Treatment Of Congenital Heart Disease Research Articles

Patient-Specific 3D-Printed Models in Pediatric Congenital Heart Disease

Three-dimensional (3D) printing technology has become increasingly used in the medical field, with reports demonstrating its superior advantages in both educational and clinical value when compared with standard image visualizations or current diagnostic approaches. Patient-specific or personalized 3D printed models serve as a valuable tool in cardiovascular disease because of the difficulty associated with comprehending cardiovascular anatomy and pathology on 2D flat screens. Additionally, the added value of using 3D-printed models is especially apparent in congenital heart disease (CHD), due to its wide spectrum of anomalies and its complexity. This review provides an overview of 3D-printed models in pediatric CHD, with a focus on educational value for medical students or graduates, clinical applications such as pre-operative planning and simulation of congenital heart surgical procedures, and communication between physicians and patients/parents of patients and between colleagues in the diagnosis and treatment of CHD. Limitations and perspectives on future research directions for the application of 3D printing technology into pediatric cardiology practice are highlighted.

Impact of Newborn Screening Programme for Congenital Heart Disease in Shanghai: a five-year observational study in 801,831 newborns

Newborn Screening Programme for Congenital Heart Disease (CHD) in Shanghai has been in operation for over 5 years, and its feasibility and effectiveness still lack a systematic and comprehensive evaluation. This study aimed to detail the implementation of the programme and evaluate its results, benefits, and reliability in clinical practice. This study was an observational study involving all newborns received CHD screening in Shanghai from 2017 to 2021. Pulse oximetry (POX) plus cardiac murmur auscultation (namely the dual-index method) was used for CHD screening in newborns aged 6-72h. Newborns who screened positive was recommended for echocardiography, and those diagnosed with CHD would be planned for further evaluation and intervention. Data were aggregated by birth year and district of birth. Results of neonatal CHD screening, diagnosis and treatment, and temporal trends of infant mortality rate (IMR) and the proportion of under-five mortality (U5M) attributed to CHD were analysed. A retrospective cohort study was also conducted to assess the reliability of the dual-index method in clinical practice. In total, 801,831 (99.48%) newborns were screened for CHD, 16,489 (2.06%) were screened positive, and 3541 (21.47%) of the screened-positive newborns were identified with CHD. Seven hundred and fifty-two patients with CHD received surgical or interventional treatment with a successful rate of 94.81%. The period from 2015 to 2021 witnessed an approximately twofold decrease in IMR from 4.58‰ to 2.30‰, and a downtrend in the proportion of U5M attributed to CHD from 25.93% to 16.61%. High sensitivity and specificity of the dual-index method in clinical practice were observed for both critical (100.00% and 97.72%) and major CHD (98.47% and 97.76%). Newborn screening programme for CHD has been well implemented in Shanghai, and this programme is a successful public health intervention to reduce infant death. Our study provides encouraging evidence and experience for implementing newborn screening programme for CHD nationwide in China. This study was supported by the National Key Research and Development Programme of China (2021YFC2701004 and 2016YFC1000506), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-002), and Three-Year Planning for Strengthening the Construction of Public Health System in Shanghai (No. GWIV-24).

The Impact of Neighborhood Socioeconomic Status, Race and Ethnicity, and Language on Prenatal Diagnosis of CHD.

Congenital heart disease (CHD) is the most prevalent birth defect. This study aimed to assess whether prenatal diagnosis (PD) of CHD and time of the diagnosis are associated with maternal race, ethnicity, neighborhood SES, and language. In this retrospective cohort study, we analyzed data on 163 patients who underwent surgical intervention for CHD within 30days of birth between 2011 and 2020 at the University of Maryland Children's Hospital. A neighborhood SES score was calculated using the mother's address at time of discharge and 6 SES variables from the US Census block group data with a previously published method by Diez Roux et al. Neighborhood SES did not impact the likelihood of receiving a PD of CHD; however, patients of Latino ethnicity were 3.2 times and non-English-preferred language patients were 5.1 times more likely to not receive a PD. Patients whose preferred language was a non-English language received a prenatal diagnosis 5.3weeks later, resulting in the PD being made in the third trimester rather than the second. Patients from the highest quartile SES received an earlier prenatal diagnosis, although this association was less significant when controlling for insurance type and preferred language. Significant disparities in PD of CHD were seen in patients of Latino ethnicity and patients who prefer non-English language. Better understanding of the root causes of these disparities will be important to guide interventions to reduce these disparities.

