Types Of Congenital Heart Disease Research Articles

Association of nurse–mother partnerships with parenting stress and family resilience among South Korean mothers of children with congenital heart disease

PurposeAdvances in the management of congenital heart disease (CHD) have significantly decreased mortality rates, indicating a need for continuous care as a chronic condition throughout the child's lifespan. This study examined the association of nurse–mother partnerships with parenting stress and family resilience among South Korean mothers of children with CHD. Design and methodsThis descriptive study involved 93 mothers of children aged six years or younger with CHD admitted to a hospital. Data were collected from September to November 2020 and analyzed using SPSS/WIN (version 29.0) for t-tests, analyses of variance, Pearson's correlation coefficient, and multiple regression analyses. ResultsThe means and standard deviations of the nurse–mother partnership, parenting stress, and family resilience were 4.13 ± 0.47, 76.98 ± 16.6, and 56.54 ± 7.86 points, respectively. Parenting stress increased as the number of hospitalizations and surgeries increased and with complex types of CHD. Nurse–mother partnerships were stronger with longer hospital stays. Family resilience was higher with younger children, fewer rehospitalizations, and shorter hospital stays. A positive correlation was found between nurse–mother partnerships and family resilience, and a negative correlation between parenting stress and family resilience. Factors influencing parenting stress included family resilience, rehospitalizations, and complex types of CHD, and those affecting family resilience were nurse–mother partnerships, parenting stress, and the child's age. ConclusionNurse–mother partnerships significantly affect family resilience. Practical implicationsEnhancing nurse–mother partnerships can improve family resilience, which in turn can reduce parenting stress, thus offering guidance for future nursing interventions.

Noninvasive Tools to Predict Necrotizing Enterocolitis in Infants with Congenital Heart Diseases: A Narrative Review

Background: Necrotizing enterocolitis (NEC) is the most frightening gastrointestinal emergency in newborns. Despite being primarily a disease of premature infants, neonates with congenital heart disease (CHD) are at increased risk of development. Acute and chronic hemodynamic changes in this population may lead to mesenteric circulatory insufficiency. Objectives: In this narrative review, we describe monitoring tools, alone or in multimodal use, that may help in the early recognition of patients with CHD at major risk of NEC development. Methods: We focused on vital parameters, echocardiography, Doppler flowmetry, abdominal near-infrared spectroscopy (aNIRS), and abdominal ultrasound (aUS). Results: The number of studies on this topic is small and includes a wide range of patients’ ages and types of CHD. Peripheral oxygen saturation (SpO2) and certain echocardiographic indices (antegrade and retrograde velocity time integral, cardiac output, etc.) do not seem to differentiate infants with further onset of NEC from those not developing it. Hypotensive events, persistent diastolic flow reversal in the descending aorta, and low mesenteric oxygen saturation (rsSO2) measured by aNIRS appear to occur more frequently in infants who later develop NEC. aUS may be helpful in the diagnosis of cardiac NEC, potentially showing air contrast tracked to the right atrium in the presence of pneumatosis. Conclusions: This narrative review describes the current knowledge on bedside tools for the early prediction of cardiac NEC. Future research needs to further explore the use of easy-to-learn, reproducible instruments to assist patient status and monitor patient trends.

Early Detection of Congenital Heart Diseases among Infants Using Artificial Neural Network Algorithm

Congenital Heart Disease (CHD) detection has continued to witness a consistent increase in research attention. CHD diseases are vast and also span across diverse demographics, without sparing pregnant women, unborn babies, or newly born babies. The aim of this study is to develop a detection model capable of detecting heart disease among infants with high accuracy and to also suggest solutions to manage it. To achieve this, the CHD types were identified to develop a data model that considered infants. The data model was processed through imputation, feature selection, and transformation using the imputation method and Principal Component Analysis (PCA). After the data processing stage, Artificial Neural Network (ANN) algorithm is adopted and trained with the data to generate the model for the detection of the CHD. Comparative analysis was used to evaluate the performance of the models in comparison with other models adopted in other works, considering metrics that defined the success of the detection models. The results showed that the ANN has the best detection outcome with an accuracy of 97.44%. Although the use of Logistic Regression algorithm attained a high level of performance with an accuracy of 95.00%, but it still falls below the proposed ANN algorithm. Another highly performing algorithm is the use of Extreme Gradient Boosting (XGB) which achieved an accuracy of 92.00%.

