Cardiol Young [JOURNAL]
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200 papers
A scoping review of the evidence supporting antiarrhythmic use after paediatric cardiac surgery.
Sullenger RD, Kohlmann T, Kilborn AG … +6 more , Commander SJ, Foote HP, Zimmerman KO, Hill KD, Hornik C, Thompson EJ
Cardiol Young · 2026 Jul · PMID 42394265 · Publisher ↗
BACKGROUND: Arrhythmias after paediatric cardiac surgery occur frequently and contribute to postoperative morbidity and mortality. There is limited literature assessing the safety and efficacy of common antiarrhythmics a...
BACKGROUND: Arrhythmias after paediatric cardiac surgery occur frequently and contribute to postoperative morbidity and mortality. There is limited literature assessing the safety and efficacy of common antiarrhythmics administered in this population. METHODS: We systematically searched PubMed and EMBASE for literature on antiarrhythmic use in children <18 years of age after cardiac surgery from 2000 to 2024. Two reviewers independently screened abstracts and then reviewed full-text manuscripts to determine eligibility. RESULTS: We identified 28 studies of 3,752 patients across 11 different antiarrhythmics: flecainide, procainamide, esmolol, landiolol, propranolol, amiodarone, sotalol, dexmedetomidine, digoxin, ivabradine, and magnesium. Most studies were small, with 17 enrolling fewer than 100 children. Only eight studies were randomised, 16 were retrospective, 12 were prospective, and one was multicenter. Safety and efficacy endpoints varied widely, limiting our ability to combine data for meta-analysis. Overall, evidence supporting the use of these drugs in children after cardiac surgery was limited. CONCLUSION: Although antiarrhythmics are commonly used in children after cardiac surgery, randomised trials with standardised endpoints to guide choice of therapy are lacking. Pragmatic trials to generate real-world data should be considered to further evaluate the safety and efficacy of various antiarrhythmics in this population.
Dexrazoxane in children receiving anthracyclines: efficacy, safety, and region-specific considerations for Latin America.
Goldsman A, Stelmaszewski EV, Gonzalez Ortiz A … +7 more , Prada Casilimas MDP, Arevalo Leal O, Biancolini J, Sardella A, Maza Caneva O, Pignatelli R, working group on paediatric and adolescent cardio-oncology of the paediatric cardiology and ACHD Council, Inter-American Society of Cardiology (SIAC)
Cardiol Young · 2026 Jun · PMID 42374822 · Publisher ↗
BACKGROUND: Anthracyclines are indispensable in paediatric oncology but are associated with well-recognised dose-dependent cardiotoxicity that may result in progressive cardiomyopathy and late heart failure. Dexrazoxane...
BACKGROUND: Anthracyclines are indispensable in paediatric oncology but are associated with well-recognised dose-dependent cardiotoxicity that may result in progressive cardiomyopathy and late heart failure. Dexrazoxane has emerged as a potential primary cardioprotective strategy; however, concerns regarding safety, secondary malignancies, and possible interference with antitumour efficacy have historically limited its widespread adoption. OBJECTIVES: To critically review current evidence regarding the efficacy, safety, and clinical applicability of dexrazoxane in children receiving anthracycline-based chemotherapy, including region-specific implications for Latin America. METHODS: Narrative review of randomised controlled trials, observational studies, systematic reviews, meta-analyses, and international guideline statements evaluating cardiac outcomes, survival, toxicity profiles, and second primary malignancy risk. RESULTS: Dexrazoxane consistently demonstrates cardioprotective effects, including reduced biomarkers of myocardial injury and improved preservation of left ventricular systolic function, particularly among patients exposed to higher cumulative anthracycline doses. Available data indicate no significant adverse impact on relapse rates, event-free survival, or overall survival. Although early studies raised concerns about increased second primary malignancies, subsequent investigations have yielded inconsistent results, leaving residual uncertainty. CONCLUSIONS: Dexrazoxane represents an effective cardioprotective strategy in selected high-risk paediatric patients. A risk-adapted approach balancing cardioprotection, oncologic safety, and healthcare resources is warranted.