Biological Scaffolds for Congenital Heart Disease.

Congenital heart disease (CHD) is the most predominant birth defect and can require several invasive surgeries throughout childhood. The absence of materials with growth and remodelling potential is a limitation of currently used prosthetics in cardiovascular surgery, as well as their susceptibility to calcification. The field of tissue engineering has emerged as a regenerative medicine approach aiming to develop durable scaffolds possessing the ability to grow and remodel upon implantation into the defective hearts of babies and children with CHD. Though tissue engineering has produced several synthetic scaffolds, most of them failed to be successfully translated in this life-endangering clinical scenario, and currently, biological scaffolds are the most extensively used. This review aims to thoroughly summarise the existing biological scaffolds for the treatment of paediatric CHD, categorised as homografts and xenografts, and present the preclinical and clinical studies. Fixation as well as techniques of decellularisation will be reported, highlighting the importance of these approaches for the successful implantation of biological scaffolds that avoid prosthetic rejection. Additionally, cardiac scaffolds for paediatric CHD can be implanted as acellular prostheses, or recellularised before implantation, and cellularisation techniques will be extensively discussed.

Multicentre experience with Optimus balloon-expandable cobalt–chromium stents in congenital heart disease interventions

ObjectivesTo evaluate bare-metal Optimus and polytetrafluoroethylene (PTFE)-covered Optimus-CVS balloon-expandable, cobalt–chromium, hybrid cell–designed stents in congenital heart disease (CHD) interventions.MethodsRetrospective multicentre review of patients with CHD receiving Optimus stents. Stent mechanical...

The Year in Hungarian Cardiology 2022: Cardiac Imaging

In 2022, the Hungarian Cardiovascular Imaging community contributed to several scientifi c papers that were published in international journals. Clinical research activities employed novel echocardiographic methods including two- and three-dimensional, strain and tissue Doppler imaging of all cardiac chambers. These echocardiographic modalities were applied in diff erent patient populations such as patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or post-SARS-CoV-2 aff ected individuals, athletes, patients with systemic autoimmune diseases, cardiomyopathies, hematologic diseases, metabolic diseases, congenital heart disease or valvular interventions. Beyond resting echocardiography, original research results revealed important information in the fi eld of exercise stress echocardiography as well. Hungarian studies using cardiac magnetic resonance imaging evaluated patients with diff erent pathologies such as cardiac amyloidosis, cardiomyopathies, myocarditis due to SARS-CoV-2 vaccinations, and athletes in post-SARS-CoV-2 states. Hungarian research activities in the fi eld of cardiac computed tomographic imaging covered the evaluation of moderate coronary lesions, correlates of myocardial ischemia, coronary plaques, coronary calcium, recurrence of atrial fi brillation after radiofrequency ablation and morphological changes after valvular interventions. Novel technologies have been applied in cardiac computed tomographic imaging by Hungarian researchers, with higher spatial resolution and enhanced spectral capabilities in coronary artery assessment.

Bioresorbable PPDO sliding-lock stents with optimized FDM parameters for congenital heart disease treatment

Stent implantation has been a promising therapy for congenital heart disease (CHD) due to better efficacy. Compared to permanent metal stents, bioresorbable polymer stents have shown a great advantage in accommodating the vascular growth of pediatric patients, but the application is still limited due to inferior radial strength. Here, bioresorbable poly(p-dioxanone) (PPDO) sliding-lock stents for CHD treatment were fabricated by fused deposition modeling (FDM). The effects of FDM processing parameters, including nozzle temperature, bed temperature, layer thickness, and printing speed, on the mechanical properties of PPDO parts were investigated to optimize the processing condition to enhance the radial strength of stents. Finite element analysis (FEA) was also used to evaluate the mechanical properties of stents. PPDO sliding-lock stents fabricated under optimized FDM parameters showed radial strength of 3.315 ± 0.590 N/mm, superior to benchmark commercial metal stents. Radial strength curve and compression behavior of PPDO sliding-lock stents were investigated. Results of FEA exhibited that strut width, shape of the mesh cell and surface coverage ratio had an impact on the compression force of PPDO sliding-lock stents. PPDO sliding-lock stents fabricated with optimized FDM parameters show favorable mechanical performance and meet the requirement of CHD treatment.