Fetal Cardiovascular Magnetic Resonance Feature Tracking Myocardial Strain Analysis in Congenital Heart Disease

BackgroundCardiovascular magnetic resonance (CMR) is an emerging imaging modality for assessing anatomy and function of the fetal heart in congenital heart disease (CHD). This study aimed to evaluate myocardial strain using fetal CMR feature tracking (FT) in different subtypes of CHD. MethodsFetal CMR FT analysis was retrospectively performed on four-chamber cine images acquired with Doppler US gating at 3 Tesla. Left ventricular (LV) global longitudinal strain (GLS), LV global radial strain (GRS), LV global longitudinal systolic strain rate (SR), and right ventricular (RV) GLS were quantified using a dedicated software optimized for fetal strain analysis. Analysis was performed in normal fetuses and different CHD subtypes (d-Transposition of the great arteries (dTGA), hypoplastic left heart syndrome (HLHS), coarctation of the aorta (CoA), tetralogy of Fallot (TOF), RV-dominant atrioventricular septal defect (AVSD), and critical pulmonary stenosis or atresia (PS/PA)). Analyses of variance (ANOVA) with Tukey post-hoc test was used for group comparisons. ResultsA total of 60 fetuses were analyzed (8/60 (13%) without CHD, 52/60 (87%) with CHD). Myocardial strain was successfully assessed in 113/120 ventricles (94%). Compared to controls, LV GLS was significantly reduced in fetuses with HLHS (-18.6±2.7% vs. -6.2±5.6%; p<0.001) and RV-dominant AVSD (-18.6±2.7% vs. -7.7±5.0%; p=0.003) and higher in fetuses with CoA (-18.6±2.7% vs. -25.0±4.3%; p=0.038). LV GRS was significantly reduced in fetuses with HLHS (25.7±7.5% vs. 11.4±9.7%; p=0.024). Compared to controls, RV GRS was significantly reduced in fetuses with PS/PA (-16.1±2.8% vs. -8.3±4.2%; p=0.007). Across all strain parameters, no significant differences were present between controls and fetuses diagnosed with dTGA and TOF. ConclusionsFetal myocardial strain assessment with CMR FT in CHD is feasible. Distinct differences are present between various types of CHD, suggesting potential implications for clinical decision-making and prognostication in fetal CHD.

Hearing loss in children with congenital heart disease

Background : Congenital heart disease (CHD) is a dangerous disease, about 50% of deaths will occur in the first month of life. In developed countries almost all types of congenital heart disease have been detected in infancy even at less than 1 month of age, whereas in developing countries many are only detected after the child is older, so in some severe CHD types may have died before being detected. Rubella infection in pregnancy or congenital rubella syndrome (CRS) can cause miscarriage, fetal death, or congenital abnormalities after birth. CRS is characterized by sensorineural hearing loss (SNHL), congenital cataracts or glaucoma, congenital heart disease, and developmental delays. Purpose : This case report was submitted in order to find out how to properly treat patients with hearing loss with sensory deafness and congenital heart disease. Case : Reported a 3-year-old 6-month-old boy diagnosed with very severe degree sensorineural deafness and congenital heart disease based on anamnesis, physical examination and examination of OAE, BERA and ASSR for examination of auditory function) and echocardiography examination for examination of cardiac function. Conclusion : From the history, physical examination and examination of OAE, BERA, ASSR showed patients with very severe sensorineural hearing loss of the left and right ear and congenital heart disease, planned use of hearing aids or cochlear implantation and cardiac consul for CHD treatment.

