Cardiology in the Young最新文献

{"title":"Minimising an outpatient medication regimen after paediatric cardiac surgery.","authors":"Jamie Smith Penk, Lindsay Jackson, Guilherme Baptista de Faria, Laura Doyle, Nicole Janus, Rohit Seth Loomba, Bradley Marino, Amy Lay","doi":"10.1017/S1047951126123737","DOIUrl":"https://doi.org/10.1017/S1047951126123737","url":null,"abstract":"<p><strong>Background: </strong>We implemented a quality improvement initiative to optimise the outpatient medication regimen after paediatric cardiac surgery. A previous trial that limited furosemide found no readmissions for pleural effusion but an increase in pericardial effusions. A similar quality improvement project had implemented prophylactic non-steroidal anti-inflammatory drugs and found a decrease in readmissions for pericardial effusion. We used these results to design an outpatient medication regimen that minimises furosemide and uses only targeted ibuprofen and report readmission rates from this project.</p><p><strong>Methods: </strong>Single-centre analysis of outcomes since the adoption of a quality improvement initiative aiming to limit outpatient diuretics (≤5 days) while using targeted ibuprofen to prevent pericardial effusion readmissions.</p><p><strong>Results: </strong>Two hundred and one patients were eligible for analysis. Forty-one patients (20.4%) were prescribed >20 days of diuretics due to compliance failure and were not considered to have received a limited diuretic regimen, leaving 160 patients. Of those, 53 (33.1%) were correctly prescribed targeted ibuprofen based on meeting \"high-risk\" criteria. There was one readmission for pleural effusion and 2/160 (1.3%) readmissions for pericardial effusion. The previous prospective study of limited furosemide without ibuprofen had a pericardial effusion readmission rate of 4/61 (6.6%) versus the 2/160 (1.3%) after implementing the regimen described in this report (<i>p</i> = 0.04).</p><p><strong>Conclusions: </strong>We describe a medication regimen using limited outpatient furosemide without increased readmissions for pleural effusions. Targeted ibuprofen was used for high-risk patients only, and there were fewer readmissions for pericardial effusions than in a previous trial that used furosemide alone.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-5"},"PeriodicalIF":0.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672987","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":"Extracorporeal membrane oxygenation in congenital cardiac surgery: a 10-year single-centre experience.","authors":"Sayar Kumar Munshi, Mahendra Narwaley, Tommaso Generali, Ramesh Kutty, Attilio Lotto, Rafael Guerrero, Marie Horan, Alison Brady, Laura Simpson, Ram Dhannapuneni","doi":"10.1017/S1047951126123658","DOIUrl":"https://doi.org/10.1017/S1047951126123658","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal Membrane Oxygenation (ECMO) has evolved as an effective mechanical support for cardiorespiratory failure in patients undergoing congenital cardiac surgery, and the threshold of using it has substantially reduced. This study presents a 10-year single-centre experience evaluating outcomes, survival, and risk factors associated with perioperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in paediatric congenital cardiac surgery.</p><p><strong>Methods: </strong>A retrospective review was undertaken for all patients younger than 16 years old who required ECMO during the perioperative period between January 2013 and December 2022. Patients were categorised according to the timing of ECMO initiation into pre-operative, intra-operative, immediate post-operative (<24 hours), and early post-operative (>24 hours) groups, while extracorporeal cardiopulmonary resuscitation (ECPR ECMO) cases were analysed separately using standard statistical methods.</p><p><strong>Results: </strong>A total of 150 patients required ECMO support, with overall survival to discharge of 54%. Survival was higher in patients requiring ECMO within 24 hours after surgery (57.4%) compared with those requiring ECMO later (35.1%), while ECPR ECMO patients showed 46.0% survival. Prolonged cardiopulmonary bypass time (<i>p</i> = 0.017), aortic cross-clamp time (<i>p</i> = 0.002), and longer ECMO duration (<i>p</i> < 0.001) were significantly associated with mortality. Intracranial haemorrhage, ischaemia, sepsis, acute kidney injury, gastrointestinal complications, and mediastinal bleeding were major complications linked to increased mortality. Survival at 1 and 5 years was 50.3% and 41.6%, respectively.