Al Haddad H, Choueiter N, Harahsheh AS
… +18 more, El-Segaier M, Alrabte H, Kotby A, Ladj MS, Abu Shukair M, Agha H, Alsenaidi K, Alzyoud R, Benali Khoudja N, Bouayed K, El Ganzoury M, El Sayed MH, Madany M, Nadder M, Rugige N, Abed MY, Abu Al-Saoud SY, Dahdah N
Kawasaki disease (KD) carries a favorable prognosis with timely diagnosis and treatment, yet fatal events still occur. Data on KD-related mortality in Arab countries and how patterns may have shifted since COVID-19 are u...Kawasaki disease (KD) carries a favorable prognosis with timely diagnosis and treatment, yet fatal events still occur. Data on KD-related mortality in Arab countries and how patterns may have shifted since COVID-19 are unreported. We aimed to describe clinician-recalled KD-related deaths in Arab countries before and after the COVID-19 pandemic and to characterize the timing and reasons of death. The survey invited participation from all clinicians within the collaborating centers, allowing inclusion of respondents both with and without experience managing KD-related fatalities. The Kawasaki disease Arab initiative (KAWARABI) conducted a cross-sectional descriptive survey to assess the extent and circumstances of KD-related mortality across Arab countries. The survey was distributed to KAWARABI institutions and covered the period from 1990 to 2024. Seventeen clinicians from eight Arab countries completed the survey. One-third reported KD-related deaths before the pandemic and more than half did afterwards. Across both pre- and post-COVID periods, reported deaths most commonly occurred during acute disease hospitalization or within the first three months following initial KD diagnosis. Reported patterns of death reflected distinct clinical contexts in both periods. Year-by-year responses suggested a peak in (2020–2021) with a regressive trend from 2022. Most respondents indicated that autopsy is performed only when legally mandated. KD related mortality in Arab countries is rare but appeared higher during the COVID-19 pandemic. This increase may reflect diagnostic overlap between KD and MIS-C, as well as limited availability of advanced cardiac life support therapies in some Arab countries. Strengthening regional collaboration, developing prospective registries, and enhancing knowledge-sharing may help improve KD care pathways.
The advent of partial heart transplant (PHT) of living valves necessitates robust measures of valve growth. Traditional measurement of aortic valve annular dimension can be confounded by cardiac dilation and does not eva...The advent of partial heart transplant (PHT) of living valves necessitates robust measures of valve growth. Traditional measurement of aortic valve annular dimension can be confounded by cardiac dilation and does not evaluate the growth of aortic valve leaflets. Measurement of valve leaflet length growth over time has not been studied. We conducted a retrospective cohort study of 12 infants post–orthotopic heart transplant (OHT) and 12 infants with ventricular septal defects (VSDs) with ≥ 5 years of serial echocardiographic data. Leaflet length and annular dimension were measured, and inter-rater reliability assessed. Aortic leaflet length demonstrated good inter-rater reliability and consistent growth over time. Leaflet length is a reliable, feasible, and theoretically dilation-independent measure of semilunar valve growth and may improve longitudinal assessment in patients undergoing PHT.
Care of children with single ventricle anatomy has advanced, leading to improved survival, however, mortality remains high. By understanding the end-of-life trajectory for these children, we aim to identify ways to optim...Care of children with single ventricle anatomy has advanced, leading to improved survival, however, mortality remains high. By understanding the end-of-life trajectory for these children, we aim to identify ways to optimize their care. This retrospective review was conducted for children with complex congenital heart disease following a single-ventricle surgical pathway who underwent at least second stage palliative surgery [N = 20 (< 18 years)], between 2010 and 2023 at a single institution. Descriptive statistics are presented as median (range) for continuous variables and as frequencies and percentages for categorical variables. Median age at death was 3.1 years (4 months-16.7 years). Eighteen deaths (90%) occurred in the intensive care unit (ICU). During the final year of life, children spent a median of 122 days (8-254) in hospital. Death occurred following withdrawal of life-sustaining therapies in 13 (65%) children, non-escalation in 6 (30%) children, and failed resuscitation in 1 (5%) child. Palliative care was consulted for 13 children (65%), a median of 68 days (2-470) before death. In the last week of life, children experienced a median of five symptoms (3-12), most commonly pain (95%), anxiety/agitation (95%), respiratory distress (65%), and edema (65%). Children with single-ventricle anatomy experience a high symptom burden, with most dying in ICU following withdrawal of life-sustaining therapies. While palliative care was frequently utilized, its timing varied. Understanding these patterns can improve symptom management, optimize palliative care integration, and enhance support for children and families.