Patterns and Complications of Congenital Heart Disease in Adolescents and Adults in Ethiopia.

Congenital heart disease (CHD) encompasses morphofunctional anomalies in the heart and circulatory system present at birth, which may not become apparent until later in life. In Ethiopia, there needs to be more understanding of the prevalence, patterns, and associated complications of CHD malformations. This study aimed to investigate the patterns and complications of CHDs among patients receiving follow-up care at a specialized university referral hospital in Ethiopia. A hospital-based cross-sectional study was conducted on 199 patients with CHDs to assess the patterns and complications of defects. Retrospective data were collected from 16,972 patients who had follow-ups at a cardiac clinic in 2021 using medical records, and a statistical analysis was performed with SPSS version 24. The most prevalent types of CHDs in our study population were atrial septal defects (ASDs) at 41.2% (82 cases), ventricular septal defects (VSDs) at 26.6% (53 cases), and patent ductus arteriosus (PDAs) at 9.5% (19 cases). Complications related to CHDs were observed in 69.3% (138) of patients, with 30.7% (61) experiencing a single complication and 39.2% (87) experiencing multiple complications. This study found a higher prevalence of CHDs in females (77.8%) compared to males, a trend consistent across various atrial and ventricular defect types. Individuals aged 15 to 25 years exhibited the highest incidence of ASD and VSD. Moreover, CHD-related anomalies were present in 69.3% of the patients studied.

Impact of postoperative necrotizing enterocolitis after neonatal cardiac surgery on neurodevelopmental outcome at 1 year of age.

We analyzed the impact of postoperative necrotizing enterocolitis (NEC) after cardiac surgery in neonatal age on neurodevelopmental (ND) outcome at 1 year of age. Using data from the Swiss Neurodevelopmental Outcome Registry for Children with Congenital Heart Disease (ORCHID), we analyzed perioperative variables including postoperative NEC (Bell's stage ≥2) and 1-year ND outcome (Bayley III). The included patients (n = 101) had congenital heart disease (CHD), categorized as follows: 77 underwent biventricular repair for CHD with two functional chambers, 22 underwent staged palliation until the Fontan procedure for CHD with single ventricle physiology (n = 22), or 4 underwent single ventricle palliation or biventricular repair for borderline CHD (n = 4). Neonatal cardiopulmonary bypass (CBP) surgery was performed at a median age (IQR) of 8 (6) days. NEC occurred in 16 patients. Intensive care unit (ICU) length of stay (LOS) and the total duration of the hospitalization were longer in children with NEC than those in others (14 with vs. 8 days without NEC, p < 0.05; 49 with vs. 32 days without NEC, p < 0.05). The Bayley III scores of the analyzed patients determined at an age of 11.5 ± 1.5 months showed cognitive (CCS) (102.2 ± 15.0) and language scores (LCS) (93.8 ± 13.1) in the normal range and motor composite scores (MCS) (88.7 ± 15.9) in the low-normal range. After adjusting for socioeconomic status and CHD type, patients with NEC had lower CCS scores [β = -11.2 (SE 5.6), p = 0.049]. Using a cumulative risk score including NEC, we found a higher risk score to be associated with both lower CCS [β = -2.8 (SE 1.3), p = 0.030] and lower MCS [β = -3.20 (SE 1.3), p = 0.016]. Postoperative NEC is associated with longer ICU and hospital LOS and contributes together with other complications to impaired ND outcome at 1 year of age. In the future, national and international patient registries may provide the opportunity to analyze large cohorts and better identify the impact of modifiable perioperative risk factors on ND outcome. ClinicalTrials.gov identifier: NCT05996211.

Effects of Aerobic Exercise on Cardiopulmonary Function in Postoperative Patients with Congenital Heart Disease: A Meta-analysis.