Evaluation of clinical, laboratory, and epidemiological features of children with Kawasaki disease.
Aydin Z, Akın A, Ture M … +1 more , Yolbaş I
Cardiol Young · 2026 Jun · PMID 42374821 · Publisher ↗
OBJECTIVES: Kawasaki disease is a systemic vasculitis of unknown aetiology that is usually seen in children younger than five years of age. In our study, the demographic, clinical, laboratory, and echocardiographic chara...
OBJECTIVES: Kawasaki disease is a systemic vasculitis of unknown aetiology that is usually seen in children younger than five years of age. In our study, the demographic, clinical, laboratory, and echocardiographic characteristics of children diagnosed with Kawasaki disease were evaluated, and patients were compared between complete and incomplete Kawasaki disease, as well as according to the presence or absence of coronary artery involvement. METHODS: This retrospective study included 35 paediatric patients diagnosed with Kawasaki disease. Patients were classified as having complete Kawasaki disease or incomplete Kawasaki disease and were further stratified based on the presence or absence of coronary artery involvement. Laboratory parameters were compared between patients with and without coronary artery involvement before treatment and one week after treatment. RESULTS: The study included 35 patients, 71.4% of whom were male ( = 25). Complete Kawasaki disease was diagnosed in 68.6% of patients, and coronary artery involvement was detected in 37.1%. Patients with complete Kawasaki disease had more frequent extremity changes ( = 0.011), higher C-reactive protein ( = 0.014), and lower alanine aminotransferase levels ( = 0.014) than those with incomplete Kawasaki disease. Patients with coronary artery involvement were younger ( = 0.001), had longer hospitalisation ( = 0.020), prolonged fever before intravenous immunoglobulin treatment ( = 0.003), and delayed defervescence ( = 0.028) compared to patients without coronary artery involvement. Before treatment, erythrocyte sedimentation rate ( = 0.033), lymphocyte ( = 0.022), and platelet ( = 0.001) were higher in patients with coronary artery involvement, whereas no significant differences were observed after treatment. CONCLUSION: Patients with coronary artery involvement in Kawasaki disease were younger and exhibited more pronounced inflammatory findings compared with those without involvement; however, these inflammatory differences disappeared after treatment. This finding supports the importance of early and effective treatment during the acute phase.
The Pediatric Inventory for Parents: an evaluation of the Norwegian translation applied to mothers of infants with CHD.
Hjorth-Johansen E, Børøsund E, Tandberg BS … +1 more , Pedersen GAF
Cardiol Young · 2026 Jun · PMID 42374819 · Publisher ↗
INTRODUCTION: The Pediatric Inventory for Parents measures the frequency and difficulty of parental disease-related stress. We describe the psychometric properties and evaluation of the Norwegian version for mothers of i...
INTRODUCTION: The Pediatric Inventory for Parents measures the frequency and difficulty of parental disease-related stress. We describe the psychometric properties and evaluation of the Norwegian version for mothers of infants with CHD. MATERIALS: The Pediatric Inventory for Parents contains 42 items within four domains: (1) communication, (2) emotional functioning, (3) medical care, and (4) role function. Participants assessed the frequency and difficulty of disease-related stressful events over the previous seven days. Data were collected from 48 Norwegian-speaking mothers of infants with CHD one month after hospital discharge. The psychometric properties of the frequency subscale were explored using exploratory factor analysis, and the discriminant and concurrent validity of the total scale were examined. RESULTS: Factor analysis revealed that some items had poor loadings in our sample of mothers of infants with CHD. Cronbach's alpha in domains was between 0.69 and 0.90. The Pediatric Inventory for Parents discriminated between stress levels in CHD severity in both subscales and all domains (-values 0.03 to 0.001). Difficulty of disease-related stress and symptoms of depression were moderately correlated ( = 0.56 to 0.63). CONCLUSION: The domains on the frequency subscale were multidimensional, and some items had lack of relevance to the population studied. Despite this, the Pediatric Inventory for Parents differentiated between stress in different CHD severity groups and correlated moderately with symptoms of depression. We recommend developing an infant version of the instrument. If the original version is used in mixed populations, lack of relevance of some items to infants should be accounted for.
