BACKGROUND: Adolescents with congenital heart disease (CHD) have high cardiovascular risk (CVR), related to clinical, behavioral and socioeconomic factors. A sedentary lifestyle, physical inactivity and unfavorable socio...BACKGROUND: Adolescents with congenital heart disease (CHD) have high cardiovascular risk (CVR), related to clinical, behavioral and socioeconomic factors. A sedentary lifestyle, physical inactivity and unfavorable socioeconomic conditions can aggravate this risk, while regular physical activity, a healthy diet and lipid profile control are protective factors. OBJECTIVE: To determine the relationship among clinical, behavioral, and socioeconomic factors and CVR in adolescents with CHD. METHODS: Cross-sectional study with 75 adolescents, aged 10 to 18 years old, attending a reference outpatient service in Alagoas, Brazil. The Physical Activity Questionnaire for Children, Questionnaire for Screen Time of Adolescents, lipid and glycemic profile and Pathobiological Determinants of Atherosclerosis in Youth score were used. Associations were tested by chi-square for categorical variables and Student's t-test for continuous variables. Multivariate binary logistic regression was used by the backward non-conditional method, adjusted for significant confounding factors (p < 0.20). RESULTS: A total of 75 adolescents were recruited, 62.6% showed low CVR, 82.7% exhibited excessive sedentary behavior and 90.7% were physically inactive, both associated with lipid alterations. Females had a lower odds ratio (OR) of 0.32 (95% CI = 0.11; 0.91) for higher CVR, while high complexity of CHD had an OR of 4.38 (95% CI = 1.02; 18.69) for high LDL-c levels. Adolescents with lower income had an OR of 3.29 (95% CI = 1.20; 9.08) for low HDL-c levels. CONCLUSION: Adolescents with CHD have a high sedentary lifestyle, low levels of physical activity and clinical and socioeconomic factors that increase cardiovascular risk.
The extracardiac Fontan procedure is the most widely adopted surgical approach for definitive palliation of single-ventricle anomalies, offering improved hemodynamics and reduced arrhythmogenic risk. However, limited acc...The extracardiac Fontan procedure is the most widely adopted surgical approach for definitive palliation of single-ventricle anomalies, offering improved hemodynamics and reduced arrhythmogenic risk. However, limited access to the pulmonary venous atrium during follow-up poses significant challenges for electrophysiologic and interventional procedures. We describe a simple technical modification of the extracardiac Fontan designed to preserve these advantages while facilitating future percutaneous access.
The 21st century requires a new kind of pediatric cardiologist. One who is not only a skilled clinician but also a continuous learner, educator, leader, and humanist. The boundaries of our discipline now extend from anat...The 21st century requires a new kind of pediatric cardiologist. One who is not only a skilled clinician but also a continuous learner, educator, leader, and humanist. The boundaries of our discipline now extend from anatomy and intervention to culture, communication, and self-awareness. This essay outlines the emerging paradigm of the master learner: a professional whose technical expertise is grounded in empathy, curiosity, and reflective intelligence. Drawing from contemporary literature on medical education and leadership, it proposes that mastery today is defined not only by clinical and procedural competence but also by the ability to integrate compassion, learning agility, and adaptive leadership within complex systems.
