Congenital Heart Disease In Children Research Articles

Epidemiological Survey of Congenital Heart Disease Among Children Aged from 2 to 18 in Suo County, Nagqu, Tibet.

Lin, Tian, Huaping Jia, Yunming Li, Yongxing Xu, Bei Zhao, Dong Zheng, Hongfeng Yan, Meihui Zhao, Yanlei Li, Liping Xia, Fengxia Zhou, Cuiping Liu, Ke Ma, Ma Mi, and Jianwen Gu. Epidemiological survey of congenital heart disease among children aged from 2 to 18 in Suo County, Nagqu, Tibet. High Alt Med Biol. 00:000-000, 2024. Background: Studies have reported the prevalence of congenital heart disease (CHD) in parts of Tibet, but relative epidemiological surveys are rare. We aimed to explore the prevalence of CHD in children and its relationship with family history in Suo County, Nagqu, Tibet, an altitude of 3,980 meters. Methods: We recruited 4,002 children aged 2-18 years. Subjects underwent a family history investigation, cardiac auscultation, and clinical manifestation examination and then received echocardiographic screening. Results: The prevalence of CHD among children in Suo County was 0.97% (39 cases), much higher than the prevalence at sea level. The most common subtype was atrial septal defect, accounting for 53.9% of CHD, followed by patent ductus arteriosus (33.3%) and ventricular septal defect (12.8%). We also found that children whose mothers had previously borne children with CHD had a higher risk of CHD than those without (p = 0.002); other factors related to CHD during pregnancy, such as smoking, drinking, drug use, and viral infection, showed no statistical differences between children with and without CHD. Conclusions: The prevalence of CHD in children in Suo County is much higher than at low altitude, consisting mostly of simple forms with left-to-right shunt, with rare complex CHD. These results support implementing diagnostic and treatment plans to prevent CHD in Suo County.

Clinical Features and Cardiac Anomalies of Children with Down Syndrome. A Literature Report

Background: Clinical diagnosis of Down syndrome is based on the characteristic features and associated malformations. Nonetheless, there is significant individual diversity in the clinical presentation. Not every physical characteristic may be present, particularly in infants. At the same, congenital heart abnormalities (CHD) remain a major predictor of death in children with Down syndrome (DS) despite improvements in surgical therapy for these conditions. The effects of DS vary from person to person, with some people having a significant impact while others are well and capable of living unassisted as adults. So, this study is done to understand the pattern of clinical features and cardiac anomalies in various research reports.Aim: This scoping review aims to describe the frequency and distribution of clinical features and cardiac anomalies in children with Down syndrome and to consider the clinical implications of this knowledge.Methods: Medline, CINHAL, and PubMed databases were searched electronically to identify pertinent articles from 2000 to 2023. Children with Down syndrome and cardiac comorbidities aged 18 years or younger met the inclusion criteria. Articles that were not peer-reviewed or written in English were disqualified at the title or abstract level.Results: Literature revealed that the common physical and dysmorphic features found in individuals with Down syndrome include flat facial profile, epicanthal folds, upward slanting eyes, hypotonia, small ears, short neck, protruding tongue, small hands and feet, brushfield spots, sandal gap, and short stature. It's important to note that while these physical features are commonly associated with Down syndrome, not all individuals will exhibit every characteristic, and the severity can vary greatly among individuals.A high prevalence of CHD was reported in DS children from a group where consanguinity was relatively frequent. The prevalence of congenital heart disease in children with Down syndrome is the highest reported, especially when the researchers have used diagnostic ultrasound. VSD and AVSD, followed by persistent ductus arteriosus, and tetralogy of Fallot are the most common CHD in DS children. Recent research suggests that though the incidence of CHD in DS children has remained stable over time, there may be trends in some forms of CHD, with a rise in isolated, less severe kinds and a reduction in complicated, more severe ones. Individuals with Down syndrome can lead fulfilling lives with appropriate support and resources.Conclusion: All neonates with a new diagnosis or suspicion of DS must undergo comprehensive screening, which includes clinical examination, ECG, and echocardiography in the second trimester combined with fetal echocardiography when the fetal ultrasonography raises the likelihood of an abnormality. Literature proves that regardless of the existence of DS, early CHD repair is advised for newborns susceptible to biventricular surgery. For the most part, DS is not linked to an increased perioperative risk for CHD.Understanding DS heterogeneity will help professionals provide better prenatal counseling, assist parents in establishing focused early interventions to improve daily activities and the quality of life for their children, and assist policy-makers in providing and allocating resources for disability services. A sustaining commitment to scientific and clinical research studies is necessary to enhance the quality of life and survival for DS patients from infancy into adulthood.