Financial fragility in adults with CHD: a report from the CHD Project to Understand Lifelong Survivor Experience.
Golden C, Shi C, Oster ME … +5 more , Kochilas L, Marino B, Gaitonde M, Ilardi D, Fundora M
Cardiol Young · 2026 Jun · PMID 42366897 · Publisher ↗
BACKGROUND: Understanding the long-term implications of CHD has become a priority as survival rates have improved. Little is understood about the economic implications of living with CHD into adulthood. OBJECTIVES: We ai...
BACKGROUND: Understanding the long-term implications of CHD has become a priority as survival rates have improved. Little is understood about the economic implications of living with CHD into adulthood. OBJECTIVES: We aimed to determine the prevalence and risk factors of financial fragility (i.e., ability to pay $2,000 for an emergency expense) among adults with CHD in the United States and compare outcomes to their healthy siblings. METHODS: We conducted a cross-sectional study using data from the CHD Project to Understand Lifelong Survivor Experience survey (2021-2023). The survey assessed demographics, medical history, and economic outcomes, including financial fragility. Analyses included chi-square and Wilcoxon rank-sum tests with multivariable logistic regression models adjusted for demographic and socioeconomic factors. RESULTS: There were 3074 adults with CHD and 324 siblings who answered the financial fragility question. The prevalence of financial fragility was 20.6% for individuals with CHD versus 12.7% in siblings ( = 0.02); individuals with CHD had higher odds (OR 1.50, 95% CI 1.04-2.17, = 0.029) of financial fragility compared to siblings. Single ventricle anatomy was the only CHD group significantly associated with financial fragility (aOR 1.59, 95% CI 1.12-2.26). Financially fragile individuals were more likely to report blindness, be female or a race other than non-Hispanic white, and have single ventricle CHD. CONCLUSION: Adults with CHD experience greater financial fragility than their siblings and disease severity is associated with increased risk. Addressing financial fragility is essential to mitigate the long-term economic burden of CHD on patients and families.
Prone back electrocardiogram in healthy children: comparison with routine supine electrocardiogram.
Argun M, Yıldızoğulları GN, Karaçelik G … +9 more , Yörük K, Kaya EN, Konak HK, Takcı MZ, Kızıltuğ M, Dündar MA, Sunkak S, Elmalı F, Narin N
Cardiol Young · 2026 Jun · PMID 42366895 · Publisher ↗
BACKGROUND: In children, oxygen support in the prone position may be preferred for certain conditions such as acute respiratory distress syndrome. However, it is very difficult to place such patients in the supine positi...
BACKGROUND: In children, oxygen support in the prone position may be preferred for certain conditions such as acute respiratory distress syndrome. However, it is very difficult to place such patients in the supine position to obtain an electrocardiogram. We aimed to determine the effectiveness of prone back 12-lead electrocardiogram and detect electrocardiogram changes in healthy children. METHODS: The present study comprised 50 healthy children aged between 3 and 7 years. The patients first underwent a supine electrocardiogram test used in routine practice. Back electrocardiogram in prone position was obtained by placing six of the precordial leads (prone V1-prone V6) to the back of the patient. RESULTS: The average P wave, Q wave, R wave, S wave, and T wave amplitudes were significantly smaller in prone back leads (prone V1-prone V5) compared to supine precordial leads (supine V1-supine V5) ( < 0.001). The only exceptions were that the mean T wave amplitude in prone V3 and supine V3 was similar, and the mean Q wave amplitude in prone V5 and supine V5 was similar. The average P wave, Q wave, S wave, and T wave amplitudes were similar when prone V6 was compared with supine V6. CONCLUSION: A back electrocardiogram in the prone position is a useful and practical approach that provides valuable information to the clinician.
Impact of conotruncal anomalies on outcomes following total cavopulmonary connection.
Avgeridou S, Matsubara M, Dumitru R … +9 more , Schaeffer T, Palm J, Ruda C, Piber N, Heinisch PP, Hager A, Ewert P, Hörer J, Ono M
Cardiol Young · 2026 Jun · PMID 42366888 · Publisher ↗
OBJECTIVES: The impact of conotruncal anomalies on long-term outcomes after total cavopulmonary connection remains unclear, particularly regarding haemodynamic performance and dominant ventricular morphology. METHODS: Al...
