Pediatric Cardiology Research Articles

Assessment of Risk Factors for Cerebrovascular Accidents in Children with Congenital Heart Diseases

Abstract Background Children with congenital heart disease (CHD) are at an increased risk of cerebrovascular accidents (CVA), including arterial ischemic stroke (AIS), cerebral venous sinus thrombosis (CVST), and hemorrhagic stroke. The risk varies depending on age, comorbidities, underlying cardiac defect, and other factors, such as changing hemodynamics, cardiac procedures, and the need for mechanical circulatory support devices. Aim To determine the risk factors and neurological outcome of cerebrovascular accidents, that occur either spontaneously or peri-procedurally in children with congenital heart diseases. Patients and Methods A retrospective case-control study was conducted on the records of 72 patients collected from the patients' files between 2015 and 2023 at the Pediatric Neurology Clinic, and Pediatric Cardiology Clinic, Children's Hospital, Cardiothoracic Surgery Academy, Radio-diagnosis Department, Faculty of Medicine, Ain Shams University Hospitals with age ranged from 2 months to 18 years. Children with CHD and radiologically confirmed CVA (case group) were compared to CHD children without CVA (control group). Results Seventy-two children with CHD were included, 30 of whom had radiologically confirmed CVA (case group), and the remaining studied children (42 patients) who had CHD without CVA (control group). In the case group, they were 12 females (40%) and 18 males (60 %), 29 females (69%) and 13 males (31%) in the control group. The age at diagnosis of CVA in case group ranged from (2 months to 1 year) in 17 patients (56.7%), (2 – 6 years) in 7 patients (23.3%), and(7 – 12 years) in 3 (10.0%),and (13 – 18 years) in 3 (10.0%). Males in patients with stroke (60.0%) than in patients without stroke (31.0%) with p-value = 0.014. Twenty-four (57.1%) without stroke and 15 (50.0%) with stroke had acyanotic cardiac disease with the most common being VSD in 7 (23.3%) of those with stroke. there was no statistically significant difference between patients with and without stroke regarding cardiac cyanotic and acyanotic cardiac diagnosis. Twenty-one (70%) out of 30 were diagnosed AIS, 2 (6.7%) CVST, and 7 (23.3%) with hemorrhagic stroke. Stroke occurred following cardiac procedures in 20 patients (66.7%): 15 after cardiac surgery and 5 after cardiac catheterization. Risk factors for CVA were high blood pressure at admission in 12 patients (16.7%), hypoperfusion in 7 patients (9.7%), thrombus on the tip of central venous line (CVL) in 2 patients (2.8%), deep vein thrombosis (DVT) in 1 patient (1.4%), a hypercoagulable state in 1 patient (1.4%), high hematocrit level in 1 patient (1.4%), previous brain insult in 2 patients (2.8%), intracardiac mass in 1 patient (1.4%), infective endocarditis in 2 patients (2.8%), abnormal heart valve in 1 patient (1.4%), disseminated intravascular coagulation (DIC) in 1 patient (1.4%), and chronic disease in 10 patients (13.9%). Taking into consideration that more than one risk factor was found in the same patients. The results revealed that there was a statistically significant increase in the percentage of risk factors in patients with stroke (66.7%) than in patients without stroke (26.2%) with p-value = 0.001. Conclusions Individuals with CHD are at a higher risk of CVA, and this suggests that the risk assessment for CVA based on conventional cardiovascular risk factors should be considered in these patients. Early diagnosis of CHD is important to prevent further recurrences of stroke, and because they are potentially curable. Prospective cohort studies are required to determine effective primary and secondary prevention strategies.