Low heart rate variability (HRV) has been associated with increased risk of morbidity and mortality. While HRV measurements from Holter monitoring have been available for over 3 decades, pediatric reference limits have n...Low heart rate variability (HRV) has been associated with increased risk of morbidity and mortality. While HRV measurements from Holter monitoring have been available for over 3 decades, pediatric reference limits have not been adequately defined. We sought to determine these limits using meta-analysis. Multiple databases were searched through 2024 for relevant studies. Data extraction with meta-analysis and estimation of 95% reference ranges were performed. Linear time- and frequency-domain HRV variables were grouped by the following age ranges: infants (birth-11 months), younger children (1–6 years), older children (7–12 years), and adolescents (13–18 years). Forty-nine studies including 2993 participants were analyzed. SDNN (standard deviation of all sinus NN intervals), SDANN (standard deviation of averages of NN intervals in all 5 min segments), SDNNi (mean of standard deviations of NN intervals for all 5 min segments), rMSSD (root mean square of differences between adjacent NN intervals), and pNN50 (percentage of adjacent NN intervals that varied by more than 50ms) all demonstrated a progressive increase in younger children that required subdivision of that reference range. SDNN and SDANN exhibited further milder increases into adolescence, while SDNNi, rMSSD, and pNN50 remained relatively stable after age 4 years. LF (low frequency) and HF (high frequency) parameters increased abruptly from infancy to early childhood with minimal change thereafter. Remarkably, pediatric age-group lower limits for rMSSD, pNN50, and LF/HF were frequently at or near zero, limiting their utility for detecting decreased HRV. Age-stratified Holter monitor reference limits for HRV parameters in infants, children and adolescents are proposed.
Hand grip strength (HGS) is a validated measure of muscle function. We aimed to determine HGS and its predictors in young children after complex cardiac surgery in early infancy. A prospective inception-cohort of childre...Hand grip strength (HGS) is a validated measure of muscle function. We aimed to determine HGS and its predictors in young children after complex cardiac surgery in early infancy. A prospective inception-cohort of children who had complex cardiac surgery in early infancy between 2010-2019 had HGS measured using the Martin Vigorimeter at age 4.5 years. Predictor variables (demographics, severity-of-illness perioperatively and at age 4-5 years, and outcomes at 4-5 years of age) association with HGS were determined using univariate and two multiple linear regression models (considering all variables, and excluding distal variables). Of 390 survivors, 165 (42%) completed and 162 (42%) did not complete HGS assessment, and 63 (16%) were lost to follow-up or pending. Children who did not complete HGS had significantly higher illness severity and adverse outcome variables versus children who had HGS assessed. Stronger hand Z-scores for HGS were mean 1.16 (SD 1.72). In model 1, lower HGS z-score was statistically associated with small for gestational age, while higher HGS z-score was statistically associated with full-scale intelligence quotient and height z-score. In model 2, highest lactate after surgery was statistically associated with lower HGS z-score (Effect Size -0.11 (95% CI -0.21, -0.02), p=0.022). HGS measurement was feasible in 42% of survivors, limiting its application at the young age of 4.5 years after having had complex cardiac surgery in infancy. Risk factors including small for gestational age and highest lactate after surgery may be modifiable.
Accessory mitral valve tissue is a congenital cardiac anomaly that can lead to left ventricular outflow tract obstruction. Although it is predominantly diagnosed in pediatric populations, true incidence remains unknown b...Accessory mitral valve tissue is a congenital cardiac anomaly that can lead to left ventricular outflow tract obstruction. Although it is predominantly diagnosed in pediatric populations, true incidence remains unknown but is considered rare, and clinical recognition can be challenging. With the widespread use of echocardiography, this anomaly is being diagnosed more frequently. This retrospective study was conducted on patients diagnosed with accessory mitral valve tissue between April 2010 and August 2025. Accessory mitral valve tissue was identified in 47 patients (17 females, 30 males) with a mean age at diagnosis of 121 ± 53.2 months. The most common indication for echocardiographic evaluation was murmur (n = 15). Additional congenital heart defects were observed in 18 patients (38%). The most frequent associated anomaly was bicuspid aortic valve (n = 6, 13%). Left ventricular outflow tract obstruction was noted in 6 patients with accessory mitral valve tissue. Two patients underwent surgical resection of accessory mitral valve tissue; one due to subaortic obstruction and the other due to mitral valve stenosis. Concomitant congenital heart diseases mainly from left-sided heart structures are frequently seen. Left ventricular outflow tract obstruction and aortic regurgitation owing to accessory mitral valve tissue may gradually increase during follow-up. Cardiac surgery may be necessary in patients with left ventricular outflow tract obstruction or aortic regurgitation. Echocardiography is the cornerstone for the initial diagnosis, serial follow-up, and management guidance of patients with this condition.