Thirty-Year Survival After Cardiac Surgery in Children With Williams–Beuren Syndrome (from the Pediatric Cardiac Care Consortium Study)

Williams-Beuren syndrome (WBS)is a genetic condition frequently requiring interventions for associated congenital heart disease (CHD). Long-term survival data after cardiac interventions for children with WBS are sparse. This is a retrospective cohort study aiming to describe the 30-year survival outcomes ofchildren with WBSafterinterventions forCHD using thePediatric Cardiac Care Consortium (PCCC), a large North American-based registry of interventionsforpediatric heart diseases, between 1982and2009. Outcomes were obtained from the PCCC and by linkage with the National Death Index through2020. Survival of patients with WBS and their major subgroups was assessed by Kaplan-Meier survival curves and Cox regression. A total of 200 patients met the inclusion criteria of having their first intervention for CHD at a US PCCC center and age <21years at time of intervention. The most common lesions were left heart obstructive lesions (LHOL), either in isolation (37%) or in combination with right heart obstructive lesions (RHOL) (49.0%), whereas isolated RHOL accounted for 11% of the total. The first procedure was surgery for 85.5% of the group, and the remainder underwent a transcatheter procedure. There were 5 in-hospital deaths (2.5%), and among survivors to hospital discharge, 164 had sufficient identifiers for National Death Index linkage. Over a median period of postdischarge follow-up of 23.7years (interquartile range 18.7 to 27.3), 16 deaths occurred, with an overall 30-year survival rate of 90%. Survival rates ranged from 96.1% for isolated LHOL or RHOL to 83.4% for patients with combined disease (adjusted hazard ratio 4.7, 95% confidence intervals 1.35 to 16.59).

Abstract 15588: Effect of Covid-19 on the Mortality of Patients With Congenital Heart Disease

Introduction: Cardiovascular conditions have been recognized as risk factors for poor outcomes in association with COVID-19. However, the effect of the COVID-19 pandemic on different severity types of congenital heart disease (CHD) patients remains unknown. This study aims to examine whether patients with history of interventions for CHD experienced a higher mortality risk during the COVID-19 pandemic. Methods: This is a retrospective cohort study using data from the Pediatric Cardiac Care Consortium (PCCC). We included patients having US residence and direct identifiers, who were enrolled between 1982 and 2003 after undergoing transcatheter or surgical interventions for CHD. The observation window (2017-2020) was divided to a pre-SARSV2 and SARSV2 exposure period defined around the state specific onset of COVID-19 disease in 2020. Patients were categorized as having mild, moderate, severe-2 ventricle (2V) or single ventricle (SV) CHD. Standardized mortality ratios (SMRs) were used to describe the observed risk of mortality in CHD patients compared to the age- and sex-adjusted rates from the general U.S. population. Multivariable analysis was conducted using time-varying covariate Cox proportional hazards model with adjustment for age, sex and severity of CHD. Results: A total of 50,138 patients with history of interventions for CHD were included. Pooled pre-SARSV2 SMR was 2.38 [95% CI: 2.06, 2.75], while the SARSV2-exposure SMR was 2.07 [95% CI: 1.78, 2.35] (not significantly different). No significant differences in pooled SMRs were found by severity of CHD. The adjusted hazard risk for all-cause mortality in the SARSV2-exposure vs pre-SARSV2 period did not increase for patients with CHD (aHR: 0.59, 95%CI:0.19 - 1.84), and we did not find any differences in risk by severity subgroups or sex of patients. Conclusion: In this large cohort study monitoring long term outcomes after interventions for CHD, we could not detect any evidence of increased risk for all-cause mortality among this population during the early part of the COVID-19 pandemic. Additional data will be required over longer period to fully understand the impact of COVID-19 on adults with repaired CHD.