This meta-analysis aimed to evaluate the impact of aerobic exercise on Peak VO2 (Oxygen Consumption) in postoperative patients with congenital heart disease (CHD). Besides this, we also tried to discover whether the improvement was influenced by patient ages, modes of supervision, types of exercise, the total dose of exercise, intervention periods, and types of CHD. Following the Population Intervention Comparison Outcome Study Design (PICOS) principle, a comprehensive search of the PubMed, Web of Science, Embase and Cochrane Library databases was conducted for randomized controlled trials (RCTs) evaluating the intervention effects of aerobic exercise on cardiopulmonary function in postoperative CHD patients until December 2023. This meta-analysis and publication bias tests were conducted using Stata 17.0, and the mean differences (MDs) with 95% confidence intervals (CIs) were used as effect sizes in statistics. A total of 15 RCTs (762 cases) were included in this meta-analysis, with 407 cases in the experimental group and 355 cases in the control group. Meta-analysis showed that aerobic exercise had a positive effect on Peak VO2 in postoperative CHD patients (MD = 2.14, 95% CI (1.34, 2.94), p 0.00001, I2 = 36%). The analysis of subgroups showed that intervention effects of aerobic exercise were superior to the control group when patients were 18 years old (MD = 2.53, p 0.00001), 18 years old (MD = 1.63, p = 0.01), under supervision (MD = 2.23, p 0.00001), unsupervised (MD = 2.06, p 0.00400), performing aerobic exercise (MD = 1.87, p = 0.0003), performing aerobic exercise combined with resistance training (MD = 2.57, p 0.00010), with a total dose of exercise 1440 minutes (MD = 2.45, p 0.00010), with the intervention period of 10-12 weeks (MD = 2.31, p 0.00001), with that 12 weeks (MD = 1.97, p = 0.00300), or with mixed types of CHD (MD = 2.34, p 0.00001). This meta-analysis did not deduct points for limitations, inconsistency, indirectness, imprecision, or publication bias, so the quality of evidence was graded as high. Aerobic exercise has a significantly positive impact on improving Peak VO2 in postoperative CHD patients. Moreover, it was found that for patients aged 18 and above, supervised aerobic exercise combined with resistance training, implemented for 10-12 weeks with a total dose of exercise 1440 minutes, had a better intervention effect on Peak VO2. This finding provided evidence-based medicine for the exercise rehabilitation of postoperative CHD patients, and explored the optimal exercise prescription for clinical practice as well. Registered on INPLASY No.202440016 (https://inplasy.com).

Cardiovascular malformation associated with esophageal atresia

Abstract Background Congenital heart disease (CHD) is the commonest abnormality associated with esophageal atresia (EA). EA is a rare congenital malformation occurring in 3-4 in 10,000 births, in 87% occurs along with a distal tracheoesophageal fistula (TEF). The coexistence of a cardiac malformation and in addition, prematurity can be challenging and affects the further treatment and quality of life (QOL) of the child and family. Knowledge of the anatomical type and physiological consequences of CHD allows a well-coordinated treatment plan. Purpose The aim of this paper is to investigate whether the presence of underlying associated malformations, disease-specific problems and prematurity would have a considerable influence on the family of a child after surgical repair of EA. Methods We used a crossed-sectional questionnaire study. The impact of EA was assessed using an Authors-Designed Questionnaire (ADQ) to collect medical and sociodemographic background data (gestational week (HBD), comorbidities, type of EA, according to the Gross classification) as well as standardized questionnaire: the PedsQL™ Family Impact Module (PedsQL-FIM). Results Of the 76 children born with EA/TEF included in this study, 26% had a vascular malformation. Mean age was 5.3 years (SD = 3.7 years). Cardiovascular malformation associated with EA significantly (p=0.037) affects the functioning of the family in the emotional domain (FIM – ED). The QOL (p &amp;lt; 0,034) of children born before 37th HBD is lower that children born in term The presence of concomitant anomalies does affect the overall generic QoL. No statistical correlation was found between the type of anomaly (with/without TEF) and patients' QoL. Conclusions Cardiovascular malformation and prematurity significantly affect child’s QOL and the functioning of the family with EA. Patients who have undergone EA treatment require specialist outpatient care, not only in the first years of life, but also in adolescence and adulthood.