</p><p><strong>Conclusions: </strong>VA-ECMO remains a life-saving strategy after congenital cardiac surgery with survival exceeding 50%. Early initiation and shorter ECMO duration may improve outcomes, while prevention of major complications and careful patient selection are essential to optimise survival in paediatric cardiac centres.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629630","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":"Anomalous left coronary artery from the pulmonary artery as the cause of sudden cardiac arrest in an adult patient.","authors":"Alexander Suchodolski, Urszula Faron, Jan Głowacki, Mariola Szulik","doi":"10.1017/S104795112511086X","DOIUrl":"https://doi.org/10.1017/S104795112511086X","url":null,"abstract":"<p><p>We present the case of a 36-year-old male with the anomalous origin of the left coronary artery from the pulmonary artery surgically corrected in childhood who has suffered from sudden cardiac arrest twice later in life. Anomalous left coronary artery from the pulmonary artery is a rare congenital abnormality most commonly manifesting itself in early infancy, less frequently only becoming apparent in adulthood. Uncorrected defect is associated with a high mortality rate hence surgical treatment is advisable, both in children and few asymptomatic adults. Adequate management of adult patients with anomalous left coronary artery from the pulmonary artery remains a subject of discussion as complications secondary to even a congenital anomaly corrected in childhood, such as myocardial scarring, could ultimately lead to life-threatening ventricular arrhythmias and/or sudden cardiac death.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-3"},"PeriodicalIF":0.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629668","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":"Association of postoperative haemodynamic parameters with progression of left atrioventricular regurgitation in infants: leveraging high-fidelity data: a hypothesis-generating study.","authors":"Rohit Seth Loomba, Oscar Dominguez, Jamie Smith Penk, Keats Ewing, Allison Davila, David Winlaw, Michael Monge","doi":"10.1017/S1047951126123634","DOIUrl":"https://doi.org/10.1017/S1047951126123634","url":null,"abstract":"<p><strong>Background: </strong>The success of an atrioventricular septal defect repair depends largely on the function of the left atrioventricular valve. Given the exposure of this valve to systemic pressures, postoperative haemodynamic management has been of interest, though practices are variable.</p><p><strong>Methods: </strong>A single-centre, retrospective study of infants less than 1 year of age admitted to the paediatric cardiac ICU following atrioventricular septal defect repair between January 2022 and May 2025 was conducted. Utilising high-fidelity physiologic data, the primary aim of this study was to characterise haemodynamics in the first 48 h of progression of left atrioventricular valve regurgitation after complete repair. Regurgitation data was collected from echocardiograms. Generalised estimation equation modelling was done to help further isolate the association of worsening left atrioventricular valve regurgitation with haemodynamic variables.</p><p><strong>Results: </strong>Among twenty-eight patients, nine (32%) exhibited worsening left atrioventricular valve regurgitation. Haemodynamic parameters significantly correlated with worse left atrioventricular valve regurgitation were increased mean arterial blood pressure, increased blood pressure variability, and decreased cerebral and renal near-infrared spectroscopy. Of note, blood pressure variability had a greater association with worsening left atrioventricular valve regurgitation when compared to absolute mean arterial blood pressure.</p><p><strong>Discussion: </strong>In infants recovering from atrioventricular septal defect repair, early postoperative haemodynamic alterations, in particular mean arterial blood pressure variability, are associated with worse left atrioventricular valve function. A high cardiac output, low systemic vascular resistance state with minimal blood pressure variability appears optimal to decrease impact on the left atrioventricular valve.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-9"},"PeriodicalIF":0.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618464","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":"Education passports: customised roadmaps for different learners in the cardiac ICU.","authors":"Melinda Cory, Michael Green, Sonali Patel, Priya Bhaskar","doi":"10.1017/S1047951126123713","DOIUrl":"https://doi.org/10.1017/S1047951126123713","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical education for graduate medical education trainees is challenged by time constraints, diverse backgrounds, and lack of structured curricula. Education passports (checklist-based educational tools) have been used in medical education to customise the educational experience, re-centre the education to the learner, and ensure exposure to high-impact topics. We implemented an education passport in the Pediatric Cardiac ICU where multiple groups of trainees with varying educational needs have clinical rotations.