ECG is the most used tools in cardiology. Some life-threatening arrhythmias and cardiac abnormalities can be diagnosed with ECG. The aim is to assess the role of ECG for the detection of cardiac disease in children, from...ECG is the most used tools in cardiology. Some life-threatening arrhythmias and cardiac abnormalities can be diagnosed with ECG. The aim is to assess the role of ECG for the detection of cardiac disease in children, from September 2014 to January 2020, ECG was performed in 52 primary school in Como. 5793 children (49.4% female) aged 8.1 (± 1.3) years had an ECG; 79 (1.3%) were abnormal due to the following findings: 34 (43%) right bundle branch block (RBBB), 9 (11%) abnormal ventricular repolarization, 7 (9%) long QT, 7 atrio-ventricular block (AVB), 7 (9%) accessory pathway, 5 (5%) premature ventricular beat, 5 (5%) anterior hemiblock, 4 (5%) left ventricular hypertrophy, 1 (2%) ST alteration. Long QT syndrome was excluded in all children with long QT. Among those with RBBB, 2 had severe inter-atrial septal defect (one underwent to closure), while one had moderate mitral valve regurgitation and bicuspid aortic, and 2 had moderate mitral regurgitation. One child with AVB had pacemaker implantation. One child with accessory pathway had Wolf-Parkinson syndrome and undergone to catheter ablation. Among apparently healthy children, ECG may be useful to detect cardiac disease with potential consequence in the adulthood.
Fetal pleural effusion is most commonly associated with lymphatic abnormalities such as congenital chylothorax or fetal heart failure, with obstruction of the systemic venous return representing a particularly rare and u...Fetal pleural effusion is most commonly associated with lymphatic abnormalities such as congenital chylothorax or fetal heart failure, with obstruction of the systemic venous return representing a particularly rare and underrecognized cause. Herein, we report the case of a neonate with fetal pleural effusion caused by cor triatriatum dexter, in whom superior vena cava syndrome developed and progressed after birth. The infant was delivered at 33 weeks of gestation because of premature rupture of membranes, with a birth weight of 1.9 kg. The patient’s pleural effusion and upper-body edema worsened shortly after birth as a result of fixed intracardiac venous obstruction. We propose that obstruction of the SVC by a persistent right atrial membrane elevated central venous and thoracic duct pressures, ultimately leading to refractory chylothorax. At 61 days of life, when body weight reached 3.1 kg, surgical resection of the right atrial membrane with enlargement of the superior and inferior vena cava vessels was performed. Because of mild right ventricular hypoplasia, the atrial septal defect was initially partially closed during surgery; however, persistent systemic venous congestion after the operation necessitated balloon atrial septostomy to enlarge the interatrial communication. Pleural effusion and edema resolved completely. This case highlights the fact that systemic venous obstruction caused by cor triatriatum dexter represents a rare but important cause of refractory fetal pleural effusion of which clinicians should remain aware.
Emery-Dreifuss muscular dystrophy is an inherited myopathy which can cause forms of tachycardia and bradycardia. We present a complex case of a patient with multiple flutter and intra-atrial re-entrant circuits with comp...Emery-Dreifuss muscular dystrophy is an inherited myopathy which can cause forms of tachycardia and bradycardia. We present a complex case of a patient with multiple flutter and intra-atrial re-entrant circuits with complex ablation performed. To minimize deep anesthesia risk, pulse field ablation was used with good outcome and without complication in this teenager.