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options.

Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long-term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.

Epidemiology of Congenital Heart Disease in Kazakhstan: Data from the Unified National Electronic Healthcare System 2014-2021

The aim of this study was to investigate the epidemiology of congenital heart disease (CHD) in Kazakhstan, using the data from the Unified National Electronic Healthcare System (UNEHS) for the period of 2014-2021. This retrospective cohort study included all patients diagnosed with CHD in Kazakhstan and registered in the UNEHS between January 2014 and December 2021. CHDs were defined based on ICD-10 codes Q20-Q26. Incidence, prevalence, and all-cause mortality rates were calculated per 100,000 population. Survival analysis was performed using Cox proportional hazards regression modeling and Kaplan-Meier method. The cohort consisted of 68,371 CHD patients, of whom 61,285 (89.6%) had a single CHD type, 40,767 (59.6%) were diagnosed before the age of 1 year, and 5,225 (7.6%) died over the study period. Incidence of CHD decreased from 64.6 to 47.3 cases per 100,000 population in males, and from 68.7 to 42.5 cases in females between 2014 and 2020. All-cause mortality rates per 100,000 population increased from 3.3 to 4.7 cases among males, and from 2.7 to 3.7 among females between 2014 and 2020. Survival analysis showed that in patients diagnosed with CHD before 1 year of age, risk of death was significantly associated with male sex (hazard ratio [HR] 1.17), multiple CHD types (HR 1.70), and no performed surgery (HR 0.57). In patients diagnosed with CHD after 1 year of age, risk factors were male sex (HR 1.65), multiple CHD types (HR 1.55), and no performed surgery (HR 1.82).

Tachyarrhythmias in congenital heart disease.

The prevalence of congenital heart disease (CHD) in adult patients has risen with advances in diagnostic and surgical techniques. Surgical modifications and hemodynamic changes increase the susceptibility to arrhythmias, impacting morbidity and mortality rates, with arrhythmias being the leading cause of hospitalizations and sudden deaths. Patients with CHD commonly experience both supraventricular and ventricular arrhythmias, with each CHD type associated with different arrhythmia patterns. Macroreentrant atrial tachycardias, particularly cavotricuspid isthmus-dependent flutter, are frequently reported. Ventricular arrhythmias, including monomorphic ventricular tachycardia, are prevalent, especially in patients with surgical scars. Pharmacological therapy involves antiarrhythmic and anticoagulant drugs, though data are limited with potential adverse effects. Catheter ablation is preferred, demanding meticulous procedural planning due to anatomical complexity and vascular access challenges. Combining imaging techniques with electroanatomic navigation enhances outcomes. However, risk stratification for sudden death remains challenging due to anatomical variability. This article practically reviews the most common tachyarrhythmias, treatment options, and clinical management strategies for these patients.

Antenatal Screening for Congenital Heart Disease: A Single Center 11-Year Study of the Incidence, Antenatal Detection Rate, and Outcomes of Fetal Cardiac Anomalies