Cyanotic heart defects in children: neurological aspects of the problem

Background. The goal is to justify the need to monitor neurodevelopment in children with congenital heart defects (CHD) and to study neurological disorders in patients under 3 years of age with cyanotic heart defects. Materials and methods. Modern research on the neurodevelopment of children with CHD were analyzed. Sixty-two patients with cyanotic heart defects who underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine were studied. They are divided into 2 groups: group 1 are children with critical cyanotic CHD and group 2 — with non-critical cyanotic CHD. The control group consisted of 35 healthy patients. A neurological examination was performed using standardized neurological scales. Data processing was carried out using the Stata 12.1 licensed statistical package. Results. Neurodevelopmental disorders were diagnosed in 33 (53 %) of 62 children with cyanotic CHD: in group 1 — in 29 % of cases and in group 2 — in 24 %. These groups were statistically homogeneous in terms of gestational age (p = 0.492) and body weight at birth, with no significant difference from the control group. Older age is characterized mainly by delays in the stages of motor development (16 % in group 1 and 15 % in group 2) and speech disorders (7 % in group 1 and 3 % in group 2). Acute disorders of cerebral circulation (6 % in group 2) and the presence of epileptic seizures (up to 3 %) were characteristic of children under 1 year. Apgar score was lower in patients with critical cyanotic CHD with neurodevelopmental delay and a longer duration of artificial circulation during surgical treatment. Conclusions. 1. Neurological disorders were diagnosed in 53 % of patients with cyanotic heart defects: in 29 % with critical heart defects and 24 % with non-critical heart defects. 2. Older children are characterized mainly by delays in the stages of motor development and speech disorders. Behavioral disorders are more typical for children with non-critical CHD. Acute disorders of cerebral circulation and the presence of epileptic seizures were characteristic of children under 1 year of age. 3. The influence of body weight and gestational age on neurodevelopmental disorders is excluded. The severe state of children with neurodevelopmental delay at birth and an increase in the duration of artificial circulation during surgical treatment were found. 4. Interdisciplinary examination of patients with cyanotic heart defects, including examination by a pediatric neurologist, as well as a follow-up is necessary for timely referral to the next stages of rehabilitation.

Operations for increasing the pulmonary blood flow in newborns with cyanotic congenital heart defects: results and features of outpatient postoperative monitoring

Background. In patients with cyanotic congenital heart defects, pulmonary blood flow is maintained by a functio­ning patent ductus arteriosus (PDA). Most patients with complex ductal-dependent cyanotic defects require intermediate staged treatment before radical correction of the defect. Timely and comprehensive outpatient monitoring by a pediatrician and pediatric cardiologist are important for patient survival following palliative treatment, along with determining optimal timing for consultations at specialized cardiac surgical centers. Objective: to present the outcomes of using two methods for increasing pulmonary blood flow (systemic-to-pulmonary artery shunt (SPAS) and PDA sten­ting), as well as the features of outpatient cardiological observation and treatment in these patients. Materials and methods. From 2000 to February 2024, 22 patients underwent SPAS, and 25 — PDA stenting at the State Institution “Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery” of the Ministry of Health of Ukraine. Results. After interventions, the mean arterial oxygen saturation (SatO2) increased in both groups, significantly higher in the PDA stenting group (p < 0.05). The ave­rage length of stay in the intensive care unit in the SPAS group was 19.6 ± 11.1 (range: 5 to 91) days compared to 12.8 ± 6.3 (range: 4 to 37) days in those with PDA stenting (p = 0.05). The duration of artificial lung ventilation in the SPAS group was 290.3 ± 215.3 (range: 63 to 751) hours, and in the PDA stenting group, it was shorter, 151.8 ± 75.5 (range: 39 to 549) hours (p < 0.05). Early (30-day) postoperative mortality in the SPAS group was 13.6 % (3/22 patients), with a late mortality of 18 % (4/22). In contrast, there was not early (30-day) postoperative mortality in the PDA stenting group, and late mortality was 8 % (2/25). Before the subsequent stage of surgical correction, sufficient growth of pulmonary artery branches was noted (Nakata index increased from 156.9 ± 33.3 mm2/m2 to 277.0 ± 35.9 mm2/m2 in the SPAS group and from 142.7 ± 55.2 mm2/m2 to 289.1 ± 149.2 mm2/m2 in the PDA stenting group), and the left ventricular end-diastolic index has increased (from 51.2 ± 32.4 mm2/m2 to 67.5 ± 15.5 mm2/m2 in the SPAS group and from 50.8 ± 24.9 mm2/m2 to 56.7 ± 28.5 mm2/m2 in the PDA stenting group). Thirteen patients in the SPAS group underwent the next stage of surgical correction (Glenn shunt or total repair of the congenital heart defect), while in the PDA stenting group — 17 patients. Conclusions. For cyanotic congenital heart defects, which have ductus-dependent pulmonary blood flow, both described methods are quite effective.