</p><p><strong>Methods: </strong>A needs assessment was conducted among fellows, alumni, and faculty. Based on these results, a passport was created with 10 topics individualised to each fellowship, allowing fellows to track learning and guide topic selection. In the second year, the passport transitioned to a digital platform, integrating learning resources and gamification elements. Post-implementation surveys evaluated topic completion and perceived impact.</p><p><strong>Results: </strong>Over three years, 49 fellows utilised the education passport. Median topic completion rates among first-time passport users: 5 (interquartile range (IQR) 3-7.5) topics in year 1, 6 (IQR 1.75-10) in year 2, and 4 (IQR 1.5-8.5) in year 3. Fellows reported that the passport was easy to use, improved clarity in learning objectives, and improved their understanding of educational needs. The digital format increased engagement and topic completion; however, educational impact plateaued with repeat use. Persistent barriers to learning include time constraints and clinical workload.</p><p><strong>Conclusion: </strong>An individualised education passport is a feasible, effective tool to support learner-centred education in high-acuity clinical settings. Future efforts should address continued barriers in clinical education, including time and workload challenges.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-7"},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590068","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":"Serial changes of mitral and tricuspid valve diameter after the Norwood procedure in patients with aortic atresia - CORRIGENDUM.","authors":"Muneaki Matsubara, Alexander Pletschacher, Thibault Schaeffer, Teresa Lemmen, Christoph Röhlig, Jonas Palm, Paul Philipp Heinisch, Nicole Piber, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1017/S1047951126123798","DOIUrl":"10.1017/S1047951126123798","url":null,"abstract":"","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590419","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":"Evaluation of cardiac abnormalities in multi-system inflammatory syndrome in children related multi-organ dysfunction syndrome.","authors":"Ashlee Christmas, Alina N West, Vasu Gooty, Samir Shah","doi":"10.1017/S1047951126113201","DOIUrl":"https://doi.org/10.1017/S1047951126113201","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-system inflammatory syndrome in children hyperinflammation can cause multiple organ system dysfunction syndrome through mechanisms, including endothelial dysfunction and thrombotic microangiopathy. We evaluated potential endothelial damage and thrombotic microangiopathy as an underlying multi-system inflammatory syndrome in children associated multi-organ dysfunction syndrome pathophysiology. Cardiac dysfunction was assessed using echocardiogram and copeptin.</p><p><strong>Methods: </strong>In pediatric ICU multi-system inflammatory syndrome in children patients, multi-organ dysfunction syndrome and thrombotic microangiopathy criteria were established using medical record data. Terminal complement and copeptin levels were evaluated alongside imaging (including echocardiogram), blood work, signs and symptoms of multi-organ dysfunction syndrome, and interventions documented during hospitalisation. Copeptin level correlation with multi-organ dysfunction syndrome severity and biomarkers of cardiac dysfunction were analysed.</p><p><strong>Results: </strong>Of 12 pediatric ICU patients with multi-system inflammatory syndrome in children, 7 (58.33%) patients met multi-organ dysfunction syndrome criteria, and 8 (66.67%) met thrombotic microangiopathy criteria. Renal (66.67%) and cardiovascular (58.33%) dysfunction were most associated with multi-organ dysfunction syndrome. Multi-system inflammatory syndrome in children patients had higher terminal complement and copeptin levels compared to eight control subjects. Copeptin had a significant negative relationship with left ventricular ejection fraction and positive relationships with B-type natriuretic peptide and blood urea nitrogen but no other markers of renal or cardiac dysfunction. There was a strong positive relationship between copeptin and terminal complement.