Inpatient costs of congenital heart surgery in China: results from the National Centre for Cardiovascular Diseases

Economic data on congenital heart disease (CHD) in China are scarce. Therefore, this study aimed to explore the inpatient costs of congenital heart surgery and related healthcare policies from a hospital perspective. We used data from the Chinese Database for Congenital Heart Surgery (CDCHS) to prospectively analyse the inpatient costs of congenital heart surgery from May 2018 to December 2020. The total expenditure was divided into 11 columns (medications, imaging, consumable items, surgery, medical cares, laboratory tests, therapy, examinations, medical services, accommodations, and others), and explored according to the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, year, different age group, and CHD complexity. Authority economic data (index for gross domestic product [GDP], GDP per capita, per capita disposable income and average annual exchange rate of 2020 Chinese Yuan against US dollar) were accessed via the National Bureau of Statistics of China to better describe the burden. In addition, potential factors contributing to the costs were also investigated by using generalised linear model. All values are presented in 2020 Chinese Yuan (¥). A total of 6568 hospitalisations were enrolled. The median of overall total expenditure was ¥64,900 (≈9409 US Dollar [USD], interquartile range [IQR]: ¥35,819), with the lowest in STAT 1 (¥57,014≈8266 USD, [IQR]: ¥16,774) and the highest in STAT 5 (¥194,862≈28,251 USD, [IQR]: ¥130,010). The median costs during the 2018 to 2020 period were ¥62,014 (≈8991 USD, [IQR]: ¥32,628), ¥64,846 (≈9401 USD, [IQR]: ¥34,469) and ¥67,867 (≈9839 USD, [IQR]: ¥41,496). Regarding to age, the median costs were highest in the ≤1 month group (¥144,380≈20,932 USD, [IQR]: ¥92,584). Age, STAT category, emergency, genetic syndrome, delay sternal closure, mechanical ventilation time, and complications were significantly contributed to the inpatient costs. For the first time, the inpatient costs of congenital heart surgery in China are delineated in detail. According to the results, CHD treatment has achieved significant progress in China, but it still causes substantial economic burden to both families and society. In addition, ascending trend of the inpatient costs was observed during the period of 2018-2020, and the neonatal was revealed to be the most challenging group. This study was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS,2020-I2M-C&T-A-009), Capital Health Research and Development of Special Fund (2022-1-4032), and The City University of Hong Kong New Research Initiatives/Infrastructure Support from Central (APRC, 9610589).

Clinical Profile of Post-Operative Treatment Duration in Pediatric Congenital Heart Disease Patients

ABSTRACT CHD (Congenital Heart Disease) is still a dangerous disease that causes a high infant mortality rate in the world. Nowadays, there are two groups of actions to treat congenital heart disease, surgical management and non-surgical management. This study discusses Clinical Profile of Post-Operative Treatment Duration in Pediatric Congenital Heart Disease Patients. Fourty medical records used for this analytical descriptive study were obtained from Department of Pediatrics and Department of Thoracic, Cardiac, and Vascular Surgeons, Dr. Soetomo General Hospital, Surabaya, Indonesia. This study described post operative treatment duration in pediatric congenital heart disease patients. The total patients in the study were 40 pediatric patients with the majority being female, namely 52.50% with higher mortality rate in patients with congenital heart disease with surgical treatment (16.6%). Most patients with CHD in children with surgical and non-surgical treatment were diagnosed in the infant age group (0-5 years), namely 31 patients (77.50%) with 5 surgical treatment patients and 26 non-surgical treatment patients. The majority of patients with congenital heart disease with surgical and non-surgical management in good nutritional status (60.00%). Most cases of cyanotic congenital heart disease are tetralogy of fallot (50%) with all of cases treated with cardiac catheterization for non-surgical treatment, zero case surgical treatment, and 5 cases without surgical or non surgical treatment. Acyanotic cases are ASD (28.56) with 4 cases cardiac catheterization, 2 cases treated with ASO device, and 1 case with ASD closure as surgical treatment. The duration of hospitalization after the procedure was shorter in good nutritional status (3.2 days) in both surgical and non-surgical treatment while shorter duration after procedure also appeared in cases of congenital heart disease with non-surgical treatment (4.25 days). CHD patients with non-surgical treatments have shorter duration compared to patients with surgical treatment. Most CHD cases were TOF for cyanotic and ASD for acyanotic with higher mortality rate in surgical treatment. Good nutritional status were found in both of the CHD treatment. Most CHD patients with surgical and non-surgical treatment were infant, female. Keywords: CHD, Surgical, Non-Surgical, Pediatrics, Treatment Duration

Effect of comprehensive nursing intervention for congenital heart disease in children: A meta-analysis.

