Children's Heart Research Articles

Asymmetric Occluder Occlusion of Outlet Ventricular Septal Defect Via a Subaxillary Approach

Surgical transpleural minimally invasive occlusion of perimembranous and muscular ventral septal defects provides excellent results, but there is limited experience in outlet ventral septal defects (OVSDs) because of the specific anatomy and because OVSDs may occur with aortic valve prolapse. The procedure was performed in 84 children (mean age, 2.5 ± 2.3 years; mean weight, 12.1 ± 10.3 kg) between July 2014 and December 2018 at the Children's Heart Center of Henan Provincial People's Hospital. An approximately 2-cm right subaxillary incision was made, and the right ventricle was punctured under transesophageal echocardiographic guidance. The OVSD was occluded under transesophageal echocardiographic guidance with an asymmetric occluder. Mean size of the OVSDs and the occluders was 4.6 ± 1.0 and 6.2 ± 1.2 mm, respectively. No patients died and no complications occurred, such as third-degree atrioventricular block, new aortic regurgitation, reoperation, or serious infection. All patients were observed for 32.1 ± 17.1 months. After surgery, there were 4 cases of residual shunt, which resolved spontaneously during follow-up. No complications, such as reoperation, aortic regurgitation, atrioventricular block, or occluder detachment, were observed during the follow-up period. Occluding OVSDs using an asymmetric occluder through the subaxillary approach was safe and effective, with satisfactory short-term and mid-term results. Further follow-up is required regarding the long-term results.

Comparison of the Effect of Massage and EMLA Cream on Children's Physiological Indices During Venipuncture: A Factorial Clinical Trial

PurposeThe aim of this study was to identify the effect of massage, EMLA cream, and the combination of these two methods on changes in physiological indices because of pain caused by intravenous line insertion in preschool children. DesignA four-group randomized nonblinded clinical trial with factorial design. MethodsIn total, 140 eligible 3- to 6-year-old children entered the study in Tabriz Children's Hospital in 2017 and were randomly allocated to four groups (EMLA cream, massage, combination of the two, and control). Physiological responses were measured before and immediately after interventions in all groups. Data were collected and analyzed using SPSS version 19. FindingsComparison of the physiological indices changes caused by pain between groups showed that changes in children's heart rate (HR) and respiratory rate (RR) in the EMLA group and in the combined-method group were statistically significant (P < .05). No significant differences were found in systolic blood pressure and oxygen saturation (SPo2) between the four groups. ConclusionsResults indicated that EMLA cream was more effective than massage and a combination of EMLA and massage in reducing an increase in the HR and RR caused by pain in children. Massage alone was not effective in significantly lowering the children's increased physiological indices such as the HR and RR, and it seems the effectiveness of massage is more noticeable in conjunction with EMLA cream.

Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned.

Background: Developing countries are profoundly affected by the burden of congenital heart disease (CHD) because of limited resources, poverty, cost, and inefficient governance. The outcome of pediatric cardiac surgery in developing countries is suboptimal, and the availability of sustainable programs is minimal.Aim: This study describes the establishment of a high quality in-situ pediatric cardiac surgery program in Lebanon, a limited resource country.Methods: We enrolled all patients operated for CHD at the Children's Heart Center at the American University of Beirut between January 2014 and December 2018. Financial information was obtained. We established a partnership between the state, private University hospital, and philanthropic organizations to support the program.Results: In 5 years, 856 consecutive patients underwent 993 surgical procedures. Neonates and infants constituted 22.5 and 22.6% of our cohort, respectively. Most patients (82.6%) underwent one cardiac procedure. Our results were similar to those of the Society of Thoracic Surgeons (STS) harvest and to the expected mortalities in RACHS-1 scores with an overall mortality of 2.8%. The government (Public) covered 43% of the hospital bill, the Philanthropic organizations covered 30%, and the Private hospital provided a 25% discount. The parents' out-of-pocket contribution included another 2%. The average cost per patient, including neonates, was $19,800.Conclusion: High standard pediatric cardiac surgery programs can be achieved in limited-resource countries, with outcome measures comparable to developed countries. We established a viable financial model through a tripartite partnership between Public, Private, and Philanthropy (3P system) to provide high caliber care to children with CHD.