How to diagnose macrophage activation syndrome early: own experience of the Department of Paediatric Cardiology and Rheumatology in Lodz

How to diagnose macrophage activation syndrome early: own experience of the Department of Paediatric Cardiology and Rheumatology in Lodz

Generalized infantile arterial calcification in the practice of a pediatric cardiologist

Generalized infantile arterial calcification in the practice of a pediatric cardiologist

Prevalence, Management, and Outcomes of Atrial Fibrillation in Paediatric Patients: Insights from a Tertiary Cardiology Centre.

Background and Objectives: Atrial fibrillation (AF) is increasingly recognised in paediatric patients, presenting unique challenges in management due to its association with various underlying heart conditions. This study aimed to evaluate the prevalence, management strategies, and outcomes of AF in this population. Materials and Methods: A retrospective analysis was conducted at a tertiary paediatric cardiology centre, including patients aged ≤18 years diagnosed with AF between January 2015 and December 2023. The study focused on demographic details, clinical presentations, treatments, and outcomes. Descriptive statistics were employed to assess treatment efficacy, recurrence rates, and complications. Results: The study included 36 paediatric patients (median age: 15 years, IQR: 13-17; 58% male). Of these, 52.8% had acquired heart disease, 16.7% had congenital heart anomalies, and 16.7% presented with lone AF. The initial management strategies involved electrical cardioversion in 53.3% of patients and pharmacological conversion with amiodarone in 46.7%. Rhythm control therapy was administered to over 80% of the cohort, and 63.9% were placed on oral anticoagulation, predominantly for rheumatic and congenital heart diseases. The overall success rate of rhythm control was 96.2%, with an AF recurrence rate of 3.8%. Ischemic stroke was the most common complication, occurring in three patients, all with underlying rheumatic heart disease. Conclusions: AF in paediatric patients is predominantly associated with rheumatic and congenital heart diseases, though a significant proportion of patients present with lone AF. Despite effective rhythm control in most cases, neurological complications, particularly ischemic strokes in patients with underlying heart disease, remain a critical concern. These findings underscore the need for more comprehensive studies to better understand the aetiology, risk factors, and optimal management strategies for paediatric AF.

Management of aortic disease in children with FBN1-related Marfan syndrome.

Marfan syndrome (MFS) is a hereditary connective tissue disorder with an estimated prevalence of 1:5000-1:10 000 individuals. It is a pleiotropic disease characterized by specific ocular, cardiovascular, and skeletal features. The most common cardiovascular complication is aortic root dilatation which untreated can lead to life-threatening aortic root dissection, mainly occurring in adult patients. Prompt diagnosis, appropriate follow-up, and timely treatment can prevent aortic events. Currently there are no specific recommendations for treatment of children with MFS, and management is greatly based on adult guidelines. Furthermore, due to the scarcity of studies including children, there is a lack of uniform treatment across different centres. This consensus document aims at bridging these gaps of knowledge. This work is a joint collaboration between the paediatric subgroup of the European Network of Vascular Diseases (VASCERN, Heritable Thoracic Aortic Disease Working Group) and the Association for European Paediatric and Congenital Cardiology (AEPC). A group of experts from 12 different centres and 8 different countries participated in this effort. This document reviews four main subjects, namely, (i) imaging of the aorta at diagnosis and follow-up, (ii) recommendations on medical treatment, (iii) recommendations on surgical treatment, and (iv) recommendations on sport participation.

Use of ultrasound for vascular access during cardiac catheterisation in children with congenital heart disease: a Swiss multicentre cohort study.