Despite the growing use of social media platforms for health information, limited research has examined how individuals affected by congenital heart disease (CHD) communicate online. The aim of this study is to character...Despite the growing use of social media platforms for health information, limited research has examined how individuals affected by congenital heart disease (CHD) communicate online. The aim of this study is to characterize themes, user perspectives, sentiment, and accuracy of social media discussion related to CHD using a mixed-methods approach integrating qualitative review and natural language processing (NLP). Five hundred posts from the Reddit page r/CHD (2018–2025) were analyzed. Two independent raters performed thematic and perspective analysis. VADER (Valence Aware Dictionary and sEntiment Reasoner), an NLP tool optimized for social media text, quantified sentiment of posts. For posts that sought health advice, responses were graded for accuracy by two pediatric cardiologists. Post volume increased by 1,195% from 2018 To 2025. Mean sentiment score was 0.43 ± 0.60; 71.6% of posts were positive, 20.2% negative, and 8.2% neutral. There was no significant difference in sentiment between mild, moderate, or severe lesions; however, posts about multiple defects were significantly more positive (0.55 +/- 0.55, p = 0.017) and sentiment varied by individual diagnosis. Perspective analysis showed 39.8% of posts written by parents, 13.6% by expectant parents, 31% by CHD patients, and 1% by healthcare professionals. For posts seeking health advice, 82% of responses shared purely anecdotal experiences or deferred to clinicians, while 11% offered direct medical guidance – 67% of which were fully accurate and 29% with gross inaccuracies. These findings highlight social media as an emerging and potentially underutilized resource for understanding patient experience and information-seeking behavior in CHD.
Fontan circulation is characterized by elevated central venous pressure (CVP) and reduced preload, resulting in low perfusion pressure (PP). Maintaining adequate PP and low CVP may prevent multi-organ failure in post-Fon...Fontan circulation is characterized by elevated central venous pressure (CVP) and reduced preload, resulting in low perfusion pressure (PP). Maintaining adequate PP and low CVP may prevent multi-organ failure in post-Fontan patients. Vasodilatation, characterized by low systemic vascular resistance index (SVRI) and high cardiac index (CI), is a poor prognostic predictor. CI–SVRI plots have been proposed to visualize Fontan hemodynamics; however, direct comparisons with biventricular physiology are limited. We compared catheterization data between post-Fontan and repaired tetralogy of Fallot (TOF) patients, focusing on PP, and visualized hemodynamic differences using CI–SVRI plots. This single-center retrospective study included 45 post-Fontan patients and 28 with repaired TOF aged ≥ 18 years who underwent cardiac catheterization and cardiopulmonary exercise testing between 2017 and 2023. Patients were stratified by the percentage of normal peak oxygen uptake to account for exercise tolerance. Hemodynamic data were plotted on CI-SVRI plots. Logistic regression was used to identify independent correlates of Fontan physiology. Despite similar CI, post-Fontan patients had significantly higher CVP and lower systemic arterial pressure, resulting in lower PP and SVRI, than those with repaired TOF. These differences persisted after adjusting for similar exercise capacity. In CI-SVRI plots, patients with post-Fontan physiology occupied the lower-left area more frequently, indicating low PP and vasodilated systemic circulation. PP was independently associated with Fontan physiology after adjusting for confounding variables. Reduced PP due to systemic vasodilatation, even with a preserved CI, represents a distinct feature of Fontan physiology and may define hemodynamic targets beyond low CVP.