CARDIOVASCULAR DISEASES AND EVALUATE OUTCOMES IN TREATMENT OF CARDIOVASCULAR DISEASES AT VIETNAM NATIONAL CHILDREN’S HOSPITAL IN 2019

Objectives: To describe characteristics of cardiovascular disease and treatment results at the Children's Heart Center, Vietnam National children’s hospital in 2019. Subjects: Children aged 2 months to 15 years diagnosed with cardiovascular disease at Children's Heart Center, Vietnam National children’s hospital from January 2019 to December 2019. Research methodology: cross-sectional description. Results and conclusions: Congenital heart disease was common in children &lt;5 years old, especially the age &lt;12 months. Complications of the disease are mainly pneumonia, malnutrition. Most treated children get relief of symptoms and leave the hospital early in about 1 week.&#x0D;

Found in translation: navigating uncertainty to save a child's heart. Paediatric cardiac surgery in Cape Town, South Africa

This medical humanities paper describes our qualitative research into pathways to care and informed consent for 10 children who had cardiac surgery in the Red Cross War Memorial Children’s Hospital,...

Maternal emotion dysregulation and physiological concordance in mother‐preschooler dyads

AbstractMaternal emotional and physiological dysregulation has been found to influence child stress physiology. This study characterizes diurnal cortisol and basal heart rate variability (HRV) patterns in a predominately high‐risk sample of mothers with a full range of emotion dysregulation and assessed the magnitude of concordance (N = 68 mother‐preschooler dyads). Overall, dyads exhibited concordance in evening salivary cortisol levels, but not for morning levels or HRV. Maternal emotion dysregulation was associated with maternal and child evening cortisol levels, child morning cortisol levels, and maternal HRV. Bootstrapping analyses showed that maternal emotion dysregulation was associated with higher child evening cortisol levels through its impact on mother evening cortisol levels. This study offers preliminary evidence for understanding child stress physiology and dyadic concordance in a sample of mothers with a range of emotion regulation capabilities.Highlights Maternal physiology may explain the association between maternal emotion dysregulation and child physiological patterns. Emotionally dysregulated mothers were oversampled and mothers and children's heart rate variability and cortisol were collected, with findings showing dyadic concordance in evening cortisol. This work highlights the importance of transdiagnostic approaches for examining concordance and child stress physiology.

Health-related quality of life for children and adolescents in school age with hypoplastic left heart syndrome: a single-centre study.

Data from neurological and radiological research show an abnormal neurological development in patients treated for hypoplastic left heart syndrome. Thus, the aim of this study was to survey the quality of life scores in comparison with healthy children and children with other heart diseases (mild, moderate, and severe heart defects, heart defects in total). Children with hypoplastic left heart syndrome (aged 6.3-16.9 years) under compulsory education requirements, who were treated at the Children's Heart Center Linz between 1997 and 2009 (n = 74), were surveyed. Totally, 41 children and 44 parents were examined prospectively by psychologists according to Pediatric Quality of Life Inventory, a health-related quality of life measurement. The results of the self-assessments of health-related quality of life on a scale of 1-100 showed a wide range, from a minimum of 5.00 (social functioning) to a maximum of 100 (physical health-related summary scores, emotional functioning, school functioning), with a total score of 98.44. The parents' assessments (proxy) were quite similar, showing a range from 10 (social functioning) up to 100. Adolescent hypoplastic left heart syndrome patients rated themselves on the same level as healthy youths and youths with different heart diseases. The results show that patients with hypoplastic left heart syndrome aged 6-16 years can be successfully supported and assisted in their psychosocial development even if they show low varying physical and psychosocial parameters. The finding that adolescent hypoplastic left heart syndrome patients estimated themselves similar to healthy individuals suggests that they learnt to cope with a severe heart defect.

Children's Heart Foundation research grants

Children's Heart Foundation research grants

"Retirement, what?"Herminia Palenzuela MD PhDCoordinator, National Pediatric Cardiology NetworkWilliam Soler Children's Heart Center, Havana.