Objectives:This meta-analysis aimed to assess the impact of nursing interventions (e.g., educational and empathic interviewing, motor exercise, therapeutic play interventions) on the perioperative outcome of children with congenital heart disease (CHD).Methods:We searched PubMed, Embase, Web of Science, Scopus, Cochrane, EBSCO, The Chinese National Knowledge Infrastructure, Wan Fang Data and the VIP Chinese Journal Service platform from the date of database creation to August 2021. Our study adhered to the recommendations of the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RevMan 5.4 and Stata 16.0 were used to complete the meta-analysis.Results:This meta-analysis showed that comprehensive nursing intervention reduced both the length of hospital stay (weighted mean difference [WMD] = −1.982, 95%CI [−2.329, −1.634], P < .001) and the related risk of post-operative complications [OR = 0.345, 95%CI (0.225, 0.528), P < .001]. In addition, nursing intervention increased parental satisfaction with the care provided [OR = 0.308, 95%CI (1.923, 6.863), P < .001]. Nursing interventions have also had a positive impact in reducing preoperative anxiety [WMD = −6.721, 95% CI (−7.194, −6.249), P < .001] and postoperative pain [WMD = −7.103, 95% CI (−7.103, −7.663), P < .001] in children.Conclusions:This meta-analysis confirms the beneficial effects of comprehensive nursing interventions in terms of reduced complication rates and shorter hospital stays. The effectiveness of comprehensive nursing in reducing anxiety and pain levels was also demonstrated. The findings support the implementation of comprehensive care interventions in the perioperative period for children with CHD to improve clinical outcomes.

Percutaneous interventions in Fontan circulation

Abstract Background In light of increased survival of patients with Fontan circulation, percutaneous interventions in these patients have become growingly significant in the recent years. Percutaneous treatments in patients with univentricular physiology can optimize the short term hemodynamics in these patients. However, information on long term outcomes is scarce. Purpose To present the cumulative work experience in percutaneous interventions of a tertiary center in the past 12 years in patients that have undergone total cavopulmonary deviation (TCD) and to investigate long term outcomes. Methods In this retrospective study, all patients with TCD that underwent follow-up in our specialized department of congenital heart disease in the past 12 years, were eligible for chart-review. Cardiac catheterization was performed by experienced interventional cardiologists, specialized in structural interventions in congenital heart disease. All catheterizations were performed under general anesthesia and mechanical ventilation. All patients underwent Fontan pressure measurements and cardiac output estimation with Fick method. Results A total of 80 patients, with a mean follow-up time of 24 (±7.1) years, were included in the study. Details on baseline characteristics are depicted in Table 1. Fifty-two (65%) patients underwent percutaneous intervention during follow-up, and 33% (n=17) of these patients required multiple interventions. Angioplasty with stent implantation of the Fontan conduit or the pulmonary arteries was the most common intervention (30 (58%) and 8 (15%) patients, respectively), followed by embolization of collaterals (11 (21%) patients). Patients with right systemic ventricle physiology needed more interventions and had a shorter time-to-first-intervention period. (Figure 1) Pacemaker implantation was required in a total of 15 patients, being significantly more frequent in patients with atriopulmonary connection than in patients with lateral tunnel or extracardiac conduit (11 (36%) vs 4 (11%), p&amp;lt;0.01). Overall long-term outcome (with regards to mortality) was good (4 (0.5%) patients). Patients that required percutaneous structural interventions showed a tendency towards a higher mortality than those not in need of intervention (4 (8%) vs 0 (0%), respectively, p=0.14). Conclusions During long-term follow-up of patients with Fontan circulation, almost two thirds of the patients required percutaneous intervention. Patients with right systemic ventricle physiology were in greater need of intervention. Patients that required intervention had a tendency towards a worse clinical outcome. Funding Acknowledgement Type of funding sources: None.

Novel TrueVue series of 3D echocardiography: Revealing the pathological morphology of congenital heart disease.

Aims: This study explored the advantages and limitations of novel series of three-dimensional (3D) echocardiographic techniques and summarized their application methods for congenital heart diseases (CHDs). Method and result: Two-dimensional (2D), traditional 3D echocardiography, and TrueVue plus light and/or Glass novel 3D technologies were performed on 62 patients with CHD, and a clinical survey was designed to judge whether the novel 3D images were more helpful for understanding the cardiac condition and guide treatment than traditional 3D images. TrueVue increased the visual resolution and simulated the true texture of cardiac tissue, significantly improving the display ability of abnormal anatomical structures in CHDs. TrueVue Glass displayed the blood channel and the internal structure of cardiac cavity more intuitively, indicating a new observation aspect not shown by conventional echocardiography. The clinical survey results showed that the new 3D imaging methods effectively increased the diagnostic confidence of echocardiographers, enabled surgeons to better understand the details of lesions, promoted efficient communication, and improved the confidence of both doctors and patients in treatment. Conclusion: The combined application of TrueVue, TrueVue Light, and TrueVue Glass more closely simulated real anatomical features, showed more comprehensive and subtle blood flow in the lumen, not only increased the visual effect but also provided more useful diagnostic information, improved the accuracy of evaluation and treatment of CHD when compared to traditional imaging techniques, indicating that this combined application has significant clinical value.