OBJECTIVES: The impact of conotruncal anomalies on long-term outcomes after total cavopulmonary connection remains unclear, particularly regarding haemodynamic performance and dominant ventricular morphology. METHODS: All patients who underwent total cavopulmonary connection between 1994 and 2023 at a single centre were reviewed. Conotruncal anomalies were defined as transposition of the great arteries, double outlet right ventricle, tetralogy of Fallot, truncus arteriosus, and interrupted aortic arch type B. Four endpoints were analysed: transplant-free survival, Fontan failure, tachyarrhythmia, and ventricular dysfunction. Multivariable Cox regression, inverse probability of treatment weighting, and subgroup analyses were performed to disentangle conotruncal anomaly effects from dominant ventricular morphology. RESULTS: Among the 650 patients, 291 (44.8%) were identified with conotruncal anomalies. During a median follow-up of 6.3 years, no differences were observed in transplant-free survival (log-rank = 0.136) or Fontan failure ( = 0.717) between groups. Dominant right ventricular morphology was independently associated with Fontan failure (hazard ratio: 2.20; = 0.006) and tachyarrhythmia (hazard ratio: 3.22; = 0.004). These findings were confirmed across all sensitivity analyses. No differences were detected in filling pressures, cardiac index, or peak oxygen uptake on post-operative catheterisation ( = 226) and cardiopulmonary exercise testing ( = 161). When stratified into four groups by conotruncal status and dominant ventricular morphology, freedom from Fontan failure clustered by morphology rather than diagnostic category (4-way log-rank < 0.001). CONCLUSIONS: Conotruncal anomalies are not independently associated with adverse outcomes following total cavopulmonary connection. Dominant right ventricular morphology, not diagnostic category, is the principal determinant of long-term Fontan outcomes.
Health-related quality of life in children with cyanotic CHD compared with healthy peers: a case-control study, Sulaimani, Iraq.
Mustafa Kamal N
Cardiol Young · 2026 Jun · PMID 42357967 · Publisher ↗
BACKGROUND: Children with cyanotic CHD experience chronic hypoxaemia and recurrent medical interventions that may adversely affect health-related quality of life. AIMS: To compare health-related quality of life between c...
BACKGROUND: Children with cyanotic CHD experience chronic hypoxaemia and recurrent medical interventions that may adversely affect health-related quality of life. AIMS: To compare health-related quality of life between children with cyanotic CHD and healthy peers in Sulaimani, Iraq. METHODS: A hospital-based case-control study was conducted between October 2023 and April 2024, including 200 children with cyanotic CHD and 200 age- and sex-comparable healthy controls aged 3-13 years. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL™), including the Generic Core Scale Version 4.0 and the Cardiac Module Version 3.0, through parent-reported interviews. Group differences were examined using independent-samples -tests and analysis of covariance, adjusting for age, sex, peripheral oxygen saturation (SpO), and educational level. RESULTS: Children with cyanotic CHD had significantly lower health-related quality-of-life scores across all domains compared with healthy children (all -values < 0.001). After adjustment, the largest differences were observed in physical functioning and total quality of life, with large effect sizes (partial = 0.50 and 0.63, respectively). Mean SpO levels were also significantly lower among children with cyanotic CHD ( < 0.001). CONCLUSIONS: Cyanotic CHD was independently associated with substantial impairment in quality of life across physical and psychosocial domains. Lower peripheral oxygen saturation (SpO) was independently associated with poorer health-related quality of life. These findings support integrating health-related quality-of-life assessment and multidisciplinary care into the routine management of children with cyanotic CHD.
Transcatheter intervention for bilateral patent ductus arteriosus with isolated left brachiocephalic artery.
Hayashi K, Matsuo K, Aoki H
Cardiol Young · 2026 Jun · PMID 42345070 · Publisher ↗
In cases of isolated left brachiocephalic artery, if both ductus arteriosus remain patent, excessive pulmonary blood flow can occur, and cerebral perfusion may be compromised by a steal phenomenon, potentially leading to...