While numerous risk factors for poor outcomes in Fontan patients have been investigated, much remains unknown about potential predictors of clinical well-being or long-term morbidity. Additionally, accurate non-invasive...While numerous risk factors for poor outcomes in Fontan patients have been investigated, much remains unknown about potential predictors of clinical well-being or long-term morbidity. Additionally, accurate non-invasive assessment of single ventricle (SV) systolic and diastolic function has remained elusive, making it even more difficult to evaluate cardiac performance as a determinant of patient outcome. Our study aimed to evaluate the relationship between SV longitudinal strain (SV-LS) measured via speckle-tracking echocardiography and several markers of clinical status. This was a retrospective study of Fontan patients with an echocardiogram at the Medical University of South Carolina from August 2022 to July 2023. SV-LS and other echocardiographic parameters were obtained and evaluated along with laboratory values, exercise test measures, cardiac catheterization data, and clinical outcomes. Bivariate tests of association were used to determine statistically significant relationships. 105 patients were included. SV-LS was associated with percent predicted VO2 max (p = 0.034). ROC analysis identified an SV-LS cutoff of –17.5% (AUC = 0.67, sensitivity 75%, specificity 62%) for detecting reduced exercise capacity. Echocardiographic indices of ventricular function including ejection fraction (r= –0.49) and fractional area change (r= –0.48) (p < 0.0001) correlated with SV-LS. There were no significant associations between SV-LS and laboratory measures of end-organ function, cardiac catheterization data, or adverse clinical events including transplant listing or protein-losing enteropathy. SV-LS is a non-invasive echocardiographic measure that may be associated with exercise capacity and has the potential to be a useful tool for primary cardiologists caring for this growing cohort of patients.
Atrioventricular valve regurgitation (AVVR) remains a significant complication post-Fontan. This study evaluates the accuracy of 4D flow AVVR quantification in post-Fontan patients by comparing 4D flow to conventional ec...Atrioventricular valve regurgitation (AVVR) remains a significant complication post-Fontan. This study evaluates the accuracy of 4D flow AVVR quantification in post-Fontan patients by comparing 4D flow to conventional echocardiographic (AVVREcho) and CMR assessments. Patients in the multi-institutional FORCE registry with high-quality 4D flow CMR were included. Regurgitant fractions (RFs) were calculated using two 4D-flow based methods: AVVRAVV−Ao (4D), calculated from atrioventricular valve and aortic flows, and AVVRJet, which directly measures AVVR jet volume. 4D flow RFs and severity classifications were compared with AVVREcho and CMR-reported AVVR severity (AVVRReport−Cat), and examiner-reported RFs (AVVRReport−RF). Statistical tests included Pearson correlation, Cohen’s kappa, and Bland-Altman analysis. The study included 218 post-Fontan patients (median age: 16.2 years, IQR: 12.8–22.5) and 36.2% were female. Both 4D flow methods displayed excellent interobserver reproducibility (interclass correlation > 0.95) and RFs approximately 7% lower than AVVRReport−RF. AVVRAVV−Ao (4D) showed stronger agreement with AVVRReport−RF (κ = 0.50 [95% CI: 0.25–0.75]; r = 0.49, p < 0.01). AVVRJet demonstrated better concordance with AVVRReport−Cat (κ = 0.31 [95% CI: 0.17–0.45]). Both AVVRAVV−Ao (4D) (OR = 1.53, p = 0.004; AUC = 0.71) and AVVRJet (OR = 1.74, p = 0.002; AUC = 0.65) were associated significantly with the composite outcome of death and heart transplantation listing. This is the first study analyzing the accuracy of 4D flow AVVR quantification in post-Fontan patients, demonstrating reproducibility, prognostic value, and good concordance with conventional methods. These findings suggest that 4D flow AVVR quantification may serve as a complementary method for assessing AVVR in post-Fontan patients.