The evaluation of the SMAD1 rs1016792 polymorphism and gene expression on pulmonary hypertension due to congenital heart disease in children: a preliminary study

Smad Family Member (SMAD), a protein family responsible for transducing the signal induced by TGF-β into the nucleus, is thought to play a role in the pathology of many heart diseases. Therefore, we aimed to evaluate the influence of the SMAD1 rs1016792 polymorphism and gene expression on pulmonary arterial hypertension (PAH) due to congenital heart disease (CHD) in children. A total of 90 children, 45 of whom were PAH-CHD children and 45 healthy children, were included in the study. Patients were selected from those who were diagnosed and followed in the Department of Pediatric Cardiology.The SMAD1 rs1016792 genotyping and expression analysis was performed using a real-time polymerase chain reaction (RT-PCR)-based system. It was determined that the left ventricular end-diastolic diameter (LVEDD) value was lower in the patient group than in the control group, while the pulmonary artery pressure (PAP) value was higher in the patient group than in the control group. When the SMAD1 gene expression level was examined, a statistically significant difference was found between the patient and control groups. Patients had decreased SMAD1 expression compared to controls (p˂0.001). We found no significant difference between the patient and control groups in terms of SMAD1 rs1016792 genotype distribution or allele frequency (p > 0.05). There was no difference between genotype distribution and SMAD1 expression levels in the groups. In this study, we showed for the first time that SMAD1 expression is decreased in children with PAH-CHD. These results will be a preliminary step toward understanding the role of SMAD1 in the etiopathogenesis of CHD.

Effects of 6-month customized home-based exercise on motor development, bone strength, and parental stress in children with simple congenital heart disease: a single-blinded randomized clinical trial

BackgroundNew “noncardiac” problems in children with congenital heart disease (CHD), such as developmental delay or long-term neurodevelopmental impairments, have attracted considerable attention in recent years. It is hypothesized that exercise might attenuate CHD-associated neurodevelopmental impairments; however, this has not been thoroughly investigated. The objective of this prospective, single-blinded, randomized controlled experiment was to evaluate the impact of customized home-based exercise for children with CHD.MethodsChildren aged 0–5 years with echocardiography-confirmed simple CHD subtypes who were scheduled to undergo cardiac catheterization were screened for enrolment. Among 420 screened CHD children, 192 were enrolled and randomly assigned at a 1:1 ratio to receive a 6-month intervention (30 min daily customized home-based exercise program with supervision for no less than 5 days per week, combined with home-based exercise education) or control treatment (home-based education). The primary outcome was motor development (gross motor quotient (GMQ), fine motor quotient (FMQ), and total motor quotient (TMQ)). The secondary outcomes were cardiac function and structure, bone quality, physical development, parental anxiety, caregiver burden, and quality of life. Children and their families were assessed before and 1, 3, and 6 months after catheterization; 183 (95.3%) children were included in the primary analysis.ResultsAfter 6-month treatment, the intervention group significantly increased their motor quotient, which was consistently higher than that of the control group (GMQ p < 0.0001, FMQ p = 0.02, TMQ p < 0.001). The physical developments in height, weight, and circumferences of the upper-arm, chest, and head were also significantly improved by exercise (all p < 0.017). No significant improvements in the bone strength or the cardiac structure and function were found among patients in the intervention group (all p > 0.017). For parents, higher quality of life level (total score p = 0.016) was observed in the intervention group; while effects of exercise on the anxiety (rude score p = 0.159, standard score p = 0.159) or the Zarit caregiver burden scale score (p = 0.404) were non-significant. No adverse events occurred during the study period.ConclusionsCustomized home-based exercise improved motor development in children with CHD. While the long-term effects of parent training in home-based exercise are unknown, the study results suggest positive outcomes.Trial registrationA home-based exercise program in congenital heart disease children with cardiac catheterization: a randomized controlled trial. (http://www.chictr.org.cn/, ChiCTR-IOR-16007762, January 14, 2016).

Application of a modified clinical classification for pulmonary arterial hypertension associated with congenital heart disease in children: emphasis on atrial septal defects and transposition of the great arteries. An analysis from the TOPP registry.