"Our family wasn't rich, but we didn't want for anything," says Dr Palenzuela by way of introduction. In 1950s Cuba, her father drove a taxi and her mother was a homemaker, raising two daughters-one now an economist and the other a top pediatric cardiologist. In many ways, Dr Palenzuela's career rode the wave of social change that swept Cuba beginning in 1959. Like many others, time and again she stepped up to the plate, and in 1986, she became a founder of one of the Cuban health system's premier institutions: the William Soler Children's Heart Center, a tertiary facility in Havana. There, to this day, she balances multiple responsibilities-as coordinator of the National Pediatric Cardiology Network, head of the Center's Quality Assurance Program and lead professor of the annual National Certificate Course in Pediatric Cardiology. MEDICC Review spoke with her between phone calls, meetings and patient consults.

A Different Heart in Children´s Literature: The Juvenile Literature in Medical Education

Abstract Jose Saramago, Nobel Prize in Literature, is the author of a statement that provokes adult readers: “What if children’s stories become mandatory reading for adults? Would they really learn what they’ve been teaching for so long?”. 1 It is in this context that literary texts dedicated to children have been used at times in medical education and clinical practice to bring up often invisible subjectivities.

Gandhi’s Contribution to Education

Mahatma Gandhiji was an extremely open-minded seeker of truth. This quality gives Gandhiji a unique dimension which can attract the new generation. Education is for life, life in its entire and then education through life. Gandhiji philosophy of non-violence has great relevance in current scenario.Such philosophy of life helped him in developing his philosophy of Education which can be the true source of inspiration for the present system of education. Gandhiji’s Basic Principles of Education includes: i)From 7 to 14 years of age, education of each child should be free, compulsory and universal. ii)The medium of instruction should be mother-tongue. iii) Mere literacy cannot be equated with education. Education should employ some craft as a medium of education so that the child gains economic self - reliance for his life. iv) Education should develop human values in the child. v)Education should create useful, responsible and dynamic citizens. By education all the hidden powers of child should develop according to the community of which he is an integral part. vi)Education should achieve the harmonious development of child's body, mind, heart and soul. The inspiration of Mahatma Gandhi, we have adopted Basic Education as the pattern of national education. The distinctive feature of education that it makes productive work is the main basis of the whole educative process. Gandhiji thought that education should be provided to mothers, and they could provide education to children effectively. He stressed upon the education of women, for the development of nation depends upon women. Education is vital for the effectiveness of both strategies. For this to happen, education has to go beyond the warehousing of information to a celebration of awareness, which is best facilitated through education for peace. Gandhiji by sponsoring the New Education made the Indian educational system.

Failure to Rescue in Humanitarian Congenital Cardiac Surgery

Cardiac surgeons have a significant history of participating in humanitarian work; however, the outcomes in this arena are not well delineated. We sought to define and describe failure to rescue (FTR) in this setting by analyzing the outcomes of the International Children's Heart Foundation. From 2008 to 2017, 3009 patients underwent operations during the course of an International Children's Heart Foundation mission. Of these, 1165 patients had at least one complication. These patients were divided into those who ultimately died (FTR group, n= 107) and those who survived (survivor group, n= 1058). Clinical presentation and outcomes were compared. The overall FTR rate was 10%. Patients in the FTR group were significantly younger, weighed less, and were shorter. Children who required a preoperative admission to the intensive care unit were more likely to be in the FTR group. Intraoperative data demonstrated significantly longer cardiopulmonary bypass time among FTR patients, with similar use of intraoperative blood product. Postoperatively, patients in the FTR group had more reintubations than survivors. Cardiopulmonary bypass and intensive care unit times were shown to be significant predictors of FTR. There was a trend between program volume and FTR rate. Program volume appeared to be correlated with FTR. Failure to rescue occurs at a rate of 10% in the humanitarian congenital cardiac surgery setting. The FTR patients were younger, required more intubations, and had significantly more diagnoses of transposition of the great arteries. Longer cardiopulmonary bypass time and intensive care unit admission were associated with increased risk of FTR.