Patients with congenital heart disease (CHD) and cardiac implantable electronic devices (CIEDs) are at risk for ventricular dysfunction. Cine cardiac computed tomography (CCT) is increasingly used for functional assessme...Patients with congenital heart disease (CHD) and cardiac implantable electronic devices (CIEDs) are at risk for ventricular dysfunction. Cine cardiac computed tomography (CCT) is increasingly used for functional assessment, but its reproducibility among observers has not been described in this population. Patients who underwent CCT and echocardiogram within a 3-month interval without intervening intervention were reviewed. Inter-observer and inter-modality agreement for left ventricular (LV) volumes and ejection fraction (EF), qualitative right ventricular (RV) size and function, and presence of dyssynchrony were measured using kappa statistic and intraclass correlation coefficient (ICC). The study included 72 patients. There was excellent inter-observer agreement for LV volumes and LVEF by both echocardiography and CCT and moderate inter-modality agreement for all LV measurements. In patients with functional single ventricles, there was excellent inter-observer agreement for LV volumes and LVEF (ICC 0.99) by CCT and moderate agreement for LVEF by echocardiography (ICC 0.67). There was moderate agreement in RV size (κ = 0.70) and strong agreement in systolic function (κ = 0.83) by echocardiography and strong agreement in RV size (κ = 0.81) and excellent agreement in systolic function (κ = 0.96) by CCT. Dyssynchrony was observed in more than half of patients by CCT, with excellent inter-observer agreement for septal flash (κ = 0.99). In patients with CHD and CIEDs, CCT provides highly reproducible estimates of ventricular size and function, with stronger inter-observer agreement than echocardiography in patients with single ventricles and RV assessment. Septal flash may have utility as a qualitative marker of dyssynchrony in patients with CIEDs.
Nield LE, Grasswill M, Romefort B
… +21 more, Prigent S, Belli E, Babu-Narayan SV, Elder RW, Ladouceur M, Khairy P, Kowalik E, Kalfa DM, Conway M, Werner O, Sellal JM, Monier A, Buratto E, Padovani P, Barron DJ, Bacha EA, Gatzoulis MA, McLeod CJ, Karakachoff M, Baruteau AE, DISCO study group
Congenitally corrected transposition of the great arteries (ccTGA) with biventricular physiology is presumed to carry a favorable outcome. We aimed to explore the differences in associated diagnoses (including conduction...Congenitally corrected transposition of the great arteries (ccTGA) with biventricular physiology is presumed to carry a favorable outcome. We aimed to explore the differences in associated diagnoses (including conduction disease), management and outcomes among prenatally vs. postnatally diagnosed ccTGA cases. Secondary objective was to examine outcomes in isolated ccTGA. An international, multicenter, retrospective cohort study was conducted in 29 tertiary hospitals (6 countries) from 1990 to 2018. Patients with a single ventricle, heterotaxy syndrome, or valvar atresia were excluded. Of 331 ccTGA patients with a median follow-up of 8.6 years [IQR: 3.5–14.1], 128 (38.7%) were diagnosed prenatally at a median gestational age of 22 weeks. As compared to the postnatal group, prenatally diagnosed patients experienced earlier cardiac conduction disorders (median age at diagnosis of conduction disorders: 0.3 versus 2.7 years, p = 0.010), earlier pacemaker implantation (median age at pacing: 6.5 years [2.5–11.6] versus 0.9 year [0.1-3.0], p < 0.001) and earlier surgical intervention (intervention-free survival rate at 3 years: 50.3% versus 34.7%, p < 0.001). The 3-year survival rate was significantly lower in patients diagnosed prenatally (91.1% versus 98.4%, p = 0.002) and the median age at death was significantly younger among patients diagnosed prenatally (0.2 versus 7.0 years, p < 0.001). In both groups, isolated ccTGA (n = 63, 19%) was associated with superior outcomes with no intervention in 46.8% and only one death. Prenatally diagnosed patients with ccTGA had earlier conduction disorders and interventions than postnatally diagnosed patients and died at a younger age. Outcomes were best in patients with isolated ccTGA.