A proportion of patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) do not fit in the current classification. We aimed to analyse the applicability of an adapted clinical classification of PAH-CHD to pediatric patients using the TOPP-1 registry (Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension) and focus on atrial septal defects (ASD) and transposition of the great arteries (TGA). Hemodynamic and clinical data of all patients with PAH-CHD in the TOPP cohort were reviewed. Patients were classified according to predefined ABCDE categories (A: Eisenmenger syndrome, B: left-to-right shunt, C: coincidental defects, including all ASDs, D: corrected CHD, E: TGA), or as complex CHD (group 5), by 2 independent investigators. In case of disagreement, a third reviewer could either settle a final decision, or the patient was deemed not classifiable. Survival curves were calculated for each group and compared to idiopathic PAH patients of the registry. A total of 223 out of 531 patients in the registry had PAH-CHD, and 193 were categorized to the following groups: A 39(20%), B 27(14%), C 62(32%) including 43 ASDs, D 58(30%), E 7(4%), whereas 6 patients were categorized as group 5, and 10 patients were unable to be classified. No survival difference could be demonstrated between the groups. This modified classification seems to be more applicable to pediatric PAH-CHD patients than the previous classification, but some patients with PAH-CHD who never had a shunt remain unclassifiable. The role of ASD in pediatric PH should be reconsidered.

Role of miRNA in Cardiovascular Diseases in Children-Systematic Review.

The number of children suffering from cardiovascular diseases (CVDs) is rising globally. Therefore, there is an urgent need to acquire a better understanding of the genetic factors and molecular mechanisms related to the pathogenesis of CVDs in order to develop new prevention and treatment strategies for the future. MicroRNAs (miRNAs) constitute a class of small non-coding RNA fragments that range from 17 to 25 nucleotides in length and play an essential role in regulating gene expression, controlling an abundance of biological aspects of cell life, such as proliferation, differentiation, and apoptosis, thus affecting immune response, stem cell growth, ageing and haematopoiesis. In recent years, the concept of miRNAs as diagnostic markers allowing discrimination between healthy individuals and those affected by CVDs entered the purview of academic debate. In this review, we aimed to systematise available information regarding miRNAs associated with arrhythmias, cardiomyopathies, myocarditis and congenital heart diseases in children. We focused on the targeted genes and metabolic pathways influenced by those particular miRNAs, and finally, tried to determine the future of miRNAs as novel biomarkers of CVD.

The detailed profile of congenital heart diseases in 254 children with Down syndrome in Saudi Arabia

BackgroundDown syndrome is the most common chromosomal abnormality in humans. It is associated with several congenital anomalies, including a spectrum of congenital heart diseases. Understanding the true prevalence and distribution of congenital heart diseases is essential for health resource planning, outcomes, and family counseling.This study aimed to assess the prevalence and distribution of congenital heart disease in children with Down syndrome. It is a retrospective cohort review that included all patients treated at King Abdulaziz University Hospital. Frequencies were estimated using the SPSS software and comparisons were made using Student’s t test.ResultsThe ages of the 254 subjects ranged from less than 1 year to 53 years. Of these, 44.5% were female and 40.6% were Saudi nationals. Congenital heart disease was present in 66.5% with a significant difference between Saudi nationals 44.6%) and non-Saudi nationals 71.5% (P = 0.01). The atrioventricular septal defect was the most common pathology, representing 33.1% of all congenital heart diseases followed by perimembranous ventricular septal defect 18.9%, and right ventricular pathology 10.2%.ConclusionThe prevalence of congenital heart diseases in Saudi children with Down Syndrome is similar to that reported worldwide. Septal defects and right-sided pathologies are the dominant forms of congenital heart diseases, with atrioventricular septal defect and perimembranous ventricular septal defect representing the most common pathologies.

Variation and significance of serum microRNA-21 level in pediatric pulmonary artery hypertension associated with congenital heart disease.