Our study aimed to assess the first-attempt success rate of ultrasound (US) and anatomical landmark (ALM) guidance for vascular cannulation in children with congenital heart disease in Switzerland. A prospective observational multicentre study was conducted from January 2022 to January 2023 in three university hospitals in Switzerland. We included patients with congenital heart disease aged 0 to 18 years who were scheduled for elective cardiac catheterisation. Periprocedural data were collected anonymously. The choice of vessel and guidance technique were at the operator's discretion. 177 arterial and 240 venous cannulations in 253 patients were analysed. The median age and weight were 4.4 years (interquartile range [IQR] 1.2-8.8) and 15 kg (IQR 8-27), respectively. Nearly all operators, 97.5%, were deemed experienced. The femoral artery and femoral vein were the most preferred vessels. US guidance was used in 62% of procedures, predominantly within populations who were younger, smaller and of lower weight.The success rate at the first attempt was notably higher with US guidance for arterial cannulation (US: 80%, ALM: 37%, p <0.001) and venous cannulation (US: 78% vs ALM: 47%, p <0.001). Overall success rates for venous and arterial cannulation were comparable between ultrasound and anatomical landmark guidance. A total of 45 complications (10.5%) occurred, with immediate uncomplicated haematoma being the most frequent. US guidance is preferred for the localisation and cannulation of vessels during cardiac catheterisation within paediatric cardiology departments in Switzerland. Given its high success rate for first-attempt cannulation, US warrants additional research to evaluate its potential in reducing complications.

ADVANCES IN DIAGNOSIS AND TREATMENT OF CONGENITAL HEART DISEASE: A COMPREHENSIVE REVIEW

The purpose of this article is to provide a comprehensive review of recent advances in the diagnosis and treatment of congenital heart disease (CHD). CHD, which affects about 1% of live births worldwide, is still a major problem in pediatric cardiology. The most prevalent congenital cardiac defects—Ventricular Septal Defect (VSD), Tetralogy of Fallot (TOF), Coronary Artery Fistula, Coarctation of the Aorta (CoA), Aortic and Pulmonary Stenosis, Valve Insufficiency, Double Outlet Right Ventricle (DORV), Ebstein Anomaly, Transposition of the Great Arteries (TGA), Anomalous Venous Return, and Hypoplastic Left Heart Syndrome (HLHS) are all thoroughly examined in this review. The review examines current diagnostic and treatment strategies, highlighting the benefits, drawbacks, sensitivity, and specificity of several imaging modalities, including as CT, MRI, and echocardiography. It also discusses the historical evolution of treatment outcomes, emphasizing the tremendous advances in patient care and surgical procedures that have significantly mproved survival rates and quality of life for CHD patients.

Gender Distribution in Paediatric Cardiology Training Programs in Canada

BackgroundDespite female medical students being the majority, there are certain medical specialities that continue to have a prevalence of male trainees, such as adult cardiology. The purpose of this study is to examine gender distribution within Canadian paediatric cardiology training programs. MethodsBoth application and successful matches to core paediatric residency programs and paediatric cardiology programs were obtained through the Canadian Resident Matching Service. Analysis was performed to determine if the association between gender of paediatric residents and paediatric cardiology applicants/fellows was significant. ResultsBetween 2016 and 2024, 12% (n = 3/26) of individuals who successfully matched into a Canadian paediatric cardiology training program identified as female and 88% (n = 23/26) identified as male. Between 2013 and 2023, 78% (n = 947/1220) of individuals who successfully matched into a Canadian paediatrics residency identified as female and 22% (n = 273/1220) identified as male. There was a statistically significant difference between the gender of paediatric residents and the gender of paediatric cardiology residents (P < 0.0001). There was no significant association between applicant gender and match outcome within paediatric cardiology training programs (P < 0.23). ConclusionsThere is a gender discrepancy within Canadian paediatric cardiology training programs with a predominance of male trainees in the recent era. It appears that female under-representation in the field is due to the low number of female applicants. Although limited by sample size, there was no clear association between applicant gender and success of admission to a paediatric cardiology training program.

How does Regular Exercise Improve Cardiovascular Function: Congenital Heart Disease and Beyond

Major advances in the fields of paediatric cardiology and cardiac surgery over the last decades have dramatically improved the survival of patients with congenital heart disease (CHD). Thus, care for CHD patients has shifted from managing short-term survival to having the best possible outcome in terms of long-term physical health, development and well-being. In this article, with a special focus on adult CHD (ACHD) population, we address the question: How does regular exercise improve cardiovascular function? We aim to underscore that regular exercise not only offers clinically relevant physiological benefits for patients living with a CHD condition but has also a positive effect on reducing the risk of future cardiovascular events.