Abstract Objectives This article describes the incidence, detection rate, and birth outcomes of congenital heart disease (CHD) within a single center over an 11-year period. Methods A database of patients diagnosed with CHD on antenatal ultrasound or within 12 months of delivery was collated from January 2010 to December 2020. A retrospective review of records was performed to establish the incidence of CHD and the antenatal detection rate (ADR). A Fisher's exact test was used to investigate the association between the type of CHD, the presence of a genetic abnormality, extracardiac anomalies, and the ADR. Results The incidence of CHD was 4.3 per 1,000 maternities (n = 161). Fifty-five percent of anomalies were diagnosed antenatally. Twenty-seven percent underwent termination of pregnancy. Seventy-three percent of cases were alive at the end of follow-up. Patients with a major form of CHD were more likely to receive an antenatal diagnosis compared with those with other forms of CHD (64.9% vs. 39.1%, p 0.002). The presence of extracardiac abnormalities was associated with a higher ADR. Conclusion The incidence of CHD was 4.3 per 1,000 maternities. Most major cardiac anomalies were diagnosed antenatally. Detection rates varied depending on the nature of the lesion and the presence of other congenital anomalies. Implications for Clinical Practice Cardiac anomalies are the most common form of birth defect. Reported incidence rates lie between 4 and 20 per 1,000 live births. This study describes the incidence, pregnancy outcomes, and ADR of cardiac anomalies within one Scottish health board. It provides insight into the effectiveness of a national screening program in detecting CHD and the factors that influence ADR. Therefore, it can be used to more effectively counsel patients on the strengths and limitations of antenatal ultrasound for detecting CHD.

Deep learning-based differentiation of ventricular septal defect from tetralogy of Fallot in fetal echocardiography images.

Congenital heart disease (CHD) seriously affects children's health and quality of life, and early detection of CHD can reduce its impact on children's health. Tetralogy of Fallot (TOF) and ventricular septal defect (VSD) are two types of CHD that have similarities in echocardiography. However, TOF has worse diagnosis and higher morality than VSD. Accurate differentiation between VSD and TOF is highly important for administrative property treatment and improving affected factors' diagnoses. TOF and VSD were differentiated using convolutional neural network (CNN) models that classified fetal echocardiography images. We collected 105 fetal echocardiography images of TOF and 96 images of VSD. Four CNN models, namely, VGG19, ResNet50, NTS-Net, and the weakly supervised data augmentation network (WSDAN), were used to differentiate the two congenital heart diseases. The performance of these four models was compared based on sensitivity, accuracy, specificity, and AUC. VGG19 and ResNet50 performed similarly, with AUCs of 0.799 and 0.802, respectively. A superior performance was observed with NTS-Net and WSDAN specific for fine-grained image categorization tasks, with AUCs of 0.823 and 0.873, respectively. WSDAN had the best performance among all models tested. WSDAN exhibited the best performance in differentiating between TOF and VSD and is worthy of further clinical popularization.

Investigating Psychological Problems in Parents of Children With Congenital Heart Diseases: A Cross-sectional Study

Objectives: Depressive disorder is the second biggest health problem worldwide regarding disability caused by the disease. It is necessary to identify factors influencing the occurrence of depression, especially in parents whose children have an underlying disease. Accordingly, this study investigates the prevalence of depression in parents of children with congenital heart disease (CHD). Methods: This cross-sectional study was conducted in 2021-2022 via the available sampling method on 88 parents of children under 12 years old with CHD, confirmed by a pediatric cardiologist. The Beck questionnaire was used to record the level of depression. Analysis of quantitative data was done with the independent sample t-test and analysis of variance. Statistical analysis was performed in the SPSS software, version 26. Results: In this study, the mean age of the participants was 36.31±6.1 years, of which 59.1% were women. The result of the study showed that 51.1% of parents had children with CHD without depression, 22.7% had mild depression, 21.6% had moderate depression, and 4.5% had severe depression. Also, the findings of our study showed that the mean score of depression in people under 40 years old, in women, and in persons with a history of depression was significantly higher than in other people. However, the mean score of depression had no statistically significant difference based on the history of underlying disease, smoking, history of addiction, education, and type of CHD. Discussion: Depression in parents of children with CHD has a high prevalence, which requires increasing the mental healthcare of parents during the period of children’s involvement, and with proper treatment improved the mental health of parents.

Non-contrast free-breathing 2D CINE compressed SENSE T1-TFE cardiovascular MRI at 3T in sedated young children for assessment of congenital heart disease.