This study strives to the variation and significance of microRNA-21 (miR-21) in children with congenital heart disease (CHD)-related pulmonary artery hypertension (PAH). Children with CHD (n = 179) were selected as subjects, including 101 children without PAH and 78 children with PAH. All children underwent general data collection, laboratory examination, echocardiography and cardiac catheterization. After detection of serum miR-21 expression, the predictive value and the impacts of serum miR-21 for PAH and postoperative critical illness were analyzed. Serum creatine kinase isoenzyme (CK-MB), B-type natriuretic peptide (BNP) and miR-21 were elevated, but ejection fraction (EF) and cardiac index (CI) were decreased in the CHD-PAH group. Serum miR-21 assisted in predicting PAH in CHD children, with the area under curve (AUC) of 0.801 (95% CI of 0.735∼0.857), a cut-off value of 2.56, sensitivity of 73.08, and specificity of 72.28%. Serum miR-21 in children with CHD-PAH was correlated with clinicopathological indicators such as systolic pulmonary artery pressure, mean pulmonary arterial pressure, BNP and CI. Serum miR-21 helped predict the development of postoperative critical illness in children with CHD-PAH, with an AUC of 0.859 (95% CI: 0.762-0.927, cut-off value: 4.55, sensitivity: 69.57%, specificity: 92.73%). Increased serum miR-21 was an independent risk factor of postoperative critical illness in children with CHD-PAH. Serum miR-21 was upregulated in children with CHD-PAH, which may serve as a predictive biomarker for the onset of PAH and postoperative critical illness in CHD children.

Children With Congenital Heart Disease Undergoing Noncardiac Surgeries in Riyadh, Saudi Arabia

Background Congenital heart disease (CHD) is the most common birth defect. There is an increased number of non-cardiac surgeries in CHD children. This study aimed to describe the characteristics of CHD patients undergoing noncardiac surgeries, the most common type of surgical procedures and the mortality rate. Methods A retrospective cohort study was conducted at King Abdullah Specialist Children Hospital (KASCH) from Jan 2020 to Dec 2021 with total number of 45 cases. Descriptive statistics were used for elaborating patients&amp;apos; demographic characteristics and outcomes. Results A total of 231 patients with congenital heart disease were identified during the study period. Among these, 45 patients with a mean age of 3.97 (SD 3.06) years underwent non-cardiac surgery which represents 19.5%. Most of the patients were Saudis (95.6%). No difference was observed between genders. Most of the patients who underwent gastrointestinal surgeries were intubated for &amp;gt;120 mins. None of children who underwent plastic surgeries were admitted to PICU. Mortality within 20 days after the noncardiac surgeries wase 0. Conclusion 19.5% represents the proportion of 0-14 years old CHD children who underwent noncardiac surgeries in KASCH in period of Jan 2020- Dec 2021. The commonest CHD in our study group was patent ductus arteriosus defect which comprised 8 (17.8%) of the patients. Plastic 14 (26.9%) and gastrointestinal 14 (26.9%) surgeries were the most frequent noncardiac surgeries performed. 20 days mortality is 0. None of children who underwent plastic surgeries were admitted to PICU, intubated for more than 120 minutes, or stayed in the hospital for more than 5 days. Future studies on this topic with a larger population from several health centers are needed to help determine the future of non-cardiac interventions for this vulnerable patient group.

Prevalence of Congenital Heart Disease in Children with Recurrent Respiratory Tract Infection

Prevalence of Congenital Heart Disease in Children with Recurrent Respiratory Tract Infection

Precision Diagnosis: An Automated Method for Detecting Congenital Heart Diseases in Children From Phonocardiogram Signals Employing Deep Neural Network

Precision Diagnosis: An Automated Method for Detecting Congenital Heart Diseases in Children From Phonocardiogram Signals Employing Deep Neural Network

Стоматологічний статус дітей з вродженими вадами серця і магістральних судин в Україні

Introduction: Congenital heart disease (CHD) is one of the most common congenital defect worldwide. The increase in the number of patients with CHD creates a group of people with individual special care needs, including dental care. Purpose: to evaluate oral health conditions (oral hygiene, caries experience, periodontal health) in children with CHD and compare their caries experience with the one of the group of healthy children in Ukraine. Materials and methods: Fifty-eight children with congenital heart disease and eighty healthy children aged 3-15 years were enrolled in this study. According to their age and period of dentition, all the children were subdivided into 3 groups: with primary, mixed and permanent dentition. Caries experience, oral hygiene, periodontal health and dental developmental defects were assessed. A one-sample Kolmogorov-Smirnov test and an independent-measures t-Test were used. All statistical analyses were performed using the statistical software (SPSS version 26.0, SPSS Inc.). The statistical significance was set at 5%. Results and discussion: The caries experience of children with CHD and healthy children in primary dentition was 4.0 and 6.4 respectively. The highest DMFT was registered in children with CHD in mixed (4.7) and permanent (4.6) dentitions. 33,3% of children with primary dentition and up to 52,9% in mixed dentition had poor oral hygiene. Conclusions: According to limitation of this epidemiological study, there were no significant differences in caries experience of children with congenital heart disease and healthy children in primary and mixed dentitions. These findings indicate the importance of preventive dental care and appropriate treatment of children with CHD. Key words: congenital heart disease, oral health, children, caries, airway volume, dentoalveolar abnormalities.