Serum Albumin and Its Influence on Immediate Outcomes in Children with Congenital Heart Disease Undergoing Cardiac Surgery

Background: Hypoalbuminemia is associated with morbidity and mortality in critically ill children and is a well-recognized predictor of general surgical risk. It frequently occurs in patients with congenital heart disease (CHD). Moreover, cardiopulmonary bypass (CPB)-induces an inflammatory response, and the overall surgical stress can affect albumin concentration greatly Objective: To estimate pre-operative, per-operative and post-operative serum albumin level and to see its influence on immediate outcomes in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass Methods: This cross-sectional observational study was conducted in Paediatric cardiology department, BSMMU in a view to find out the influence of pre-operative, per-operative and post-operative serum albumin level on immediate outcomes in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass(CPB).The study included total 48 patients of CHD who underwent CPB. Patients were selected according to inclusion and exclusion criteria. Result: Mean pre-operative serum albumin was 3.5±0.9 mg/dl whereas per-operative and post-operative serum albumin was 3.3±0.7mg/dl and 3.1±0.7 mg/dl respectively.CPB time was a bit higher in study population (98.4± 29.1min) where as other outcome parameters were within normal range. Duration of hospital stay was 12.2±3.1days. 22 patient (45.8%) developed valvular regurgitation and 6 patient (12.5%) developed pericardial effusion in post-operative echocardiography. Infection was evident by positive blood culture in 7 patients (14.8%). Pre, per and post-operative hypoalbuminaemia was associated with poor outcome after CPB. Conclusion: Pre, per and post-operative hypoalbuminaemia is a prudent indicator for speculating poor immediate outcome following CPB in children with CHD. (Bangladesh Heart Journal 2024; 39(2): 121-126

The state of pediatric cardiology and infant mortality in the subjects of the Russian Federation in 2022

The state of pediatric cardiology and infant mortality in the subjects of the Russian Federation in 2022

Comparative transcatheter occlusion of patent ductus arteriosus: multicenter collaborative study across pediatric and veterinary cardiology centers

Introduction/ObjectiveTranscatheter therapeutics have revolutionized treatment of patent ductus arteriosus (PDA). Greater understanding of corrective interventions across species can advance best practices, protocols, and outcomes while minimizing adverse events. The objective of this study was to describe characteristics and outcomes in children and dogs undergoing transcatheter PDA occlusion. Animals, Materials and MethodsThis was a multicenter, retrospective cohort study from two pediatric and three veterinary centers. Demographics, procedural characteristics, and outcomes were assessed. ResultsData included 202 children and 106 dogs treated from July 2019 to June 2021. Forty-five (23%) children and 19 (18%) dogs had congestive heart failure prior to catheterization. Transvenous and transarterial approaches for deployment were most used in children and dogs, respectively. All children had percutaneous vascular access compared to 17 (16%) dogs. Intraprocedural anticoagulation was standard for children (100% of 165 reported), but not for dogs (2/103). The median (interquartile range) pulmonary ostium diameter in children was 2.2 mm (1.5–3.0 mm) and 3.0 mm (2.0–4.2 mm) in dogs when all body sizes were considered (P<0.001). Amplatzer™ Duct Occluder was most commonly used in children (64/202, 32%); the Amplatz® Canine Duct Occluder was used in dogs (96/100, 96%). Closure was manual compression in all children, whereas vessel ligation was most used in dogs (74/104, 73%). Successful device deployment was achieved in 197 (98%) children and 98 (93%) dogs (P=0.03). Major reasons for failure included device embolization in six (2.9%) children and PDA morphology concerns in four (3.8%) dogs. ConclusionsTranscatheter PDA occlusion is successful in children and dogs. Study data might be useful for optimizing transcatheter therapeutics and animal models for interventional cardiology.