Multicentre experience with optimus balloon-expandable cobalt-chromium vascular stents in congenital heart disease interventions: Early outcomes and extended possibilities

Optimus™ and Optimus-CVS® (AndraTec, Germany) are balloon-expandable, cobalt-chrome, hybrid-cell designed stents with promising bare-metal and PTFE-covered specifications. We aim to evaluate Optimus stents in congenital heart disease (CHD) interventions. Retrospective multicentre review of CHD patients receiving Optimus stents. Stent mechanical behavior, clinical indications, and outcomes were assessed. A total of 132 stents (48.5% PTFE-covered, 53% XXL/15ZIG, 29.5% XL/12ZIG, 17.4% L/9-ZIG) were implanted (98.3% success rate) in 121 patients (59.5% males, 64.5% adults), median age 23.7 years (IQR, 15.5–40.7), and weight 63.5Kg (IQR, 49.5–77). Indications were right ventricular outflow tract standalone stenting or before revalvulation (66.1%), aortic coarctation treatment (14%), Fontan-circuit fenestration closure (9.9%), and miscellaneous (9.9%). 64 patients had covered stenting that was prophylactic in 45.3% of cases. In stenotic lesions (65/121, 53.7%), median percentage of achieved stent expansion was 91.3% (IQR, 82.3–96.8%), median vessel diameters increased from 13.8 mm (IQR, 9–17.3 mm) to 20.3 mm (IQR, 15.9–22.3 mm) ( P < 0.001), and percentage of vessel expansion was 39.4% (IQR, 18.6-84.3%). Median gradient across stenotic lesions decreased from 31 mmHg (IQR, 21–41) to 5 mmHg (IQR, 1–9) ( P < 0.001). In 20/28 (71.4%) patients, graft was dilated a median of 2 mm (IQR, 2–6 mm) above nominal diameter. Median stent shortening was 11% (IQR, 6.3%–15.1%) and was associated only with expansion diameter (OR: 0.58, 95% CI: 0.22–0.93). There was no stent embolization or dysfunction on follow-up, median 8 (IQR, 4–12) months. Optimus stents are effective tools for transcatheter treatment of simple and complex CHD. Optimus reliable mechanical behavior and particular covering design can promote widespread use.

Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults.

The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.

Assessment of Thoracic Kyphosis Using Flexicurve Ruler after Open Heart Surgery: A Cross-Sectional Study

In literature, the development of spinal deformities was reported after surgical intervention for congenital heart disease using thoracotomy and sternotomy incisions in children; however, there are not enough data regarding the incidence of spinal kyphosis after open-heart surgery in adults. This study aimed to determine the impact of open-heart surgery using median sternotomy incision on the sagittal plane thoracic spine curve and pulmonary functions after open-heart surgery. A cross- sectional study was conducted on 100 participants (53 ± 9.43 years), who underwent open heart surgery using median sternotomy. The spinal kyphotic curve was evaluated using a Flexicurve ruler and spirometry parameters [forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC)] were evaluated before and one week after open-heart surgery. The comparison between the preoperative and postoperative measurements of the variables under study was performed using the paired t-test. Statistical significance was set at (P ˂ 0.05). The results revealed a significant increase in the dorsal kyphotic curve (9.75 ± 2.32) and a significant decrease in all spirometry parameters under study [(FVC: 2.12 ± .77); (FEV1:1.55 ± .64) and (FEV1/FVC: 0.72 ± .13)] with an alpha level of (P &lt; 0.05). There is a high incidence of exaggerating the sagittal plane thoracic spine curvature (thoracic kyphosis), and reduction in the pulmonary functions after open-heart surgery using median sternotomy incision.

