Annals of Pediatric Cardiology最新文献

{"title":"Comparing closed and open large language models on pediatric cardiology board exam performance.","authors":"Nino Nikolovski, Conall T Morgan, Michael N Gritti","doi":"10.4103/apc.apc_301_25","DOIUrl":"https://doi.org/10.4103/apc.apc_301_25","url":null,"abstract":"<p><p>Large language models (LLMs) have gained traction in medicine, but there is limited research comparing closed- and open-source models in subspecialty contexts. This study evaluated ChatGPT-4.0o and DeepSeek-R1 on a pediatric cardiology board-style examination to quantify their accuracy and discuss educational and clinical utility. ChatGPT-4.0o and DeepSeek-R1 were used to answer 88 text-based multiple choice questions across 11 pediatric cardiology subtopics from a Pediatric Cardiology Board Review textbook. DeepSeek-R1's processing time per question was measured. ChatGPT-4.0o and DeepSeek-R1 achieved 70% (62/88) and 68% (60/88) accuracy, respectively (<i>p</i> = 0.53). Subtopic accuracy was equal in 5 of 11 chapters, with each model outperforming its counterpart in 3 of 11. DeepSeek-R1's processing time negatively correlated with accuracy (<i>r</i> = -0.68, <i>p</i> = 0.02). ChatGPT-4.0o and DeepSeek-R1 were comparable in accuracy and approached the passing threshold on a pediatric cardiology board examination. While further development of LLMs is required for clinical integration into pediatric cardiology, these findings suggest the potential utility of these models as educational aids.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"590-593"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for complications of necrotizing enterocolitis in term neonates with congenital heart disease at a referral hospital in Colombia: A retrospective cohort study.","authors":"Ingrid Pamela Ortega Ortega, Juan Pablo Otoya Castrillón, Laura Isabel Manosalva Arciniegas, Jhancy Rocío Aguilar Jiménez","doi":"10.4103/apc.apc_89_25","DOIUrl":"https://doi.org/10.4103/apc.apc_89_25","url":null,"abstract":"<p><strong>Introduction: </strong>Necrotizing enterocolitis (NEC) is one of the most severe complications in neonates and infants. However, term infants with congenital heart disease (CHD) represent a scenario of multiple complications due to pathophysiological mechanisms that differ from the classic pathogenesis. The objective of the study was to determine factors associated with complications of NEC in term infants hospitalized for CHD in a pediatric intensive care unit of a referral hospital in Colombia between 2010 and 2023.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted, including 148 term infants with CHD who developed NEC during their hospitalization. Demographic and clinical characteristics were analyzed. Descriptive and bivariate analyses were performed using the Chi-square and Mann-Whitney <i>U</i>-tests. A multivariate analysis was conducted using robust Poisson regression with Stata 18.0® software.</p><p><strong>Results: </strong>The most frequent CHD were hypoplastic left heart syndrome (HLHS), pulmonary atresia, and persistent ductus arteriosus. The most common NEC stages were IIa (38.5%) and IIb (23.7%), which were associated with complications such as short bowel syndrome (18.8%) and post-surgical sepsis (37.5%). Among factors related to complications from NEC, medical-surgical management increased the risk (adjusted relative risk: 10.14 and 95% confidence interval: 1.95-48.72), while cardiac surgery reduced the likelihood of complications.</p><p><strong>Conclusions: </strong>NEC in infants with CHD is associated with multiple factors currently under investigation, which may explain a pathophysiological mechanism distinct from that of classic NEC.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"571-579"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual presentation of left atrial myxoma in a child mimicking acute poststreptococcal glomerulonephritis.","authors":"Maulana Rosyady, Anisa Rahmadhany, Muhammad Arza Putra, Lisnawati Rachmadi","doi":"10.4103/apc.apc_159_25","DOIUrl":"https://doi.org/10.4103/apc.apc_159_25","url":null,"abstract":"<p><p>Cardiac myxomas are rare in children and can mimic other conditions. We report a 14-year-old boy initially diagnosed with acute poststreptococcal glomerulonephritis based on hematuria, mild proteinuria, and elevated anti-streptolysin-O titers. However, worsening dyspnea, edema, and signs of heart failure prompted further evaluation. Echocardiography revealed a large left atrial mass with impaired biventricular function and tricuspid regurgitation. Surgical excision confirmed a myxoma. The patient's renal and systemic symptoms were attributed to low cardiac output and venous congestion, not true glomerulonephritis. This case highlights the need to consider cardiac causes in pediatric patients with persistent nephritic-like features.