Cardiac MRI is a crucial tool for assessing congenital heart disease (CHD). However, its application remains challenging in young children when performed at 3T. The aim of this retrospective single center study was to compare a non-contrast free-breathing 2D CINE T1-weighted TFE-sequence with compressed sensing (FB 2D CINE CS T1-TFE) with 3D imaging for diagnostic accuracy of CHD, image quality, and vessel diameter measurements in sedated young children. FB 2D CINE CS T1-TFE was compared with a 3D non-contrast whole-heart sequence (3D WH) and 3D contrast-enhanced MR angiography (3D CE-MRA) at 3T in 37 CHD patients (20♂, 1.5±1.4 years). Two radiologists independently assessed image quality, type of CHD, and diagnostic confidence. Diameters and measures of contrast and sharpness of the aorta and pulmonary vessels were determined. A non-parametric multi-factorial approach was used to estimate diagnostic accuracy for the diagnosis of CHD. Linear mixed models were calculated to compare contrast and vessel sharpness. Krippendorff's alpha was determined to quantify vessel diameter agreement. FB 2D CINE CS T1-TFE was rated superior regarding image quality, diagnostic confidence, and diagnostic sensitivity for both intra- and extracardiac pathologies compared to 3D WH and 3D CE-MRA (all p<0.05). FB 2D CINE CS T1-TFE showed superior contrast and vessel sharpness (p<0.001) resulting in the highest proportion of measurable vessels (740/740; 100%), compared to 3D WH (530/620; 85.5%) and 3D CE-MRA (540/560; 96.4%). Regarding vessel diameter measurements, FB 2D CINE CS T1-TFE revealed the closest inter-reader agreement (Krippendorff's alpha: 0.94-0.96; 3D WH: 0.78-0.94; 3D CE-MRA: 0.76-0.93). FB 2D CINE CS T1-TFE demonstrates robustness at 3T and delivers high-quality diagnostic results to assess CHD in sedated young children. Its ability to function without contrast injection and respiratory compensation enhances ease of use and could encourage widespread adoption in clinical practice.

Maternal Gestational Diabetes Mellitus and Congenital Heart Disease in Offspring: A Meta-Analysis.

Maternal diabetes has been related to an increased risk of congenital heart disease (CHD) in offspring. However, inconsistent results were retrieved for studies evaluating the association between gestational diabetes mellitus (GDM) and CHD in offspring. We therefore performed a systematic review and meta-analysis for comprehensive investigation. Observational studies were identified by searching PubMed, Embase, and Web of Science according to the aim of the meta-analysis. A randomized-effects model was used to pool the data by incorporating the influence of potential heterogeneity. Twenty-three observational studies, involving 46953078 mother-child pairs, were available for the meta-analysis. Among them, 2131800 mothers were diagnosed as GDM and 214379 newborns had CHD. Overall, maternal GDM was associated with a higher incidence of CHD in offspring [odds ratio (OR): 1.32, 95% confidence interval (CI): 1.21 to 1.45, p<0.001; I2=62%]. Sensitivity analysis limited to studies with adjustment of maternal age and other potential confounding factors showed similar results (OR: 1.40, 95% CI: 1.30 to 1.51, p<0.001; I2=47%). Subgroup analysis suggested that the association between maternal GDM and CHD in offspring was not significantly affected by methods for diagnosis of GDM, methods for confirmation of CHD, or study quality scores (p for subgroup difference all>0.05). Subsequent analysis according to types of CHD showed that maternal GDM was associated with higher risks of atrial septal defect, ventricular septal defect, and Tetralogy of Fallot. Maternal GDM may be associated with a higher risk of CHD in offspring.

Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications.