</p><p><strong>Conclusion: </strong>Multi-system inflammatory syndrome in children requiring pediatric ICU admission are multi-organ dysfunction syndrome-susceptible due to underlying complement-associated thrombotic microangiopathy. Copeptin can be used as a marker of acute critical illness and systolic dysfunction in multi-system inflammatory syndrome in pediatric patients. These biomarkers would guide clinicians earlier in the diagnosis and treatment of thrombotic microangiopathy-related multi-organ dysfunction syndrome due to multi-system inflammatory syndrome in children. However, their utility as markers for myocardial injury, diastolic dysfunction, and the severity of multi-organ dysfunction syndrome needs further evaluation.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-6"},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590065","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":"Familial arrhythmogenic cardiomyopathy presenting with aborted sudden cardiac arrest in an adolescent: a novel <i>DSP</i> variant.","authors":"Ana Raquel Marques, Joana Novais Pimenta, Ana Grangeia, João Antunes Sarmento","doi":"10.1017/S1047951126123725","DOIUrl":"https://doi.org/10.1017/S1047951126123725","url":null,"abstract":"<p><p>Arrhythmogenic cardiomyopathy is a rare genetic disorder linked to malignant arrhythmias and sudden cardiac death. We report a 15-year-old girl presenting with sudden cardiac arrest. Imaging suggested left-dominant arrhythmogenic cardiomyopathy, and genetic testing identified a novel DSP variant. Cardioverter-defibrillator implantation was performed. Family screening revealed affected relatives, highlighting the importance of early diagnosis and risk stratification.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-5"},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590141","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":"Mid-term outcomes of Y-graft and age-matched extracardiac and lateral tunnel Fontan patients.","authors":"Medha Kallem, Wendy M Book, Fred H Rodriguez, Mollie Westrick, Lindsey C Ivey, Cheryl L Raskind-Hood","doi":"10.1017/S1047951126123476","DOIUrl":"https://doi.org/10.1017/S1047951126123476","url":null,"abstract":"<p><strong>Background: </strong>The bifurcated Y-graft Fontan was designed with computational fluid dynamics models that predicted reduced venous pressures, improved hepatic flow distribution, and reduced blood flow collision. Addressing these concerns was thought to improve complications associated with the traditional extracardiac and lateral tunnel techniques. However, clinical outcome data comparing the Y-graft to conventional approaches remain limited.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated patients aged 0-18 years who underwent clinical evaluation after Fontan operations between 2010 and 2023. Y-graft patients were age-matched 1:2 to extracardiac and lateral tunnel cohorts. Outcomes were assessed from the first outpatient cardiology visit at least one-year post-Fontan to the last visit within the study period. The primary outcome was a composite of death, stroke, advanced heart failure referral, or cardiac intervention (including balloon angioplasty, stenting, coiling, or fenestration). Cardiac intervention alone and surgical revision alone served as secondary outcomes.</p><p><strong>Results: </strong>A total of 165 patients were analysed. Baseline demographics were similar across cohorts at the time of index encounter. The composite outcome occurred at comparable rates across groups (<i>p</i> = 0.761). Cardiac intervention rates (<i>p</i> = 0.873) and surgical revision rates (<i>p</i> = 0.378) were similar.</p><p><strong>Conclusions: </strong>Despite the theoretical haemodynamic advantages of the Y-graft Fontan, no significant mid-term clinical benefit was observed compared with the extracardiac or lateral tunnel Fontan techniques. These findings suggest that computational fluid dynamics modelling may not fully capture the physiologic complexity of Fontan circulation, warranting reassessment of the Y-graft's continued use and further long-term outcome analysis.</p>","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1-4"},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590189","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":"Opioid exposure in neonates and infants following cardiac surgery: a comparative analysis - ERRATUM.","authors":"Melissa B Jones, Christine Riley, Gil Wernovsky, Vanessa Sterzbecher, Onais Tariq, Melissa Dazo, Erin Griffin, Heather Gordish, Sherrill D Caprarola","doi":"10.1017/S1047951126123750","DOIUrl":"10.1017/S1047951126123750","url":null,"abstract":"","PeriodicalId":9435,"journal":{"name":"Cardiology in the Young","volume":" ","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590175","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}