In cases of isolated left brachiocephalic artery, if both ductus arteriosus remain patent, excessive pulmonary blood flow can occur, and cerebral perfusion may be compromised by a steal phenomenon, potentially leading to cerebral atrophy. We report a case of an isolated left brachiocephalic artery with bilateral patent ductus arteriosus in which transcatheter closure of both ductus arteriosus was successfully performed.
Reframing medical therapy in the Fontan circulation: toward preservation of physiologic reserve and durability.
Stern HJ, Daugherty LR
Cardiol Young · 2026 Jun · PMID 42343191 · Publisher ↗
The Fontan circulation is defined by unique physiological constraints that limit preload, elevate systemic venous pressure, and reduce the capacity to compensate for stress or injury. Traditional paradigms for managing b...
The Fontan circulation is defined by unique physiological constraints that limit preload, elevate systemic venous pressure, and reduce the capacity to compensate for stress or injury. Traditional paradigms for managing biventricular heart failure are often misaligned with the pathophysiology of this preload-limited, non-pulsatile system. In this editorial, we propose a conceptual reframing of medical therapy in the Fontan circulation, centred on preserving physiological reserve and long-term durability rather than reversing established failure. We introduce a serial constraints model that emphasises the interconnected roles of the pulmonary vascular bed, ventricular filling, systemic output, venous and lymphatic function, and end-organ tolerance. As limitations shift over time, therapeutic focus must also evolve from pulmonary vasodilation in early stages to addressing ventricular dysfunction, venous congestion, and fibrosis later in the trajectory. We review emerging applications of phosphodiesterase type 5 inhibitors, sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and exercise within this framework, while cautioning against routine use of conventional renin-angiotensin-aldosterone system inhibition or beta-blockers in the absence of clear comorbid indications. Antithrombotic strategies remain important due to a persistent thrombo-inflammatory milieu. We advocate for a shift from reactive to trajectory-preserving therapy, targeting flow under stress, organ protection, and reserve conservation. This physiology-aligned, evidence-informed approach provides a rationale for earlier intervention and testable hypotheses for future Fontan-specific trials.
Familial hypercholesterolaemia in children: diagnostic profile and factors influencing diagnosis in a tertiary referral centre.
Kavrul Kayaalp G, Balcı MC, Kürkçü Güneş D … +3 more , Gunes S, Demirkol M, Gökçay GF
Cardiol Young · 2026 Jun · PMID 42343161 · Publisher ↗
BACKGROUND: Early identification of familial hypercholesterolaemia is critical to prevent long-term cardiovascular complications. This study assessed diagnostic features and age at diagnosis in children with familial hyp...
BACKGROUND: Early identification of familial hypercholesterolaemia is critical to prevent long-term cardiovascular complications. This study assessed diagnostic features and age at diagnosis in children with familial hypercholesterolaemia to identify factors influencing the diagnostic process and improve screening strategies. METHODS: A retrospective review was conducted on 129 paediatric patients with familial hypercholesterolaemia. Data on demographics, family history, clinical findings, lipid levels, and initial reasons for lipid testing were collected. RESULTS: Of 129 patients, 20.2% had homozygous and 79.8% had heterozygous familial hypercholesterolaemia. Diagnostic delay occurred in 82.9%, with a median of 6.8 years. The most common reason for lipid testing was incidental detection (29.5%), followed by clinical symptoms (23.2%). No significant association was found between testing reasons and age at diagnosis, diagnostic delay, duration of delay, or familial risk factors. Patients with parental hypercholesterolaemia had longer diagnostic delays (7.03 ± 3.54 vs. 4.18 ± 2.70 years, p = 0.016). No differences were observed in age at diagnosis or delay between patients with and without familial risk factors or clinical findings. CONCLUSION: The findings reveal significant diagnostic delays in paediatric familial hypercholesterolaemia, with most cases being diagnosed incidentally rather than through structured screening. There is a pressing need for systematic, context-specific screening strategies to improve early detection and reduce long-term cardiovascular risk.
