, and Tetralogy of Fallot with absent pulmonary valve, partial anomalous pulmonary venous return, and coronary anomaly. Cardiovascular surgery was performed in 10% of patients. Overall mortality was 20%, primarily due to liver failure.</div></div><div><h3>Conclusion</h3><div>Pulmonary artery branch stenosis remains the most common cardiovascular manifestation in Alagille syndrome; however, complex and rare anomalies may also be present, highlighting the wide phenotypic variability of the disease. These findings underscore the need for broader, geographically diverse studies to enhance understanding of the full clinical spectrum and guide comprehensive care.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"82 ","pages":"Article 101930"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147952222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chylothorax in critically ill children following cardiac surgery: a cohort study","authors":"Narelle N.A. Pelizaro ,&nbsp;Daniele S.J. Volpe ,&nbsp;Paulo H. Manso ,&nbsp;Ana P.C.P. Carlotti","doi":"10.1016/j.ppedcard.2026.101907","DOIUrl":"10.1016/j.ppedcard.2026.101907","url":null,"abstract":"<div><h3>Background</h3><div>Data on chylothorax after pediatric cardiac surgery are limited, and high-quality evidence-based treatment strategies are lacking.</div></div><div><h3>Objectives</h3><div>We aimed to investigate the epidemiology, clinical characteristics, management, and outcome of patients who developed chylothorax following cardiac surgery during pediatric intensive care unit (PICU) stay.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study performed between 01/2012 and 12/2022 at a tertiary-care hospital affiliated with the University of São Paulo.</div></div><div><h3>Results</h3><div>Over the study period, the incidence of chylothorax after cardiac surgery in our institution was 3.1%; 29 patients developed chylothorax during PICU stay. Their median age was 3 months, 41% had Down syndrome, and 27.5% had intrathoracic deep vein thrombosis. Comparison of patients with low-output chylothorax (&lt;20 ml/kg/day) (<em>n</em> = 17) versus those with high-output chylothorax (≥20 ml/kg/day) (<em>n</em> = 12) showed a prolonged duration of chest tube utilization, lower minimum number of lymphocytes in peripheral blood, and increased PICU length of stay in patients with high-output chylothorax. All patients with low-output chylothorax were managed conservatively, whereas half of the patients with high-output chylothorax underwent interventional treatment (pleurodesis and/or thoracic duct ligation). Eleven patients (37.9%) died; 55% of them had high output chylothorax. Cause of death was septic shock in all but one patient. The percentage of lymphocytes in pleural fluid was greater in patients who died compared to survivors, and among those who died of septic shock, the number of lymphocytes in peripheral blood was lower.</div></div><div><h3>Conclusions</h3><div>Chylothorax following pediatric cardiac surgery is associated with increased morbidity and mortality. Early resolution may contribute to outcome improvement.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"82 ","pages":"Article 101907"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147995219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum surgical repair of asymptomatic partial atrioventricular septal defect detected during pregnancy","authors":"Nail Kahraman,&nbsp;Nöfel Ahmet Binicier","doi":"10.1016/j.ppedcard.2026.101926","DOIUrl":"10.1016/j.ppedcard.2026.101926","url":null,"abstract":"<div><div>Partial atrioventricular septal defect (pAVSD) may remain clinically silent until adulthood. Pregnancy-related hemodynamic and neurohormonal changes can unmask latent defects; however, optimal management strategies and electrophysiological implications in this setting remain incompletely defined. A 28-year-old asymptomatic woman was referred after detection of a systolic murmur and left anterior fascicular block (LAFB) on electrocardiography during late pregnancy. Transthoracic echocardiography (TTE) demonstrated a large primum-type atrial septal defect associated with a mitral valve cleft, mild mitral regurgitation, moderate functional tricuspid regurgitation (TR), right-sided chamber dilatation, and moderate pulmonary hypertension, without a ventricular septal defect. Given maternal hemodynamic stability and to avoid fetal exposure to cardiopulmonary bypass, surgical intervention was electively deferred. One year later, definitive repair was performed with pericardial patch closure of the primum defect and primary mitral cleft repair. Postoperative recovery was uneventful. Follow-up echocardiography showed complete anatomical correction, normalization of right heart dimensions, and spontaneous resolution of TR without direct valve repair. Serial postoperative (Electrocardiographys) ECGs demonstrated resolution of LAFB with restoration of stable sinus rhythm. This case supports the concept of pregnancy as a physiological diagnostic stress test for latent pAVSD and suggests that conduction abnormalities and TR in selected adult patients may be predominantly functional and reversible. Primary mitral cleft repair may further improve left ventricular outflow tract flow symmetry beyond reducing mitral regurgitation.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"82 ","pages":"Article 101926"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing post-traumatic stress risk in preschoolers after cardiac surgery: A call for proactive psychosocial integration in care pathways","authors":"Javed Iqbal ,&nbsp;S.Y.E.D.M.U.H.A.M.M.A.D. ALI ,&nbsp;Kamran shahzad","doi":"10.1016/j.ppedcard.2025.101898","DOIUrl":"10.1016/j.ppedcard.2025.101898","url":null,"abstract":"","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"81 ","pages":"Article 101898"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal memory in the Glenn-Fontan acute kidney injury continuum: A window for early renal protection","authors":"Eitan Keizman ,&nbsp;Asaf Mandel ,&nbsp;Yshia Langer ,&nbsp;Salmas Watad ,&nbsp;Hiba Abuelhija ,&nbsp;Alexander Lowenthal ,&nbsp;Reut Kassif Lerner ,&nbsp;David Mishaly ,&nbsp;Alain E. Serraf ,&nbsp;Uri Pollak","doi":"10.1016/j.ppedcard.2026.101910","DOIUrl":"10.1016/j.ppedcard.2026.101910","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a common and serious complication following Fontan completion in children with single ventricle physiology. While risk factors for post-Fontan AKI are well studied, it remains unknown whether prior AKI after the Glenn procedure can predict subsequent renal injury.</div></div><div><h3>Objectives</h3><div>To determine whether AKI after the Glenn procedure is associated with AKI after Fontan completion, and to characterize the persistence of AKI severity across staged palliation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 98 pediatric patients who underwent Fontan surgery between 2009 and 2016. AKI after both Glenn and Fontan procedures was assessed using KDIGO and pRIFLE classification systems. Statistical analyses included odds ratios, cross-tabulations, and correlation tests to evaluate the relationship between post-Glenn and post-Fontan AKI.</div></div><div><h3>Results</h3><div>Among patients who developed AKI after Glenn, 87.5% (KDIGO) and 80% (pRIFLE) experienced AKI again after Fontan. Patients with Glenn-related AKI were over 14 times more likely to develop post-Fontan AKI (OR = 14.36, <em>p</em> = 0.001). Notably, 100% of patients with severe (“failure” category) Glenn AKI developed Fontan AKI, and 75% remained in the severe category. Despite weak correlation coefficients, categorical analysis highlighted a clinically significant predictive relationship. Only 2% required ECMO post-Fontan, and overall mortality was 5.1%.</div></div><div><h3>Conclusions</h3><div>AKI following the Glenn procedure is a strong predictor of subsequent AKI after Fontan completion. This finding suggests a possible continuum of renal vulnerability across staged palliation, supporting the concept of “renal memory.” Integrating prior renal response into pre-Fontan risk assessment could enable early intervention and tailored perioperative strategies.</div></div>","PeriodicalId":46028,"journal":{"name":"PROGRESS IN PEDIATRIC CARDIOLOGY","volume":"81 ","pages":"Article 101910"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}