The Fontan procedure has significantly improved survival in patients with single-ventricle physiology; however, multisystem complications have become a major source of late morbidity and mortality. In 2020, the Hospital...The Fontan procedure has significantly improved survival in patients with single-ventricle physiology; however, multisystem complications have become a major source of late morbidity and mortality. In 2020, the Hospital for Sick Children (SickKids) established a dedicated paediatric Fontan Long-Term Follow-up Clinic. This study evaluated the prevalence and spectrum of cardiac and extracardiac morbidities in the clinic cohort since inception. This single-centre retrospective study included all patients referred between January 2020 and December 2024. Standardized assessments comprised cardiac evaluations (echocardiography, Holter monitoring, exercise testing, cardiac MRI) and extracardiac investigations of hepatic, renal, hematologic, endocrine, growth, and neurodevelopmental status. Fontan-associated liver disease (FALD) was graded using MR elastography and imaging findings. A total of 161 patients (mean age 13.2 ± 3.7 years; 58.4% male) were assessed at a mean of 9.5 ± 4.3 years post-Fontan completion. Tricuspid atresia was the most common diagnosis (26.1%). Cardiac function was generally preserved, with mean predicted peak VO₂ of 63.6 ± 17.6%. Moderate or severe atrioventricular valve regurgitation occurred in 21.5%, and ventricular dysfunction in 5.6%. Moderate or greater FALD was observed in 8.0%, with mean magnetic resonance elastography 4.58 kPa (Interquartile range, 4.03-5.40). Lymphopenia (64.6%), thrombocytopenia (16.8%), vitamin D deficiency (41.9%), and reduced bone density (28.0%) were frequent. Neurodevelopmental challenges were common (39.8% learning difficulties). Despite preserved cardiac performance, Fontan patients exhibited a high burden of hepatic, hematologic, endocrine, skeletal, and neurocognitive morbidities. Multidisciplinary, longitudinal follow-up is essential to optimize outcomes and quality of life.
Right ventricular (RV) systolic dysfunction is a risk factor for morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). RV and right atrial (RA) strain evaluation by cardiac magnetic resonance (...Right ventricular (RV) systolic dysfunction is a risk factor for morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). RV and right atrial (RA) strain evaluation by cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) is feasible but knowledge of their adaptative changes to systemic pressure and association to invasive hemodynamics and adverse clinical outcomes (ACO) remains limited. We aimed to compare regional RV and RA strain in HLHS patients with and without abnormal RV ejection fraction (aRVEF) and assess strain relationship to invasive hemodynamics and ACO. CMR, TTE and cardiac catheterization data for 45 children with HLHS post-stage 2 palliation was retrospectively analyzed. RV and RA strain was assessed with speckle-tracking (TTE) and feature-tracking (CMR). Patients with aRVEF had higher indexed RV end-diastolic (p = 0.019) and end-systolic volumes (p = 0.0005), lower mass/volume ratio (p = 0.029), abnormal apical strain by CMR (longitudinal p = 0.026, circumferential p = 0.001, radial p = 0.0005) and TTE (p = 0.003), and higher global longitudinal to global radial strain ratio (p = 0.0005). RA reservoir strain (RASr) was significantly lower in aRVEF patients (CMR p = 0.009, TTE p = 0.018) and was associated with a composite of ACO (HR 0.81, p = 0.0021). There was no association between RA strain and catheterization data. RV maladaptation and systolic dysfunction in HLHS patients is characterized by increased volumes, decreased mass/volume ratio, and global and regional strain abnormalities, particularly decreased radial motion relative to longitudinal shortening and apical dysfunction. RA compliance decreases with aRVEF and is associated with ACO but not with invasive hemodynamics.