P6458The prevalence of left ventricular non-compaction in newborns

Abstract Background Pronounced trabeculation of the left ventricular myocardium, or non-compaction, may be accompanied by systolic dysfunction in ventricular non-compaction cardiomyopathy (LVNC). It is unclear whether non-compaction represents a fetal development defect or may develop later in life. Previous studies have estimated the prevalence of non-compaction to 0.01–0.31% in adults referred for echocardiography. The prevalences in unselected populations of adults or children are unknown. Purpose To determine the prevalence of non-compaction of the left ventricle in a large population-based cohort of newborns and to assess the relation to left ventricular systolic function. Methods Transthoracic echocardiography was performed according to a standardized protocol in all newborns included in a regional population-based cohort study in 2016–2018. For the present study, the extent of trabeculations were assessed by one of three primary reviewers in apical long-axis views (4-chamber, 5-chamber, and sinus coronarius views), parasternal short (SAX), and long axis (PLAX) views. Based on the presence of pronounced trabeculations, deep intertrabecular recesses and/or an impression of a ratio of &gt;1 of non-compact:compact myocardium (NC:C), the exam was regarded as either possible or not possible non-compaction: In examinations classified as possible non-compaction, an expert reviewer would determine if diagnostic criteria were fulfilled. A ratio of NC:C myocardium ≥2 was considered as non-compaction in accordance with previously suggested criteria. Results As of January 11, 2019, 6,880 neonate echocardiograms (median age 10 days [IQR 5,14], 48.8% females) had been analyzed. In total, 127 (1.8%) were considered as possible non-compaction. Six newborns (median age 14 days [IQR 8,18], 33.3% females) had a ratio of NC:C myocardium ≥2 corresponding to a prevalence of non-compaction of 8.7 per 10,000 newborns (95% CI 0.04–0.19%) (Figure). One of six neonates had a ratio of NC:C myocardium≥2 in more than one segment. Median fractional shortening (FS %), left ventricular end-diastolic (LVIDd) and end-systolic diameter (LVIDs) were 29.5% (IQR 27.0, 31.0), 1.9 cm (IQR 1.8, 2.1) and 1.3 cm (IQR 1.3, 1.5) respectively in the six newborns with non-compaction. The corresponding mean z-scores (standard deviations away from the age-matched reference mean) according to The Boston Children's Hospital z-score Calculator were FS: r=−3.0 (IQR r=−3.8, r=−2.5), LVIDd: r=−1.3 (IQR r=−2.7, r=−0.2), LVIDs: 0.2 (IQR r=−0.1, 1.6). 10-days-old boy with LVNC (FS 22%) Conclusion Echocardiography of an unselected population-based cohort of 6,880 newborns revealed a prevalence of non-compaction of 8.7 per 10,000 newborns. The prevalence is in accordance with previously described prevalences in adults referred for echocardiography and corroborate the view that non-compaction may be a fetal developmental defect. Non-compaction was not associated with left ventricular dilatation but with systolic dysfunction. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

P4645Prevalence of interatrial communications in 7,000 newborns from a large, prospective population study

Abstract Introduction The prevalence of any interatrial communication (IAC) (patent foramen ovale (PFO) or atrial septal defect (ASD)) in newborns has previously been reported to be between 24% and 92%. However, previous studies were relatively small, and no universal classification of IACs exists. We proposed a new echocardiographic diagnostic algorithm developed in collaboration with a group of international experts to classify IACs based on echocardiographic findings on subxiphoid transthoracic echocardiographic (TTE) images of the atrial septum in unselected newborns. Purpose To determine the prevalence of IACs (PFO and ASD) in newborns based on the new diagnostic algorithm. Method Echocardiograms of newborns (age 0–30 days) consecutively included in a large, prospective population study (n=25,000) were analyzed using the new algorithm. The algorithm classifies IACs into PFO and ASD based on transthoracic echocardiographic (TTE) findings including size and number of the communication(s) as well as the morphology and structure of the atrial septum, taking the normal fetal development into consideration. An IAC was classified as a PFO when either there was only one communication located in the upper 2/3 of the atrial septum with a visible communication having a diameter of ≤3.4 mm or a channel-like structure; or there was no visible communication on 2D but acceleration of colour Doppler flow crossing the septum was documented. An IAC was classified as an ASD if the diameter of a visible communication was &gt;3.4 mm, or the communication was located in the lower 1/3 part of the atrial septum, or more than one communication was present. No visible communication on 2D and no flow acceleration despite possible colour Doppler flow crossing the atrial septum was classified as an absence of IAC. Preliminary results As of 3 February 2019, 9,028 echocardiograms have been analyzed. A total of 2,026 (22.4%) were excluded due to poor image quality of the atrial septum. Of the 7,002 included echocardiograms, an IAC was detected on the TTE images in 85.9% of the newborns (median age 12 days [IQR 8; 15], 47.9% females). According to the algorithm 78.7% of the newborns were classified as having a PFO (see Table 1) whereas 7.2% were classified as having an ASD. Table 1. Prevalence of interatrial communications in newborns aged 0–30 days Type of interatrial communication: Prevalence (n=7,002): Patent foramen ovale 78.7% Atrial septal defect 7.2% No interatrial communication 14.1% Conclusion An IAC was present in the vast majority of newborns aged 0–30 days. PFOs were 11 times more frequent than ASDs. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