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"613-615"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotracheal bleeding after arterial switch operation: Think of a bleeding major aortopulmonary collateral artery.","authors":"Benjamin von der Emde, Luigi Di Pasquale, Robert Cesnjevar, Oliver Kretschmar, Walter Knirsch, Hitendu Dave","doi":"10.4103/apc.apc_142_25","DOIUrl":"https://doi.org/10.4103/apc.apc_142_25","url":null,"abstract":"<p><p>Major aortopulmonary collateral arteries (MAPCAs) in the setting of d-transposition of the great arteries (d-TGA) are a rare and occult finding, as they are often asymptomatic and difficult to detect in preoperative imaging. Consequences of undiagnosed MAPCAs in d-TGA are varied. Rarely, they lead to a catastrophic perioperative bronchial bleeding. Early identification and coiling are crucial. We report the case of a male neonate with d-TGA and ventricular septal defect (VSD) who experienced intrabronchial bleeding by the end of the arterial switch and VSD closure procedure, leading to inability to adequately ventilate and perioperative extracorporeal membrane oxygenation. Early identification and coil embolization were critical in identifying and managing the bleeding collaterals. This case underscores the need for employing emergent cath-angiography to diagnose previously unknown MAPCAs and thus salvaging the child from a dreadful but treatable cause. To our knowledge, this is one of the very few successfully treated cases of arterial switch operation complicated with MAPCA-induced perioperative bronchial bleeding.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"624-627"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of virtual reality imaging to guide complex structural cardiac interventions: A randomized controlled trial.","authors":"Ishita Garg, Pramod Sagar, Puthiyedath Thejaswi, Kothandam Sivakumar","doi":"10.4103/apc.apc_231_25","DOIUrl":"https://doi.org/10.4103/apc.apc_231_25","url":null,"abstract":"<p><strong>Background: </strong>Accurate preprocedural planning is critical for complex transcatheter structural heart interventions. Virtual reality (VR) enhanced imaging may improve accuracy compared to conventional computed tomography (CT) and may reduce variability between operators of differing experience levels.</p><p><strong>Methods: </strong>A randomized study evaluated the utility of VR across three complex interventions: sinus venosus defect (SVD) closure, pulmonary artery (PA) stenting, and percutaneous pulmonary valve implantation (PPVI). The preprocedural planning was randomized to either CT alone or CT plus VR. Independent planning based solely on CT, performed by a senior cardiologist (experience >25 years) and a junior cardiologist (experience > 5 years), was compared with CT plus VR analysis performed by the junior cardiologist. Deviation in plan during the actual intervention was analyzed.</p><p><strong>Results: </strong>Forty patients (20 SVD closure, 12 PA stents, and 8 PPVI) were randomized to receive either CT alone or CT plus VR. Comparable demographics confirmed effective randomization. The Friedman test revealed a significant overall difference (<i>P</i> = 0.0195) in deviation from the preprocedural plan between the groups. CT by a junior cardiologist showed a significantly greater deviation than that by the senior cardiologist (<i>P</i> = 0.0098). Adding VR reduced plan deviations and was comparable to those of the senior cardiologist (<i>P</i> = 0.233), indicating enhanced understanding by an early-career operator. For the SVD subset, VR showed significantly better agreement with the procedural outcome than the senior cardiologist (<i>P</i> = 0.0196). No significant differences in planning accuracy were observed between the methods in PPVI or PA stenting. Despite VR's potential to simplify the intervention, it did not affect procedural duration or contrast volume in this early experience.</p><p><strong>Conclusions: </strong>The VR interpretation by a junior cardiologist matched the senior cardiologist's plan based on CT alone and outperformed the junior cardiologist's plan when using CT alone. This indicates the potential of VR to accelerate training in structural interventions and standardize preprocedural planning.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"531-540"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare variant of mixed total anomalous pulmonary venous connection with a garland configuration of the azygous system: Expanding the spectrum of anatomical variants.","authors":"Chigurupati Bharat Siddharth, Pavan Kumar Dammalapati, Venkata Rama Muddana Subramanyam, Hareesh Kumar Munugala, Vasudev Vemala","doi":"10.4103/apc.apc_285_25","DOIUrl":"https://doi.org/10.4103/apc.apc_285_25","url":null,"abstract":"<p><p>Mixed-type total anomalous pulmonary venous connection (TAPVC) is the least common variant in Darling's classification and is further subdivided into three distinct subtypes. We report an exceptionally rare mixed TAPVC with a 2 + 2 drainage pattern, associated with an unusual venous anomaly in which the hemiazygos vein drains into the innominate vein, forming a characteristic \"garland\" configuration.