Assessment of oral bacteria potentially associated with the mobile microbiome in children with congenital heart disease.

In this case-control study, we aimed to investigate the specific oral pathogens potentially associated with the mobile microbiome in children with congenital heart disease (CHD). Caries, oral hygiene and gingival indices were evaluated in 20 children with CHD and a healthy control group, and venous blood samples and saliva were collected. Using quantitative polymerase chain reaction (qPCR), blood samples were analyzed for the presence of bacterial DNA to determine the mobile microbiome, and saliva samples were analyzed to identify and quantify target microorganisms, including Streptococcus mutans (Sm) and its serotype k (Smk), Fusobacterium. nucleatum (Fn), Porphyromonas gingivalis (Pg), Scardovia wiggsiae (Sw) and Aggregitibacter actinomycetemcomitans (Aa) and its JP2 clone (JP2). The findings were analyzed by Mann Whitney U, chi-square, Fisher's exact and Spearman's Correlation tests. Bacterial DNA was identified in two blood samples. No significant differences were found between the groups regarding the presence and counts of bacteria in saliva. However, the CHD group exhibited significantly lower caries and higher gingival index scores than the control group. The presence of Pg and Aa were significantly associated with higher gingival index scores. Sm and Smk counts were significantly correlated with caries experience. A positive correlation was found between Fn and total bacteria counts. In conclusion, the mobile microbiome, which has been proposed as a potential marker of dysbiosis at distant sites, was very rare in our pediatric population. The counts of target microorganisms which are potentially associated with the mobile microbiome did not differ in children with CHD and healthy children.

Epidemiological investigation of congenital heart diseases among children during the years 2016 to 2021

Background: Congenital heart disease is a type of birth defect that affects about 1% of babies born each year and is the leading cause of death in infancy that is diagnosed at birth or later in life. Due to the high importance of this issue and high mortality and morbidity, the aim of this study was epidemiological investigation of congenital heart diseases in children during 2016 to 2021. Methods: In this cross-sectional analytical study, all children admitted to Bo Ali Hospital in Ardabil with primary diagnosis of congenital heart disease or secondary diagnosis during hospitalization along with all children referred to the clinic of this hospital with diagnosis of congenital heart disease were included in the study. Results: A total of 449 children with congenital heart disease were included in the study. 235 cases (52.33%) were boys, 35 cases (7.79%) had diabetic mothers and 12 cases (2.6%) had obese mothers. 20 cases (4.4%) were the result of multiple pregnancy and 31 cases (6.9%) were preterm. Significantly, preterm birth was more in children with cyanotic disease (p=0.036) and multiple births and maternal diabetes and aneuploidy were more in children with cyanotic disease compared to Asianotic children (p value equal to 0.008 respectively and 0.001 and 0.001). Conclusions: The frequency of congenital heart diseases, gender composition and related risk factors such as preterm birth and maternal diabetes were aligned and similar to domestic and foreign studies. Maternal diabetes and preterm birth can be considered as risk factors for congenital heart diseases.

Prevalence of iron deficiency anaemia in congenital heart disease in children

Background: Congenital heart disease (CHD), out of all congenital anomalies, is the leading condition of mortality and morbidity in children under 5 years of age. Iron deficiency anaemia (IDA) has been clearly shown to be an important risk factor that increases morbidity and mortality in such patients. The present study is thus conducted to find out the prevalence of iron deficiency anaemia in children less than 15 years with congenital heart disease at a tertiary care centre and compare them with cases without CHD. Methods: Prospective study over a period of 2 years, included 60 cases of children below 15 years of age with echocardiographicaly confirmed CHD, investigated by serum ferritin to diagnosed IDA using cut off 12ng/ml. These cases compared with similar age controls. Results: 51cases (82%) were of acyanotic heart disease and 18% were of cyanotic heart disease. Iron deficiency or storage depletion was seen in 90% cases as compared to 75% controls. Iron deficiency anaemia was seen in 55% cases as compared to 30% controls, the difference was statistically significant. Conclusions: Present study observed higher prevalence of IDA among cases with CHD as compared to general population of children. The prevalence was found to be more in cases with cyanotic heart disease as compared to cases with acyanotic heart disease. We thus conclude that routine screening for iron deficiency should be done for these children and those found to be deficient should be treated.