BACKGROUND: Ebstein anomaly is associated with a broad spectrum of presentations. Many fetal factors have been associated with intrauterine fetal demise and early neonatal mortality. Little is described about how fetal f...BACKGROUND: Ebstein anomaly is associated with a broad spectrum of presentations. Many fetal factors have been associated with intrauterine fetal demise and early neonatal mortality. Little is described about how fetal factors may influence illness severity in the immediate postnatal period. OBJECTIVES: To identify the relationship between fetal echocardiogram measures and severity of illness on admission utilizing pSOFA scores. METHODS: Retrospective chart review of 32 neonates with prenatally diagnosed Ebstein anomaly. Fetal echocardiographic factors assessed included right ventricular pressure (RVp), presence of antegrade pulmonary blood flow, ductus arteriosus (DA) flow direction, and pulmonary regurgitation (PR). pSOFA score was calculated on admission from available data. Patients were evaluated for the composite postnatal outcome of cardiac arrest, need for ECMO, or mortality. RESULTS: Median RVp on the last fetal echocardiogram was 26 [22, 35] mmHg. In 40.6% of infants, no antegrade pulmonary blood flow was demonstrated and DA flow was left-to-right. There was more than mild PR in 31.3% of patients. Lower fetal RVp (p = 0.016), lack of antegrade pulmonary blood flow (p = 0.002), left-to-right DA flow (p = 0.001) and PR (p < 0.001) on the last fetal echocardiogram were associated with a higher pSOFA score on admission. In addition, lower fetal RVp (p = 0.003) and lack of antegrade pulmonary blood flow (p = 0.041) were associated with the composite outcome of cardiac arrest, ECMO or mortality. CONCLUSIONS: Fetal echocardiographic parameters are associated with severity of illness on CICU admission as assessed by pSOFA score. Both lower fetal RVp and lack of antegrade pulmonary blood flow remain associated with neonatal morbidity and mortality.
Lower albumin levels are a potential risk factor for intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in patients with Kawasaki disease (KD). No age-specific studies have been conducted on...Lower albumin levels are a potential risk factor for intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in patients with Kawasaki disease (KD). No age-specific studies have been conducted on the association between lower albumin levels and these outcomes. We analyzed 18,336 patients who developed KD nationwide in Japan from 2011 to 2012. These patients were divided into three age groups: <1 year, 1–4 years, and 5–9 years. Multivariable logistic regression analyses were performed to evaluate the association between serum albumin decrease and (1) IVIG resistance and (2) CALs among these age groups. Each 0.1 g/dL albumin decrease was strongly associated with IVIG resistance in the patients aged < 1 year (adjusted odds ratios [95% confidence interval]: 1.96 [1.60–2.40]). Patients aged 1–4 years demonstrated a moderate association (1.47 [1.31–1.65]), and no association was observed in those aged 5–9 years (1.24 [0.95–1.62]). Similarly, lower albumin levels had an age-specific association with CALs (1.72 [1.11–2.70] for < 1 year, 1.67 [1.19–2.33] for 1–4 years, and 0.61 [0.33–1.10] for 5–9 years). Lower albumin levels were significantly associated with an increased risk of IVIG resistance and CALs, with the association strength varying by age. When assessing risk for treatment failure and coronary complications, serum albumin levels may be stratified by age.