Serial changes of mitral and tricuspid valve diameter after the Norwood procedure in patients with aortic atresia.
Matsubara M, Pletschacher A, Schaeffer T … +9 more , Lemmen T, Röhlig C, Palm J, Heinisch PP, Piber N, Hager A, Ewert P, Hörer J, Ono M
Cardiol Young · 2026 Jun · PMID 42343159 · Publisher ↗
BACKGROUND: In hypoplastic left heart syndrome with aortic atresia, the non-functional left ventricle may influence right ventricular performance. We evaluated serial changes in tricuspid and mitral valve diameters after...
BACKGROUND: In hypoplastic left heart syndrome with aortic atresia, the non-functional left ventricle may influence right ventricular performance. We evaluated serial changes in tricuspid and mitral valve diameters after the Norwood procedure and their relationship to right ventricular function. METHODS: Of 150 patients who underwent the Norwood procedure (2001-2020), 47 died before total cavopulmonary connection. Of the 103 survivors, 76 with sufficient serial echocardiographic data were analysed (1,399 examinations). Tricuspid and mitral valve diameters were measured, and right ventricular function was assessed. Right ventricular dysfunction was defined as any degree of impairment. Mixed-effects models were used to account for repeated measures. RESULTS: Median follow-up was 4.6 years (IQR 2.4-11.8). Right ventricular dysfunction was observed in 15.9% of examinations. Patients with right ventricular dysfunction had significantly larger tricuspid valve diameters than those with normal function (24.3 mm vs 23.4 mm, = 0.006), whereas mitral valve diameters showed no significant difference (7.6 mm vs 7.1 mm, = 0.120). The mitral/tricuspid ratio was similar between groups (0.320 versus 0.324, = 0.340). Mixed-effects modelling showed that the tricuspid valve diameter remained 0.618 mm larger in the dysfunction group after adjusting for growth over time ( = 0.029). Tricuspid valve diameter differences emerged at the bidirectional cavopulmonary shunt stage and accelerated through Fontan completion ( < 0.001). CONCLUSIONS: In hypoplastic left heart syndrome with aortic atresia, right ventricular dysfunction is associated with progressive tricuspid valve enlargement but not with changes in the mitral/tricuspid ratio. While the stable ratio suggests proportional annular growth, a comprehensive volumetric assessment is needed to clarify ventricular-ventricular interactions.
Opioid exposure in neonates and infants following cardiac surgery: a comparative analysis.
Jones MB, Riley C, Wernovsky G … +6 more , Sterzbecher V, Tariq O, Dazo M, Griffin E, Gordish H, Caprarola SD
Cardiol Young · 2026 Jun · PMID 42339608 · Publisher ↗
INTRODUCTION: Both untreated pain and opioid exposure impact neurodevelopment in critically ill infants. We aimed to describe and compare opioid exposure in neonates (30 days of age) post-cardiac surgery. METHODS: We con...
INTRODUCTION: Both untreated pain and opioid exposure impact neurodevelopment in critically ill infants. We aimed to describe and compare opioid exposure in neonates (30 days of age) post-cardiac surgery. METHODS: We conducted a secondary analysis of a single-centre retrospective cohort of all cardiac ICU surgical patients for 30 days. These findings also suggest the need for careful pain assessment and additional strategies to address pain in this vulnerable population.
Echocardiographic evidence of silent carditis in asymptomatic children with elevated antistreptolysin O titers: a cross-sectional study.
Koç S, Arslan D
Cardiol Young · 2026 Jun · PMID 42339605 · Publisher ↗
OBJECTIVES: Carditis, the main determinant of long-term morbidity in acute rheumatic fever, may be detected by echocardiography even in the absence of clinical signs. This study aimed to determine the prevalence of silen...