Longitudinal development of central SBP in children with congenital heart disease.

Central SBP (cSBP) was shown to be increased already in children with congenital heart disease (CHD). However, its development over time has not yet been investigated. The aim of this study was to evaluate the natural course of cSBP over time from longitudinal assessment in children with CHD. In this longitudinal study, 306 children and adolescents (11.3 ± 2.9 years, 34% girls) with various CHD were prospectively examined from July 2014 to May 2022. Over a mean follow-up length of 30.1 ± 18.9 months, 467 follow-up assessments have been conducted. cSBP was noninvasively assessed by oscillometric measurement via Mobil-O-Graph. A linear mixed effect model was performed to examine the course of cSBP. cSBP increased significantly over time by 1.22 mmHg per year of age (P < 0.001). The longitudinal increase in cSBP over time remained significant when including sex (b = 0.68, P < 0.001), BMI (b = 1.12, P < 0.001), hypertensive medication (b = 1.13, P < 0.001), disease severity (b = 1.04, P < 0.001), and CHD type (b = 3.74, P = 0.03) in the model. Patients with transposition of the great arteries (TGA) after arterial switch had a significantly higher cSBP increase over time (b = 1.78, P < 0.001). The longitudinal cSBP increase was significantly higher in obese CHD children (b = 2.52, P = 0.005) and in boys (b = 0.85, P < 0.001). This study shows a longitudinal increase in cSBP in children with CHD. Whether observed trajectories of cSBP are normal or abnormal needs to be investigated in further studies. Monitoring of the vascular function with a special focus on patients with TGA and obese CHD children seems indicated.

The impact of pediatric congenital heart disease on primary teeth structure: a histological study.

Congenital heart disease (CHD) is an abnormality in the structure or function of the cardio-circulatory system present at birth and the ventricular septal defect (VSD) is the most common CHD in children. This study aimed to determine any differences in the histological structure of primary teeth between both healthy children and those children with ventricular septal defects in Erbil City. Methods enrolled children were divided into two groups. Group I (control) & group II (CHD) aged between 6-10 years old. A total of 44 children were collected, (22 children) in each group. Enamel, dentin, and odontoblast layers were examined histologically. Unpaired t-test used for statistical analysis. Results: The histopathological sections showed a significant difference in enamel, dentin, and odontoblast layer thickness (255.8 ± 41.68- 406.4 ±46.39), (1156 ± 116.0 - 1320 ± 117.4) and (29.74 ± 7.66 -41.38 ± 12.06) respectively, with p values (P < 0.0001) for enamel and dentin layer, and P < 0.0004 for odontoblast layer. A study of the images in the CHD group showed that the tooth tissue lost its integrity and cohesion in some places, and the thickness of the enamel and dentin layer in this group was significantly reduced compared to group I. Tissue loss in enamel, pulp, and dentin cell were observed. Also, connective tissue layers in the pulp were disrupted. Conclusions: CHD can alter the natural structure formation of primary teeth. Histologically, enamel, dentin, and odontoblasts layer thickness reduction are found in primary teeth in children with ventricular septal defects.

New Insights into the Education of Children with Congenital Heart Disease with and without Trisomy 21.