Yanagisawa A, Torii Y, Go K
… +10 more, Kawada JI, Narita A, Goto A, Enomoto S, Nishinosono T, Yamaguchi K, Kidokoro H, Sato Y, Takahashi Y, Nagoya Collaborative Clinical Research Team
Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Japan has offered free pediatric vaccination; however, coverage among children has remained low. Children with heart disease are consid...Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Japan has offered free pediatric vaccination; however, coverage among children has remained low. Children with heart disease are considered to have a higher risk of developing coronavirus disease (COVID-19) complications. This study aimed to investigate the attitudes of caregivers toward SARS-CoV-2 vaccination in this population. A questionnaire survey was conducted at 16 medical facilities between October 2023 and January 2024 among caregivers of children with heart disease aged 1 to 19 years. A total of 1142 valid responses were analyzed. It was found that vaccination rates were higher among older children. Additional factors associated with vaccination included more advanced parental age, history of influenza vaccination, and physician recommendation. The most common reason for vaccine refusal was concern about side effects. Among children with congenital heart disease, those requiring interventions or undergoing the Fontan procedure showed higher vaccination rates. These participants were also more likely to have received a recommendation from their physician. These findings suggest that physicians did not uniformly recommend vaccination, but instead tailored their advice based on the disease severity and individual circumstances. This finding underscores the critical role of physician guidance in caregiver decision-making. Understanding such attitudes under uncertain conditions may help to inform communication strategies and policy development for future public health crises involving novel vaccines.
Advances in surgical techniques have substantially improved survival in patients with repaired tetralogy of Fallot (ToF). However, residual lesions following repair may lead to long-term complications, including arrhythm...Advances in surgical techniques have substantially improved survival in patients with repaired tetralogy of Fallot (ToF). However, residual lesions following repair may lead to long-term complications, including arrhythmias and the need for device therapy. We conducted a retrospective single-center cohort study including patients who underwent surgical repair of ToF between 1960 and the present. Patients were categorized into three treatment eras (<1980, 1980-2000, >2000). Data on surgical strategy, mortality, arrhythmias, and cardiac implantable electronic device (CIED) implantation were collected from institutional databases. A total of 640 patients were included, of whom 360 (56.3%) underwent transannular patch (TAP) repair and 280 (43.7%) underwent non-TAP repair. Overall mortality was 7.2%, with cardiac causes accounting for 41.3% of deaths. Arrhythmias occurred in 14.4% of patients and were more frequently observed in those who underwent TAP repair (18.8%). CIED implantation was required in 7.5% of patients, most commonly implantable cardioverter defibrillators. The incidence of arrhythmias decreased across treatment eras, whereas overall survival did not differ significantly between eras. Long-term survival after surgical repair of ToF is favorable. Arrhythmias remain an important late complication, particularly in patients who underwent TAP repair, although their frequency appears to have decreased in more recent treatment eras. These findings underscore the long-term impact of initial surgical strategy on arrhythmic outcomes.
We sought to examine what treatment options were offered for patients with isolated single ventricle physiology (iso-SVP) versus patients with single ventricle physiology and concomitant genetic aneuploidy. Pediatric int...We sought to examine what treatment options were offered for patients with isolated single ventricle physiology (iso-SVP) versus patients with single ventricle physiology and concomitant genetic aneuploidy. Pediatric intensivists, cardiologists, and congenital heart surgeons from the United States were surveyed about treatment options offered to patients with iso-SVP or SVP with concomitant aneuploidy (trisomy 21 [t21-SVP] or trisomy 18 [t18-SVP]). For each scenario, respondents were also queried about what they would hypothetically choose for their own child. Analyses were performed on responses from 171 pediatric intensivists, 69 cardiologists, and 44 congenital heart surgeons. For iso-SVP, nearly all respondents would offer a staged surgical procedure (268/269 [99.6%]) and half would offer comfort care (130/269 [48.3%]). For their own child with iso-SVP, respondents were divided between surgery (137/266, [51.5%]) and comfort care (130/266 [48.9%]). For t21-SVP, respondents almost always offered staged surgical procedures (243/267 [91.0%]) and half of respondents would offer comfort care measures (137/267 [51.3%]). For their own child with t21-SVP, a majority would opt for comfort care (191/266 [71.8%]). For t18-SVP, only 21.8% (58/266) would offer staged surgical procedures, and virtually all (252/266, [94.7%]) would offer comfort care. Comfort care was almost unanimously chosen for their own child (276/277 [99.6%]). Respondents offered comfort care for children with iso-SVP and t18-SVP at a rate concomitant with their own preferences. However, for t21-SVP, only half of respondents offered comfort care, whereas 70% would want it for their own child. This raises ethical questions around respect for parental decision-making authority and informed consent.