Regadenoson is a well-established selective A adenosine receptor agonist able to induce coronary vasodilation, thus serving as an effective agent for stress myocardial perfusion imaging with several imaging modalities. R...Regadenoson is a well-established selective A adenosine receptor agonist able to induce coronary vasodilation, thus serving as an effective agent for stress myocardial perfusion imaging with several imaging modalities. Regadenoson is approved to be used in adults, but it is also used off-label in the pediatric setting. This paper summarizes the findings from the published literature on the use of regadenoson in pediatric populations undergoing stress CMR. Publications were identified via literature search on PubMed and Google Scholar and assessed for efficacy, adverse events, imaging-related aspects, use of stress-reversal agents, posology, and use of anesthesia. Nine publications met the criteria for this paper, reporting on a cumulative total of 276 pediatric patients, male and female, age range 2 months - 18 years, evaluated with regadenoson-based stress CMR between 2017 and 2025. Authors of all identified publications were based in the USA. In seven out of nine studies the regadenoson posology was weight-based (6-10 µg/kg). Several different contrast agents were used alongside regadenoson. No serious adverse events (AEs) were reported. All minor AEs reported in the studies were either resolved via stress-reversal agent, or self-resolved by the end of the exam. Using a random effects model that considers both within-study variance and between-study variance, the average heart rate at rest was found to be 81.9 [75.1; 88.7], and at stress 119.6 [114.9; 124.2] (delta = 37.7 bpm). In the United States, regadenoson is being used off-label for stress perfusion CMR in pediatric populations. Published reports indicate that regadenoson is efficacious and well-tolerated in this population.
Newborns with congenital heart disease (CHD) and preterm newborns are at high risk for morbi-mortality. However, the extent to which CHD affects long-term outcomes, especially neurodevelopment, in preterm newborns remain...Newborns with congenital heart disease (CHD) and preterm newborns are at high risk for morbi-mortality. However, the extent to which CHD affects long-term outcomes, especially neurodevelopment, in preterm newborns remains unclear. Retrospective case control matched study. Preterm infants (< 37 weeks of gestation) born with CHD between January 2013 and December 2022 included in the LIFT cohort and followed up at 24 months (n = 35) were matched by gender, gestational age, year and place of birth and parental socio-professional status (n = 132). Severe to moderate neurodevelopmental impairment (NI) was more frequent for patients born preterm with CHD at 24 months of age (12/35 (34.29%) vs. 16/132 (12.9%); p = 0.0073). In univariate analysis, unfavorable socio-economic level (OR 2.12, 95% CI [1.07, 4.18]), presence of CHD (OR 3.52, 95% CI [1.47, 8.43]) and duration of invasive ventilation (OR 1.08, 95% CI [1.02–1.15]) were associated with NI at 24 months in preterm infants. After multivariate analysis, duration of ventilation was the unique risk factor associated with late NI (OR 1.14, 95% CI [1.04, 1.24]). Preterm infants with CHD are at higher risk of NI compared to a similar preterm population without CHD, especially regarding motor function. Longer invasive ventilation duration was associated with NI.
To determine the prognostic value of stroke volume index (SVi) in children with idiopathic and heritable pulmonary arterial hypertension (PAH). A retrospective study was performed to assess the prognostic value of SVi ev...To determine the prognostic value of stroke volume index (SVi) in children with idiopathic and heritable pulmonary arterial hypertension (PAH). A retrospective study was performed to assess the prognostic value of SVi evaluated by right heart catheterization, and adverse outcomes (AE: lung transplant and cardiac death) in 103 incident pediatric patients with PAH. During catheterization, cardiac index was obtained using Fick method and SVi was determined by dividing cardiac index by heart rate. During follow-up period, 23 of 103 (22%) patients had AE. There were significant differences in hemodynamic parameters at baseline including SVi (median 35.6 vs. 29.1ml/m, p < 0.05) between patients with and without AE. When SVi cutoff value of 33 ml/m for prediction of AE was evaluated by Receiver-Operating Characteristic curve, the area under the curve was 0.75. Forty-two with lower SVi (≤ 33 ml/m) had 16 events (38%) and the remaining 61 patients with higher SVi had 7 events (11%) during follow-up (p < 0.05). Cumulative event-free survival rate was significantly lower when SVi was ≤ 33 ml/m (p < 0.05). SVi was a predictor of death or lung transplantation (HR = 0.92; 95% confidence interval 0.89-0.97; p < 0.05). Lower SVi was associated with higher risk of cardiac and lung transplantation in pediatric patients with idiopathic and heritable PAH. SVi appears to add prognostic information and may be useful for risk stratification.