Background and Objectives: Patients with congenital heart disease (CHD), especially as a concomitant syndromal disease of trisomy 21 (T21), are at risk for impaired neurodevelopment. This can also affect these patients' education. However, there continues to be a research gap in the educational development of CHD patients and T21 CHD patients. Materials and Methods: In total, data from 2873 patients from the German National Register for Congenital Heart Defects were analyzed. The data are based on two online education surveys conducted among patients registered in the National Register for Congenital Heart Defects (2017, 2020). Results: Of 2873 patients included (mean age: 14.1 ± 4.7 years, 50.5% female), 109 (3.8%) were identified with T21 (mean age: 12.9 ± 4.4 years, 49.5% female). T21 CHD participants had a high demand for early specific interventions (overall cohort 49.1%; T21 cohort 100%). T21 CHD children more frequently attended special schools and, compared to non-trisomy 21 (nT21) CHD patients, the probability of attending a grammar school was reduced. In total, 87.1% of nT21 CHD patients but 11% of T21 CHD patients were enrolled in a regular elementary school, and 12.8% of T21 CHD patients could transfer to a secondary school in contrast to 35.5% of nT21 CHD patients. Most of the T21 CHD patients were diagnosed with psychiatric disorders, e.g., learning, emotional, or behavioral disorders (T21 CHD patients: 82.6%; nT21 CHD patients: 31.4%; p < 0.001). Conclusions: CHD patients are at risk for impaired academic development, and the presence of T21 is an aggravating factor. Routine follow-up examinations should be established to identify developmental deficits and to provide targeted interventions.

Physical Image Quality Metrics for the Characterization of X-ray Systems Used in Fluoroscopy-Guided Pediatric Cardiac Interventional Procedures: A Systematic Review.

Pediatric interventional cardiology procedures are essential in diagnosing and treating congenital heart disease in children; however, they raise concerns about potential radiation exposure. Managing radiation doses and assessing image quality in angiographs becomes imperative for safe and effective interventions. This systematic review aims to comprehensively analyze the current understanding of physical image quality metrics relevant for characterizing X-ray systems used in fluoroscopy-guided pediatric cardiac interventional procedures, considering the main factors reported in the literature that influence this outcome. A search in Scopus and Web of Science, using relevant keywords and inclusion/exclusion criteria, yielded 14 relevant articles published between 2000 and 2022. The physical image quality metrics reported were noise, signal-to-noise ratio, contrast, contrast-to-noise ratio, and high-contrast spatial resolution. Various factors influencing image quality were investigated, such as polymethyl methacrylate thickness (often used to simulate water equivalent tissue thickness), operation mode, anti-scatter grid presence, and tube voltage. Objective evaluations using these metrics ensured impartial assessments for main factors affecting image quality, improving the characterization of fluoroscopic X-ray systems, and aiding informed decision making to safeguard pediatric patients during procedures.

TRENDS IN THE INCIDENCE AND CHARACTERISTICS OF CONGENITAL HEART DISEASE IN LOPBURI PROVINCE, CENTRAL THAILAND, 2017-2021

Background: Congenital heart disease (CHD) is the newborn’s most common congenital anomaly. Nevertheless, limited evidence is available of CHD incidence in Thailand. Therefore, we aimed to determine the trends in CHD incidence from 2017 to 2021.&#x0D; Methods: A descriptive epidemiology study was conducted using data from 2017-2021. We collected data from the medical records of pediatric patients with CHD at the Pediatric Cardiology Clinic at Ananda Mahidol Hospital, central Thailand. The pediatric cardiologist reviewed medical records to obtain participants’ characteristics and medical data, including CHD diagnosis, sex, child order and maternal risk factors during pregnancy.&#x0D; Results: In total, 27,882 live births were recorded between 2017 and 2021 in Lopburi Province, Thailand. The study included 584 pediatric patients with CHD born between 2017 and 2021. Of these, 312 (53.4%) were males, and 89 (15.2%) presented cyanotic CHD. Sex-adjusted CHD incidence was 22.4 per 1000 live-births (95% CI: 17.6-34.5) in 2017; then rose to 25.7 per 1000 live-births (95% CI 21.7- 30.2) in 2019 and dropped to 15.4 per 1000 live-births (95% CI 12.1-19.3) in 2021 (p for trend = 0.317). Two hundred and fourteen patients (36.6%) presented a ventricular septal defect. In 2017, the proportion of patients receiving a diagnosis of CHD before one year of age was 57.7% and continuously rose to 100% in 2021 (p-for trend &lt;0.001). The proportion of alcohol consumption during pregnancy was consistently high, ranging from 61.6 to 74.8% (p for trend = 0.189). In addition, contraindicated drug use during the first trimester of pregnancy was also constantly high (73.1%) among study participants over five years (p for trend = 0.235).&#x0D; Conclusion: CHD incidence in Lopburi Province has been persistently high from 2017 to 2021. The average age at diagnosis with CHD in this study population continuously declined over five years. Characteristics of CHD risk factors during pregnancy constituted a constantly high proportion among these study participants over one half decade.