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"635-637"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breastfeeding and congenital heart disease: A critical review of the methodology.","authors":"Fabian Gonzalo Ccancce Cardenas, Roberto Wilmar Castillo Ramirez, Pedro Quinto Benites Gallardo, Aronbrandol Bendezu Sulca","doi":"10.4103/apc.apc_352_25","DOIUrl":"https://doi.org/10.4103/apc.apc_352_25","url":null,"abstract":"","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"644-645"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous connection of inferior vena cava to left atrium together with cardiac total anomalous pulmonary venous connection and persistent left superior vena cava.","authors":"Renu Sharma, Dheeraj Deo Bhatt, Sakshi Sachdeva, Munish Guleria, Dinesh Kumar","doi":"10.4103/apc.apc_305_25","DOIUrl":"https://doi.org/10.4103/apc.apc_305_25","url":null,"abstract":"<p><p>A term neonate presented on day 1 with severe cyanosis and metabolic acidosis. Echocardiography and computed tomography angiography revealed a cardiac-type total anomalous pulmonary venous connection to the coronary sinus with anomalous inferior vena cava drainage to the left atrium. Despite intensive management, the infant died. This exceptionally rare dual venous anomaly illustrates abnormal incorporation of a venous pole during cardiac embryogenesis.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"641-643"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes of repair for tetralogy of Fallot with a previous right ventricular outflow tract stent.","authors":"Debasis Das, Tanulina Sarkar, Shubhadeep Das, Varsha Malladi, Manish Kumar Sharma, Shivani Gajpal, Amitabha Chattopadhyay","doi":"10.4103/apc.apc_272_25","DOIUrl":"https://doi.org/10.4103/apc.apc_272_25","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of neonates with tetralogy of Fallot (TOF) and unfavorable anatomy remains debated. Early primary repair carries risks, while palliative options such as right ventricular outflow tract (RVOT) stenting have emerged as effective alternatives to conventional shunts. However, outcomes of corrective surgery following RVOT stenting remain underexplored.</p><p><strong>Patients and methods: </strong>A retrospective study was done on 11 patients with TOF who underwent RVOT stenting followed by surgical repair between April 2021 and March 2025, from a total of 619 TOF surgeries. Data on demographics, intraoperative findings, pulmonary artery (PA) growth, and postoperative outcomes, including 30-day mortality, were collected. PA growth was assessed via <i>z</i>-scores pre- and poststenting. The correlation between time from stenting to surgery and operative duration was evaluated.</p><p><strong>Results: </strong>The median age and weight at surgery were 31 months and 10.2 kg, respectively. Complete stent excision was possible in 91% of patients. Transannular patch repair was required in 90.9% of cases. Prestent PA <i>z</i>-scores improved significantly by the time of surgery (left PA: -1.92 to -0.11; right PA: -2.95 to -0.46). Maximum PA growth occurred within 5 months poststenting. An increased interval between stenting and surgery correlated with prolonged cardiopulmonary bypass and aortic cross-clamp times. No in-hospital mortality or 30-day mortality occurred; the median ventilation was 12.7 h, and the mean intensive care unit stay was 2.1 days.</p><p><strong>Conclusions: </strong>Corrective surgery after RVOT stenting in TOF is safe and feasible, with favorable early outcomes. Early repair - preferably within 5 months of RVOT stenting - facilitates optimal PA growth and minimizes surgical complexity. Larger, prospective studies are warranted to standardize timing and assess long-term outcomes.</p>","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"551-556"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patent ductus arteriosus: A misleading clue to hidden severe pathology.","authors":"Aniket Pratap Singh, Renu Sharma, Sakshi Sachdeva, Dheeraj Deo Bhatt, Hema Gupta Mittal, Dinesh Kumar","doi":"10.4103/apc.apc_271_25","DOIUrl":"https://doi.org/10.4103/apc.apc_271_25","url":null,"abstract":"","PeriodicalId":8026,"journal":{"name":"Annals of Pediatric Cardiology","volume":"18 6","pages":"649-650"},"PeriodicalIF":0.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}