We investigated significant congenital cardiovascular malformations (CCVM) in Nevada, accompanied by declining birth rates. We identified those diagnosed pre- and postnatally in Nevada with significant CCVM between Janua...We investigated significant congenital cardiovascular malformations (CCVM) in Nevada, accompanied by declining birth rates. We identified those diagnosed pre- and postnatally in Nevada with significant CCVM between January 2012 and December 2024. We defined significant CCVM as cases that underwent or were likely to undergo a surgical or interventional cardiac catheterization procedure between 0 and 24 months of age. We excluded those with a secundum atrial septal defect or patent ductus arteriosus. We identified 1573 cases. Of the 1573, 1427 were live born. Of the 1573, 1486 (94%) had prenatal care. Of the 1486 with prenatal care, 1056 (71%) were prenatally diagnosed, and the prenatal detection rate rose from 53% in 2012 to 91% in 2024 (p < 0.001). During the same period, the Nevada birth rate fell from 12.7 to 9.9 per 1,000 population (p < 0.001). However, the overall prevalence of significant CCVM increased from 272 to 430 per 100,000 live births (p < 0.001). Simultaneously with the declining birth rates, we found, in those prenatally diagnosed with significant CCVM, a statistically significant increase in the percentage of pregnant mothers with comorbidities, increasing from 56% to 85%, p = 0.002. In Nevada, concurrent with declining birth rates, we found an increasing prevalence of significant CCVM. The increasing prevalence of significant CCVM was associated with a simultaneous increase in the percentage of comorbidities in the maternal population.
Sotalol is an antiarrhythmic with both class II and III properties, available intravenously since 2015. While its use in adults is well-documented, there is limited pediatric data. It has been used in pediatric patients...Sotalol is an antiarrhythmic with both class II and III properties, available intravenously since 2015. While its use in adults is well-documented, there is limited pediatric data. It has been used in pediatric patients for various supraventricular and ventricular tachycardias. This study aimed to characterize hemodynamic and antiarrhythmic changes following the first dose of intravenous sotalol in children with and without congenital heart disease. This single-center retrospective study included pediatric patients under 18 who received intravenous sotalol for the first time between January 2020 and January 2025. Data collected included age, congenital heart disease (CHD) status, univentricular circulation, electrophysiologic diagnosis, sotalol dose, dose discontinuation, corrected QT (QTc) interval change, and arrhythmia termination. Hemodynamic variables, including heart rate, mean arterial pressure, pulse oximetry, near infrared spectroscopy (cerebral and renal), central venous pressure, and vasoactive-inotropic score, were recorded at multiple hourly time points (1 h before to 8 h after dosing). Hemodynamic data were analyzed using the Friedman test, and longitudinal changes were assessed with a linear mixed effects model. The study included 112 patients with a mean age of 31.3 months. Of these, 60 (53.6%) had CHD and 15 (13.3%) had univentricular circulation. Of the 66 patients (59%) with active arrhythmias when receiving sotalol, 46 (70%) experienced arrhythmia termination or rate improvement with ability to pace. Heart rate significantly decreased from baseline at all time points (p < 0.01), with a 16% reduction within 2 h and an 18% reduction at 8 h. Arterial saturation increased by 1–1.4% at 6–8 h (p < 0.05). Mean arterial pressure, cerebral near infrared spectroscopy, renal near infrared spectroscopy, central venous pressure, and vasoactive inotrope score did not significantly change over time. These findings were not influenced significantly by other variables. The baseline QTc interval was 420.7 ± 65.4 ms and increased to 441.1 ± 46.7 ms post-dose (p < 0.01). Other hemodynamic variables showed no significant change. Intravenous sotalol was associated with stable short-term hemodynamic parameters in critically ill pediatric patients, supporting its safe use in the intensive care setting.