Venoarterial extracorporeal membrane oxygenation (VA ECMO) offers vital support to children with cardiopulmonary failure. Echocardiography is commonly used to assess readiness for decannulation, however pediatric data su...Venoarterial extracorporeal membrane oxygenation (VA ECMO) offers vital support to children with cardiopulmonary failure. Echocardiography is commonly used to assess readiness for decannulation, however pediatric data supporting utility is limited. This is a retrospective, single-center study analyzing echoes during pediatric VA ECMO clamp trials from 2012 ̶ 2024. Subjects were categorized as cardiomyopathy/myocarditis (CM), persistent pulmonary hypertension of the newborn (PPHN), or congenital heart disease (CHD). Subjects were grouped as those who did (+ decan) and did not (− decan) tolerate decannulation within 24 h of the trial. 103 subjects (median age 9.1 days (3.7–109.5 days), 39% female), underwent 173 unique clamp trial echoes. 49.1% (n = 85) of patients were decannulated within 24 h of first clamp trial. In the PPHN group each 1 m/s increase in tricuspid regurgitation peak velocity was associated with 73% lower odds of +decan (OR = 0.27, CI: 0.09–0.79, p = 0.02), and > mild atrioventricular valve regurgitation was associated with 84% lower odds of having + decan (OR = 0.16, CI: 0.04–0.69, p = 0.01). In the CM group, each 5% decrease in left ventricular ejection fraction was associated with 29% lower odds of having + decan (OR = 0.71, CI: 0.53–0.95, p = 0.02). No echo associations with decannulation outcome were found in the CHD group. Predictors of a well-tolerated ECMO decannulation include lower tricuspid regurgitation peak velocity and < mild atrioventricular valve regurgitation in PPHN and higher left ventricular ejection fraction in CM. Because CHD was split into single and two ventricle groups, the resulting small sample size limited evaluation for CHD patients, which deserves further study.
Socioeconomic disadvantage is linked to adverse outcomes after congenital cardiac surgery, but its long-term link is unclear. Single-center retrospective analysis of individuals who underwent cardiac surgery from 2007 to...Socioeconomic disadvantage is linked to adverse outcomes after congenital cardiac surgery, but its long-term link is unclear. Single-center retrospective analysis of individuals who underwent cardiac surgery from 2007 to 2022 measured the association of socioeconomic status and late mortality (any post-discharge death at least 30 days after initial surgery). Mortality was determined by electronic health records and the National Death Index. Socioeconomic status was based on patients’ neighborhood Child Opportunity Index (COI) score. The lowest two COI quintile neighborhoods were designated “disadvantaged” while the highest two were designated “advantaged.” Multivariable mixed model analyses measured the strength of association between socioeconomic status and mortality, adjusting for STAT category, demographic, and clinical factors. Of the 2546 patients, half (49%, n = 1,235) were from disadvantaged neighborhoods. One third (31%, n = 787) were considered advantaged. Compared to patients from advantaged neighborhoods, patients from disadvantaged neighborhoods suffered greater overall mortality (14% vs. 8%, p < 0.001), more frequent complications (14% vs. 10%, p < 0.001), more genetic syndromes (23% vs. 19%, p = 0.021), and were smaller at surgery (5.15 kg vs. 5.60 kg, p = 0.006). Multivariable analysis adjusting for STAT category, prematurity, weight at surgery, and genetic syndromes found patients from disadvantaged neighborhoods had greater overall mortality (aOR:1.52; CI 1.10–2.12, p = 0.013). Genetic syndromes and weight at surgery were associated with increased overall mortality (aOR:1.60; CI 1.17–2.20, p = 0.004, aOR: 0.66; CI 0.53–0.81, p < 0.001, respectively). Patients from disadvantaged neighborhoods carry greater risk of mortality after congenital cardiac surgery. The relationship between socioeconomic status and mortality may be mediated by weight and genetic syndromes.