OBJECTIVES: Carditis, the main determinant of long-term morbidity in acute rheumatic fever, may be detected by echocardiography even in the absence of clinical signs. This study aimed to determine the prevalence of silent carditis in asymptomatic children with elevated antistreptolysin O titers and to evaluate associations with demographic and laboratory parameters. METHODS: In this cross-sectional study, 61 asymptomatic children with incidentally detected elevated antistreptolysin O titers between September 2020 and September 2021 were evaluated. Demographic characteristics, inflammatory markers, and standardised Doppler echocardiographic assessments based on World Heart Federation criteria were analysed. RESULTS: Silent carditis was identified in 8 of 61 patients (13.1%; 95% confidence interval 6.9 to 23.3). In the silent carditis group, 75% were female, and the median age was 12 years (interquartile range 9 to 14). Echocardiographic findings showed isolated mitral regurgitation in four patients and combined mitral and aortic regurgitation in four. Erythrocyte sedimentation rate was the only parameter that differed significantly between patients with and without silent carditis ( = 0.001). Antistreptolysin O levels showed weak negative correlations with haemoglobin (rho = -0.322, = 0.011) and left ventricular posterior wall thickness (rho = -0.270, = 0.036). CONCLUSIONS: Some asymptomatic children with elevated antistreptolysin O titers had echocardiographic findings consistent with silent carditis. However, antistreptolysin O levels and most inflammatory markers were not reliable predictors of valvular involvement. Echocardiography in selected cases may help detect subclinical cardiac involvement. Findings should be interpreted cautiously due to the limited sample size and cross-sectional design.
Haemodynamic effects of ketamine in the paediatric cardiac intensive care unit: insights from high-fidelity physiologic data.
Loomba RS, Ewing K, Yao A … +4 more , Evans M, Migally K, Chauhan A, Sourour W
Cardiol Young · 2026 Jun · PMID 42339600 · Publisher ↗
BACKGROUND: There has been a growing clinical application of ketamine for procedural sedation. This study aimed to determine its hemodynamic effects when utilized in patients in the pediatric cardiac intensive care unit....
BACKGROUND: There has been a growing clinical application of ketamine for procedural sedation. This study aimed to determine its hemodynamic effects when utilized in patients in the pediatric cardiac intensive care unit. METHODS: In this single-center, retrospective study, patients who were admitted to the pediatric cardiac intensive care unit and received a single dose of intravenous ketamine were studied. Patients were monitored utilizing high-fidelity physiologic data. Variables of interest for the study included: heart rate, arterial saturation, respiratory rate, mean arterial blood pressure, central venous pressure, and renal near infrared spectroscopy These variables of interest were obtained 30 min prior to the administration of ketamine, through 30 min after, serving as the comparison arm. Secondary aims included unexpected apnea, need for a fluid bolus, vasoactive bolus, or cardiopulmonary resuscitation. RESULTS: A total of 45 administrations of intravenous ketamine were included. Average dose was 0.8 mg/kg per dose. Average age was 8.1 months. After administration of ketamine, there was a statistically significant increase in heart rate, arterial saturation, renal near infrared spectroscopy and central venous pressure and a statistically significant decrease in respiratory rate and mean arterial blood pressure. No cardiopulmonary resuscitation or bolus vasoactive was required after ketamine administration. CONCLUSION: Intravenous ketamine dosed from 0.5 mg/kg to 1 mg/kg per dose in the pediatric cardiac intensive care unit appears safe and is associated with minimal hemodynamic change, apnea, or hemodynamic collapse. This represents the first data related to a single dose of ketamine's effect captured with a 1-s temporal resolution.
Diagnostic accuracy of electrocardiographic parameters to detect left atrial enlargement in children with post-tricuspid left-to-right shunt.
Parambil RA, Bhatt DD, Sachdeva S … +2 more , Yadav DK, Mohan A
Cardiol Young · 2026 Jun · PMID 42334367 · Publisher ↗
BACKGROUND: Left atrial enlargement is a surrogate marker for disease progression in congenital post-tricuspid left-to-right shunt lesions. Despite advanced imaging, a need persists for a more accessible modality like el...