P4644Distribution of newly defined subtypes of interatrial communications in 7,000 newborns from a general population study

Abstract Introduction The prevalence of interatrial communications (IACs) (patent foramen ovale (PFO) or atrial septal defect (ASD)) in newborns has previously been reported to be between 24% and 92%. However, previous studies were generally small, and no universal classification of IACs exists. We proposed a new echocardiographic diagnostic algorithm developed in collaboration with a group of international experts to classify IACs into subtypes based on echocardiographic findings on transthoracic echocardiographic (TTE) images of the atrial septum in unselected newborns. Purpose To describe the distribution of the six newly defined subtypes of IACs in newborns based on the new diagnostic algorithm. Method Echocardiograms of newborns (age 0–30 days) consecutively included in a large, prospective population study (n=25,000) were analyzed using the new algorithm. The algorithm classifies IACs into three subtypes of PFO and three subtypes of ASD based on subxiphoid TTE findings considering the normal fetal development. The images were examined for colour Doppler signal possibly crossing the atrial septum, with or without acceleration, and with or without a visible communication on 2D. Furthermore, the size and morphology (channel-like structure or open hole) of a possible IAC as well as the number of communications were evaluated in determining the subtype of IAC according to the algorithm. The three subtypes of PFO were determined as follows: PFO1 were only detectable using colour Doppler; PFO2 had a channel-like structure visible on 2D; and PFO3 had a diameter of ≤3.4 mm and no channel-like structure. The three subtypes of ASD were determined as follows: ASD1 had a diameter of &gt;3.4 mm; ASD2 was located in the inferior 1/3 part of the septum; and ASD3 had more than one IAC. Preliminary results As of 3 February 2019, 9,028 echocardiograms have been analyzed. A total of 2,026 (22.4%) were excluded due to poor image quality of the atrial septum. Of the 7,002 included echocardiograms, an IAC was detected on the TTE images in 85.9% of the newborns (median age 12 days [IQR 8; 15], 47.9% females). According to the algorithm, 78.7% of the newborns were classified as having a PFO (35.0% had a PFO1; 21.8% had a PFO2; and 21.9% had a PFO3) whereas 7.2% were classified as having an ASD (3.5% had an ASD1; 0.2% has an ASD2; and 3.5% had an ASD3) (see Figure 1). Figure 1. Distribution of subtypes Conclusion An IAC was present in the vast majority of newborns aged 0–30 days. The most frequent PFO subtype was PFO1, which was only detectable by colour Doppler and was 1.6 times more frequent than the two other PFO subtypes, which had equal frequencies. The most uncommon ASD subtype was ASD2 which was located in the lower 1/3 part of the atrial septum and was 17.5 times less frequent than the ASD1 and ASD3 subtypes, which had equal frequencies. (Figure 1: PFO: Patent foramen ovale, ASD: Atrial septal defect, IAC: Interatrial communication) Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

P3441Impact of maternal preeclampsia on left ventricular structure and function in the newborn heart