Outcome of Early and Late Onset Fontan Operation in Patients with Univentricular Heart Repair

Objective: To determine the outcome of early and late-onset Fontan operation in patients with univentricular heart repair. Study Design: Quasi-experimental study. Place and Duration of the Study: Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi Pakistan, from Jan 2019 to Dec 2021. Methodology: During the study period, 121 patients of both genders, up to any age, with functionally univentricular hearts and who planned to undergo Fontan procedures were included. All cases were divided into two groups, Group-A had patients who underwent extra-cardiac Fontan at age ≤6 years, while Group B had patients who underwent extra-cardiac Fontan at age &gt;6 years. Pre-procedure diagnosis, demographic, anatomic and hemodynamic characteristics, post-Fontan procedure morbidity and mortality were noted. Results: As per inclusion/exclusion criteria, 121 cases underwent Fontan surgery during the study period. There were 61(50.4%) male patients. Overall, the mean age was 7.02±4.6 years. Seventy-six 76(61.2%) cases were in Group-A and 45(38.8%) in Group-B. Mortality (within 30 days post-surgery) was reported in 11(9.1%) patients. Except for the mean duration of chest tube drainage ((0.010), there was no difference in terms of post-Fontan surgery outcomes between both study groups (p&gt;0.05). Conclusion: The age of the patients at the time of the Fontan procedure did not affect the outcomes.

Changes of oxidative stress in 3D film to be prepared for echocardiography: A randomized controlled study.

Echocardiography (ECHO) is a nonprocedure that causes acute stress in children. Fear, anxiety, and fluctuations in children's blood pressure and heart rate can potentially lead to alterations in echocardiographic measurements. The insufficient research on virtual reality pediatric preparation applications, particularly in the context of echocardiographic procedures, underscores the necessity for additional studies focusing on pediatric patients. This study sought to assess the impact of virtual reality applications tailored explicitly for ECHO on children's oxidative stress levels. This was a prospective, randomized, controlled experimental study. Forty-eight children (experimental/24, control/24) aged 7 to 12 years who had an ECHO appointment in the pediatric cardiology outpatient clinic in the 3 months from June to August 2019 participated in the study. Participants whose blood analyses showed hemolysis were eliminated, and the study was completed with 37 children in total: 16 children in the experiment and 21 children in the control. Post hoc power analysis was performed for sample adequacy, and the power of the study was found to be 0.99. A 3D film was prepared for the research and applied to the experimental group before the procedure. All children's oxidative stress levels (cortisol, malondialdehyde, nitric oxide) and glutathione levels were checked after ECHO. The stress hormone cortisol and malondialdehyde levels were lower in the 3D-applied experimental group than in the control group. As another crucial anti-stress antioxidant factor, glutathione level increased in the experimental group compared to the control group (P < .05). The research revealed that the 3D film used to prepare ECHO reduces the stress parameters associated with heart risk and may affect the ECHO measurements. At the same time, the study also proved the positive effect of 3D film preparation by increasing the anti-stress factor.

Navigating Pediatric Cor Pulmonale: A Comprehensive Review of Diagnosis and Management.

Pediatric cor pulmonale, characterized by right ventricular dysfunction due to chronic pulmonary hypertension, presents significant diagnostic and management challenges. This comprehensive review delves into this complex condition's etiology, clinical presentation, diagnostic strategies, and management. Key etiological factors include congenital heart defects, chronic lung diseases, and pulmonary vascular disorders. Early diagnosis, facilitated by imaging, hemodynamic assessments, and laboratory investigations, is crucial for effective intervention. Pediatric cor pulmonale management encompasses pharmacological treatments, such as vasodilators, diuretics, and inotropic agents, and non-pharmacological interventions, including oxygen therapy, mechanical ventilation, and surgical options. Long-term follow-up is essential to monitor disease progression and adjust treatment strategies accordingly. Multidisciplinary care involving pediatric cardiologists, pulmonologists, and critical care specialists is paramount to address the multifaceted needs of these patients. The review highlights the importance of early recognition and comprehensive care, offering insights into current best practices and future research and clinical practice directions. Advances in understanding the pathophysiology of pediatric cor pulmonale and emerging therapies promise to improve patient outcomes, underscoring the need for continued collaboration and innovation in this field.

Echocardiographic strain imaging in the pediatric heart: clinical value and utility in decision making.