12 years of implementation of cardiovascular intervention techniques at of Hue University of Medicine and Pharmacy Hospital

Background: Cardiovascular Center has implemented interventional cardiology techniques since 2009 including coronary stenting, congenital heart intervention and pacemaker placement. Percutaneous coronary intervention is currently an effective treatment method for coronary artery disease. Congenital heart diseases by Amplatzer device is an effective method of treatment of congenital heart diseases. Permanent pacemaker implantation is currently the most effective modern treatment for dangerous bradyarrhythmias. Methods: All cases of coronary artery stenosis with indications for intervention, congenital heart disease including atrial septal defect, ventricular septal defect, and ductus arteriosus with the indication for intervention by percutaneous occlusion, bradyarrhythmias have indications for pacemaker placement were included in the study. Methods of book research, retrospective. Results: 1) The rate of emergency coronary intervention 26.7%. The success rate of the procedure is 95.0%. The complication rate of coronary intervention in highrisk patients was 9.4%. 2) There were 254 (68.8%) cases of VVI(R) single-chamber pacemaker and 115 (31.2%) cases of dual-chamber pacing. The complication rate was 4.6%. The success rate of the procedure is 98.7%. 3) The results of the percutaneous septal defect occlusion procedure achieved a complete success of 93.33%, ductal occlusion achieved a complete success of 100%, and ventricular septal defect occlusion with the Amplatzer instrument achieved 100% success. 100% successful results after 3 months of follow-up. Complications in patients after occlusion of atrial septal defect with Amplatzer device were 6.67%, and no complications in the group with ductus arteriosus and ventricular septal defect were noted. Conclusion: Interventional coronary stenting, pacemaker placement, and congenital heart disease interventions are safe and effective methods with high success rates. Key words: Cardiovascular intervention, deployment

Integrated multi-omic characterization of congenital heart disease.

The heart, the first organ to develop in the embryo, undergoes complex morphogenesis that when defective results in congenital heart disease (CHD). With current therapies, more than 90% of patients with CHD survive into adulthood, but many suffer premature death from heart failure and non-cardiac causes1. Here, to gain insight into this disease progression, we performed single-nucleus RNA sequencing on 157,273 nuclei from control hearts and hearts from patients with CHD, including those with hypoplastic left heart syndrome (HLHS) and tetralogy of Fallot, two common forms of cyanotic CHD lesions, as well as dilated and hypertrophic cardiomyopathies. We observed CHD-specific cell states in cardiomyocytes, which showed evidence of insulin resistance and increased expression of genes associated with FOXO signalling and CRIM1. Cardiac fibroblasts in HLHS were enriched in a low-Hippo and high-YAP cell state characteristic of activated cardiac fibroblasts. Imaging mass cytometry uncovered a spatially resolved perivascular microenvironment consistent with an immunodeficient state in CHD. Peripheral immune cell profiling suggested deficient monocytic immunity in CHD, in agreement with the predilection in CHD to infection and cancer2. Our comprehensive phenotyping of CHD provides a roadmap towards future personalized treatments for CHD.

Circular RNA circ-RCCD promotes cardiomyocyte differentiation in mouse embryo development via recruiting YY1 to the promoter of MyD88.

Congenital heart disease (CHD) is the most common birth defect, affecting approximately 1% of live births. Genetic and environmental factors are leading factors to CHD, but the mechanism of CHD pathogenesis remains unclear. Circular RNAs (circRNAs) are kinds of endogenous non‐coding RNAs (ncRNAs) involved in a variety of physiological and pathological processes, especially in heart diseases. In this study, three significant differently expressed circRNA between maternal embryonic day (E) E13 and E17 was found by microarray assay. Among them, the content of circ‐RCCD increases with the development of heart and was enriched in primary cardiomyocytes of different species, which arouses our attention. Functional experiments revealed that inhibition of circ‐RCCD dramatically suppressed the formation of beating cell clusters, the fluorescence intensity of cardiac differentiation marker MF20, and the expression of the myocardial‐specific markers CTnT, Mef2c, and GATA4. Next, we found that circ‐RCCD was involved in cardiomyocyte differentiation through negative regulation of MyD88 expression. Further experiments proved that circ‐RCCD inhibited MyD88 levels by recruiting YY1 to the promoter of MyD88; circ‐RCCD inhibited nuclear translocation of YY1. These results reported that circ‐RCCD promoted cardiomyocyte differentiation by recruiting YY1 to the promoter of MyD88. And, this study provided a potential role and molecular mechanism of circ‐RCCD as a target for the treatment of CHD.