Patent ductus arteriosus (PDA) stenting has become an accepted alternative to the modified Blalock–Taussig–Thomas shunt (mBTTS) for duct-dependent pulmonary blood flow (DDPBF). However, several key aspects of practice, i...Patent ductus arteriosus (PDA) stenting has become an accepted alternative to the modified Blalock–Taussig–Thomas shunt (mBTTS) for duct-dependent pulmonary blood flow (DDPBF). However, several key aspects of practice, including prostaglandin (PGE) titration, antiplatelet therapy, access strategy, back-up planning, and hypoplastic left heart syndrome (HLHS) palliation, remain highly variable. We conducted an international web-based survey of interventional pediatric cardiologists. Domains included PGE management, antiplatelet therapy, platelet function testing, stent-length selection, ECMO and surgical back-up, carotid access, complication profile. A total of 138 respondents participated. PGE strategies varied widely: in single-source pulmonary blood flow, 40% used saturation-guided titration, and 29% routinely discontinued PGE; in dual-source circulation, 40% always discontinued PGE and 34% used titration-based strategies. Aspirin monotherapy (46%) and dual antiplatelet therapy (45%) were equally used; clopidogrel doses typically approximated 0.2 mg/kg/day. Platelet function testing was rarely used (19%). Stent-length selection relied on straight-line measurement in 41% and tortuous central-line measurement in 39%. ECMO support was never available in 35% of centers, selectively available in 23%, and always available in 21%. A surgeon was routinely on standby in 48%. Carotid access was used percutaneously by 45% and surgically by 24%. Complications encountered by operators at any stage during their performing these procedures included ductal spasm (87%), thrombosis (51%), LPA “shut-down” (36%), and ductal dissection (33%). Contemporary PDA-stent practice varies markedly across institutions, particularly regarding PGE management, antiplatelet therapy, technical strategy, and back-up planning. HLHS and interstage practices show similar heterogeneity. These findings support the need for multicenter registries and consensus recommendations.
Patent ductus arteriosus (PDA) stenting is a less invasive alternative to surgical shunts in ductal-dependent congenital heart disease. Umbilical artery access for PDA stenting offers femoral-like retrograde advantages w...Patent ductus arteriosus (PDA) stenting is a less invasive alternative to surgical shunts in ductal-dependent congenital heart disease. Umbilical artery access for PDA stenting offers femoral-like retrograde advantages while avoiding associated risks, however is underreported in this context. This study evaluates umbilical artery access feasibility and outcomes for PDA stenting. A case series included seven neonates undergoing PDA stenting via umbilical artery access between 01/17/2020 and 10/30/2024 at Rady Children's Hospital, San Diego. Patient demographics, PDA morphology, and procedural details were collected. Existing umbilical arterial lines were rewired and exchanged for a 4 F Flexor sheath (Cook Medical Bloomington, Indiana, USA), advanced through the iliac artery to the descending aorta. A coaxial system was used to cross the PDA and deploy coronary stents with a wire-locking technique for controlled positioning. Post-procedure, patients received dual antiplatelet therapy with the umbilical catheter remaining in situ until stability. This study (71% female) had a median gestational age of 38 weeks and a median birth weight of 2.97 kg. The median age at catheterization was 8 days (range: 3-10). PDA morphology originated from the descending aorta (n = 4, 57.1%) and the brachiocephalic artery (n = 3, 42.9%). The median procedure time was 126 min (range: 42-161 min), with a median fluoroscopy time of 24.7 min (11.4-58.6). No intra- or post-procedural complications occurred. Median stent diameter was 3.5 mm; 85.7% required one stent. Scheduled reinterventions, as part of staged palliation, were performed in a subset of patients. Umbilical artery access for PDA stenting is a safe and effective alternative in select cases, with no acute complications in our study.