Abstract Background Maternal preeclampsia (PE) has been associated with an increased risk of a variety of congenital heart defects in the infant. Whether PE also confers an increased risk of subtle structural and functional cardiac deficits is unknown. Purpose We investigated whether left ventricular dimensions and systolic function differed among infants of mothers with PE, compared to infants born after uncomplicated pregnancies. Method Systematic transthoracic echocardiography (TTE) was performed in neonates included in a population-based study in the period 2016–2018 (n=25,000). TTE was preferably performed within 14 days of birth. Left ventricular (LV) posterior wall end-diastolic thickness (LVPWd), interventricular septum end-diastole thickness (IVSd), LV internal diameter in end-diastole and end-systole (LVIDd and LVIDs), LV ejection fraction (LVEF) and fractional shortening (FS) were assessed. Information on maternal PE (ICD-10 codes DO140–142 and DO159) was retrieved from an obstetric database. Using linear regression in a sample of echocardiograms, we compared the LV structure and function adjusted for maternal age; gestational age; sex; weight and length. Results In total, 447 infants were exposed to PE, and 7,178 were born to uncomplicated pregnancies (Table). In infants of PE mothers, we found significantly larger LVPWd and IVSd (0.18 mm, 95% CI [0.14; 0.22], p&lt;0.001 and 0.06 mm, 95% CI [0.02; 0.10], p=0.001, resp.) and LVIDd as LVIDs were significantly smaller (−0.15 mm, 95% CI [−0.29; −0.01], p=0.032 and −0.16 mm 95% CI [−0.28; −0.04], p=0.009, resp.) compared to infants of non-PE mothers. We found no differences in systolic function. LV measures in PE and non-PE infants Parameter Infants of PE mothers, Infants of non-PE mothers, p-value Estimate* [95% CI] p-value mean [± SD] (n=447) mean [± SD] (n=7,178) Left Ventricular Posterior Wall in end-Diastole, LVPWd (mm) 2.20 [±0.58] 2.07 [±0.40] &lt;0.001 0.18 [0.14; 0.22] &lt;0.001 Interventricular Septum in end-Diastole, IVSd (mm) 2.53 [±0.52] 2.55 [±0.41] 0.562 0.06 [0.02; 0.10] 0.001 Left Ventricular Internal Diameter in end-Diastole, LVIDd (mm) 19.35 [±2.00] 20.10 [±1.41] &lt;0.001 −0.15 [−0.29; −0.01] 0.032 Left Ventricular Internal Diameter in end-Diastole, LVIDs (mm) 13.13 [±1.43] 13.65 [±1.79] &lt;0.001 −0.16 [−0.28; −0.04] 0.009 Fractional Shortening, FS (%) 32.10 [±4.07] 32.11 [±3.86] 0.937 0.26 [−0.11; 0.63] 0.168 Left Ventricular Ejection Fraction, LVEF (%) 63.19 [±5.61] 63.09 [±5.30] 0.690 0.34 [−0.17; 0.85] 0.192 *Adjusted for maternal age; gestational age; sex; weight and length. Conclusion In the largest population-based group of neonates to date, we showed that infants born to PE mothers compared to infants of non-PE mothers had significantly thicker left ventricular myocardium, and reduced left ventricular volumes. However, PE was not associated with altered systolic function. Our results might reflect an adaption of the fetal heart to the increased resistance in the placental arteries in PE mothers, and a secondary increased left ventricular afterload. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Lundbeck Found.

P2735Ventricular function in a large cohort of healthy, term newborns assessed by tissue doppler imaging and speckle tracking echocardiography; establishment of normal values and z-scores

Abstract Background There is a paucity of published data presenting reference values for ventricular function in newborns. Purpose This study was conducted to establish echocardiographic normal data and z-scores for ventricular functional parameters in newborns assessed by Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE). Methods We included healthy, term newborns from a prospective, population-based study of newborns, who had a comprehensive, systematic echocardiographic (TTE) examination performed within 14 days of birth. Only newborns without any signs of structural or functional cardiac abnormalities were included. Measurements were obtained according to guidelines. Body surface area (BSA) was calculated using the Haycock formula. Z-score models according to birthweight and BSA at time of TTE were developed for TDI and STE parameters. Results Four hundred newborns (53% male) with gestational age of (median (IQR)) 40.3 (39.4, 41.1) weeks were included. Age, weight, and BSA at TTE were (mean±SD) 11±3 days, 3.7±0.5 kg, and 0.23±0.02m2, resp. Ejection fraction was 67±4%. TDI and STE measurements of ventricular function are presented as mean±SD (Table). Global longitudinal strain was calculated as the average of all left ventricular segmental strain values from apical 4-, 2-, and 3-chamber views. Results for selected parameters according to BSA are illustrated (Figure). TDI and STE of ventricular function Parameter View and modality Value Unit Mitral annulus septal wall e' Apical 4-chamber Tissue Doppler 5.7±0.8 cm/s Mitral annulus septal wall a' Apical 4-chamber Tissue Doppler 5.9±1.0 cm/s Mitral annulus septal wall s' Apical 4-chamber Tissue Doppler 4.6±0.6 cm/s Mitral annulus lateral wall e' Apical 4-chamber Tissue Doppler 6.9±1.0 cm/s Mitral annulus lateral wall a' Apical 4-chamber Tissue Doppler 6.0±1.1 cm/s Mitral annulus lateral wall s' Apical 4-chamber Tissue Doppler 4.8±0.6 cm/s Left ventricular longitudinal strain, 4-chamber Apical 4-chamber 2D 19±2 % Left ventricular longitudinal strain, 2-chamber Apical 2-chamber 2D 20±2 % Left ventricular longitudinal strain, 3-chamber Apical 3-chamber 2D 19±2 % Left ventricular global strain 19±2 % Right ventricular longitudinal strain, free wall Apical 4-chamber 2D 23±4 % Percentile charts Conclusion Normal data for TDI and STE assessment of ventricular function in 400 healthy, term newborns ispresented. An online z-score calculator will be available. Normal data is necessary for the evaluation of pathological changes, and these results contribute substantially to a field where available data is limited. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