Speckle tracking echocardiography (STE)-derived measures of myocardial mechanics, referred to herewithin as strain measurements, directly assess myocardial contractility and provide a nuanced assessment of ventricular function. This review provides an overview of strain measurements and their current clinical value and utility in decision making in pediatric cardiology. Strain measurements are advancing understanding of how cardiac dysfunction occurs in children with acquired and congenital heart disease (CHD). Global strain measurements can detect early changes in cardiac function and are reliable methods of serially monitoring systolic function in children. Global strain measurements are increasingly reported in echocardiographic assessment of ventricular function alongside ejection fraction. Research is increasingly focused on how strain measurements can help improve clinical management, risk stratification, and prognostic insight. Although more research is needed, preliminary studies provide hope that there will be clinical benefit for strain in pediatric cardiology management. Strain measurements provide a more detailed assessment of ventricular function than conventional measures of echocardiographic functional assessment. Strain measurements are increasingly being used to advance understanding of normal and abnormal myocardial contractility, to increase sensitivity to detect early cardiac dysfunction, and to improve prognostic management in children with acquired and CHD.

Role of new generation implantable loop recorders in managing undiagnosed pediatric cardiac symptoms

Pediatric cardiac symptoms such as palpitations, syncope, or seizure-like episodes pose diagnostic challenges for general pediatricians. These symptoms, though often benign, may reveal underlying arrhythmias or inherited cardiac conditions (ICCs), affecting the quality of life and limiting activity participation. The purpose of this study is to determine the effectiveness and safety of implantable loop recorders (ILRs) in diagnosing and managing arrhythmias in pediatric patients. A retrospective cohort study conducted over an 8-year period from January 2016 to December 2023 in a single pediatric cardiology center. A cohort of 155 pediatric patients (median age 11.4 years) who underwent ILR implantation were selected based on symptoms such as palpitations, chest pain, or syncope, and those with previously recorded arrhythmias or high-risk ICCs. The primary outcomes were the diagnostic yield of ILRs for arrhythmias and subsequent changes in patient management. Diagnostic yield was defined as the detection of relevant arrhythmias, such as pauses of 3 s or longer, high-degree AV block, sinus node dysfunction, supraventricular tachycardia, ventricular tachycardia, or inappropriate sinus tachycardia. The median follow-up period was 2.3 years (845 days). Diagnostic arrhythmias were recorded in 60% of patients with symptom-activated transmissions and 80% of device-activated transmissions. Sinus pauses (37.5%) and VT (30%) were the most common arrhythmias detected. In patients with syncope (n = 76), 30% had relevant arrhythmias. In the palpitations group (n = 20), 35% had relevant arrhythmias. Approximately 80% of patients with ILR-diagnosed arrhythmias underwent targeted management, including medication changes and additional procedures. No significant complications were observed; minor complications occurred in 2.5% of patients.Conclusions: New generation ILRs are effective and safe for diagnosing and managing pediatric arrhythmias, providing significant reassurance to patients and families. Further studies are needed to evaluate the impact of ILRs on quality of life and sports participation in high-risk young patients.What is Known:• Pediatric Cardiac Symptoms: Symptoms like palpitations, syncope, and seizure-like episodes in pediatric patients pose significant diagnostic challenges.• Diagnostic Tools: Traditional diagnostic tools such as ECG, Holter monitors, and external loop recorders often have low diagnostic yields due to the sporadic nature of symptoms.• Implantable Loop Recorders (ILRs): ILRs have been shown to improve the diagnostic yield for arrhythmias in adults and provide long-term rhythm monitoring.What is New:• Effectiveness in Pediatrics: This study demonstrates that new generation ILRs significantly enhance the diagnostic yield for arrhythmias in pediatric patients with undiagnosed cardiac symptoms.• Safety and Efficacy: The study confirms that ILRs are both safe and effective in the pediatric population, with minimal complications and high diagnostic accuracy.• Targeted Management: Findings show that ILR-diagnosed arrhythmias lead to targeted management changes in approximately 80% of cases, including medication adjustments and additional procedures.• Long-term Monitoring: ILRs provide continuous long-term monitoring, offering reassurance to patients and families, and potentially improving quality of life and participation in activities for high-risk young patients.

Which factors affect post-transfer gaps in follow-up care? A qualitative study of the insights of healthcare providers in Sweden and Belgium

BackgroundYoung people with congenital heart disease (CHD) are frequently affected by discontinued follow-up when transferring from paediatric to adult care. Identified predictors for discontinuation include mostly patient-related factors, and further...