Common to adult electrophysiology studies (EPSs), intracardiac echocardiography (ICE) use in paediatric and congenital heart disease (CHD) EPS is limited. The purpose of this study was to assess the efficacy of ICE use and incidence of associated complications in paediatric and CHD EPS. This single-centre retrospective matched cohort study reviewed EPS between 2013 and 2022. Demographics, CHD type, and EPS data were collected. Intracardiac echocardiography cases were matched 1:1 to no ICE controls to assess differences in complications, ablation success, fluoroscopy exposure, procedure duration, and arrhythmia recurrence. Cases and controls with preceding EPS within 5 years were excluded. Intracardiac echocardiography cases without an appropriate match were excluded from comparative analyses but included in the descriptive cohort. We performed univariable and multivariable logistic regression to assess associations between variables and outcomes. A total of 335 EPS were reviewed, with ICE used in 196. The median age of ICE cases was 15 [interquartile range (IQR) 12-17; range 3-47] years, and median weight 57 [IQR 45-71; range 15-134] kg. There were no ICE-related acute or post-procedural complications. There were 139 ICE cases matched to no ICE controls. Baseline demographics and anthropometrics were similar between cases and controls. Fluoroscopy exposure (P = 0.02), procedure duration (P = 0.01), and arrhythmia recurrence (P = 0.01) were significantly lower in ICE cases. Intracardiac echocardiography in paediatric and CHD ablations is safe and reduces procedure duration, fluoroscopy exposure, and arrhythmia recurrence. However, not every arrhythmia substrate requires ICE use. Thoughtful selection will ensure the judicious and strategic application of ICE to enhance outcomes.

Outlet Ventricular Septal Defect: A Case Report on the Importance of Multi-Window Sonographic Assessment

Congenital heart disease (CHD) is the existence of structural heart problems since the formation of the heart prebirth. There are different categories of CHD, all having their own unique frequency and severity characteristics. One type of CHD is a ventricular septal defect (VSD), more specifically outlet VSD. A VSD is the most common congenital heart defect; however, their presentation can be quite complex. Color and spectral Doppler transthoracic echocardiography (TTE) are valuable tools used in the diagnosis of VSDs. The often-challenging presentation of these defects requires sonographers to confirm their existence through the parasternal long-axis, parasternal short-axis, apical four chamber, apical three chamber, and apical five chamber scanning windows. Although VSDs are the most common congenital heart defect, their wide-ranging uniqueness and location along the interventricular septum (IVS) to assess all areas along the IVS on all exams, specifically those that demonstrate left-to-right shunting. The objective of this case report was to stress the importance of multi-window assessment during the sonographer’s interrogation of outlet VSDs, due to the potential implications on adjacent anatomy and the potential for surgical intervention.

High-Sensitivity Cardiac Troponin and the Management of Congenital Heart Disease in Newborns and Infants.

Early cardiac interventions in newborns and infants suspected for congenital heart disease (CHD) decrease morbidity and mortality. After updating current evidence on the use of cardiac troponins (cTn) in the context of CHD for risk stratification at early ages, we discuss relevant issues, starting from the evidence that only the measurement of the cTnT form is useful in this population. In newborns/infants with CHD, the cTnT concentration increase is correlated with: (a) cardiac stress and hemodynamic parameters, but not with the type of CHD; (b) volume overload/right ventricular pressure overload; (c) postoperative hypoperfusion injury and mortality; and (d) effects of cardioprotective strategies. For infants with CHD, high-sensitivity cTnT (hs-cTnT) concentrations >25 ng/L are an independent predictor of poor outcomes. Transitioning from cTnT to hs-cTnT in newborns/infants improves the identification of: (a) physiopathological mechanisms and factors that increased hs-cTnT early after birth; (b) myocardial injury, even when subclinical; (c) identification of patients requiring immediate therapeutic interventions; and (d) 99th percentile upper reference limits (URLs). However, no reliable URLs are currently available to allow the detection of myocardial injury associated with CHD in newborns/infants. Additional data evaluating the clinical value of hs-cTnT in the risk stratification of newborns/infants with CHD who may suffer myocardial injury is needed. Validating the measurement, possibly in amniotic fluid samples, and improving the interpretation of hs-cTnT concentrations in the prenatal period, at birth and within 1 year of age are crucial to change CHD mortality/morbidity trends in the pediatric population.