Editorial introductions

Editorial introductions

Discovering dad: paternal roles, responsibilities, and support needs as defined by fathers of children with complex cardiac conditions perioperatively.

Understanding perceptions of family caregivers' roles and responsibilities regarding their child with complex cardiac needs has potential to help care teams better support parents. Paternal experience has been under-explored in pediatric cardiac cohorts. Ten fathers of children undergoing cardiac surgery completed quantitative surveys on their knowledge needs and preferred format of communication. In face-to-face recorded interviews, they responded to open-ended questions about the definition of being a good father to a child with a complex cardiac condition, perceived paternal responsibilities, personal growth as a parent to a child with a complex heart condition, support needs, and recommendations to medical staff for paternal inclusion. Semantic content analysis was utilised. The study reports strictly followed COnsolidated criteria for REporting Qualitative research guidelines. The fathers reported high preference for knowledge about the child's heart condition, communication about the treatment plan, and desire for inclusion in the care of their child. Paternal role was defined thematically as: providing a supportive presence, being there, offering bonded insight, serving as strong provider, and acting as an informed advocate. The fathers revealed that their responsibilities sometimes conflicted as they strove to serve as an emotional and economic stabiliser for their family, while also wanting to be foundationally present for their child perioperatively. This study provides insight into paternal experience and strategies for paternal inclusion. This summary of the self-defined experience of the fathers of pediatric cardiac patients offers constructive and specific advice for medical teams.

Penanaman Nilai-Nilai Islam Dalam Membentuk Akhlak Mulia Melalui Kegiatan Mendongeng di TK Terpadu Nurul Amal Buyuk Bringkang Menganti Gresik

Islamic religious values ​​are all rules or rules of good behavior, which all have been regulated by Allah SWT. These rules include how to establish a relationship with God, relationships between human beings, and relationships with nature. Implanting Islamic Values ​​through Storytelling is a way to instill Islamic values ​​in children with a pleasant art of storytelling where in the story there are rules or rules of behavior that have been arranged by God, how to behave to Him, to others humans or friends, and to the natural surroundings. Some of the problems that researchers want to find out through this research are: a). What is the process of planting noble morals through storytelling activities at Nuradu Amal Kindergarten Buyuk Bringkang Menganti Gresik? b). What are the advantages and disadvantages of storytelling in the cultivation of noble moral values ​​in the Integrated Kindergarten Nurul Amal Buyuk Bringkang Menganti Gresik? The method used in this research is interview, observation, and documentation. The results showed that storytelling activities at Nurul Amal Buyuk Kindergarten were held every 2 weeks, with 1 hour duration, without class grouping. Fairytale material can be obtained from various sources. Before carrying out activities there are always preparations made including setting goals, preparing material, understanding content, and preparing visuals. The values ​​conveyed include courtesy, courtesy, and worship. Before starting the fairy tale the teacher will condition the atmosphere first, then say hello, convey today's activities, mention the title, convey the contents of the tale, evaluate with questions and answers. The weakness of this activity according to the teachers is the atmosphere is not conducive, misunderstanding the needs of children, children's hearts are unpredictable. The advantages of this activity are the children's favorite, facilitating the delivery of values, closer teacher and children's relationships.