BACKGROUND: Left atrial enlargement is a surrogate marker for disease progression in congenital post-tricuspid left-to-right shunt lesions. Despite advanced imaging, a need persists for a more accessible modality like electrocardiography for early detection of left atrial enlargement. This study evaluates the diagnostic accuracy of established electrocardiography standards and a novel electrocardiography criterion (with altered position of chest leads) in identifying left atrial enlargement in children with post-tricuspid shunt lesions, enabling routine monitoring and timely referrals. METHODS: This cross-sectional observational study enrolled 227 children (1 month-18 years) with post-tricuspid shunts (ventricular septal defect, patent ductus arteriosus, and aortopulmonary window). Left atrial volume determined by 2D echocardiography was used as the reference standard to compare the diagnostic accuracy of electrocardiography parameters (negative P-terminal force at V1, P/PR segment, and bifid P wave) in detecting left atrial enlargement. The diagnostic accuracy of a novel method of measuring negative P-terminal force with lead V1 placed at the 2nd right intercostal space was compared with traditional electrocardiography parameters. RESULTS: Electrocardiography parameters showed diagnostic accuracy of 52.9-61.5%, sensitivity of 32.5-90.8%, and specificity of 17.8-89.7% for left atrial enlargement. Novel P-terminal force in V1 at the 2ndintercostal space (>151.2 mm.ms) had 32.5% sensitivity, 89.7% specificity, and 59.5% accuracy. At the 4th Rt. Intercostal space (novel P-terminal force in V1 ≥40 mm.ms), it had 74.2% sensitivity, 42.1% specificity, and 59.0% accuracy. CONCLUSION: Measurement of the terminal negative force of the P wave at 2nd intercostal space has improved the specificity in the detection of left atrial enlargement. Future studies with higher sample sizes in a heterogeneous population might characterise this as a potential tool in detecting left atrial enlargement.
North American centre perspectives about a multi-institutional paediatric exercise network registry.
Burstein DS, Paridon SM, White DA
Cardiol Young · 2026 Jun · PMID 42333779 · Publisher ↗
Fifty-three North American clinical paediatric exercise laboratories were surveyed about developing a clinical paediatric exercise laboratory network and registry. Most clinical paediatric exercise laboratories (83.0%) e...
Fifty-three North American clinical paediatric exercise laboratories were surveyed about developing a clinical paediatric exercise laboratory network and registry. Most clinical paediatric exercise laboratories (83.0%) expressed interest in joining an exercise registry, and 73.1% reported willingness to modify protocols for standardised data collection. Clinical paediatric exercise laboratories reported potential registry benefits: CHD outcomes research, clinical paediatric exercise laboratory standardisation and accreditation; potential challenges: data entry burden, protocol selection restriction, and leadership support.
Sacubitril/valsartan in paediatric cardiomyopathy: a retrospective evaluation of ventricular response and clinical outcomes.
Karaman A, Günyel B, Caran B … +6 more , Cilsal E, Sevinc Sengul F, Ayyıldız P, Gokalp S, Guzeltas A, Atik Ugan S
Cardiol Young · 2026 Jun · PMID 42333770 · Publisher ↗
BACKGROUND: Sacubitril/valsartan is widely used in adults with heart failure with reduced ejection fraction, but paediatric experience, especially across ventricular dysfunction phenotypes, remains limited. AIM: To evalu...
BACKGROUND: Sacubitril/valsartan is widely used in adults with heart failure with reduced ejection fraction, but paediatric experience, especially across ventricular dysfunction phenotypes, remains limited. AIM: To evaluate the efficacy and tolerability of sacubitril/valsartan in children with cardiomyopathy and compare outcomes in patients with predominantly right or left ventricular dysfunction. METHODS: This single-centre retrospective study included 33 patients aged 1 month to 18 years who received sacubitril/valsartan between October 2020 and October 2024. Diagnoses included arrhythmogenic right ventricular cardiomyopathy, left ventricular non-compaction, and dilated cardiomyopathy. Patients were stratified by predominant ventricular dysfunction. Echocardiographic parameters, N-terminal pro B-type natriuretic peptide, six-minute walk test, NYHA class, blood pressure, creatinine, and potassium were recorded at baseline and at 1, 3, and 6 months, and at final follow-up. Clinical outcomes included rehospitalisation, death, and heart transplantation or listing. RESULTS: The cohort included 21 male patients (63.6%), and the median age was 8.6 years. Arrhythmogenic right ventricular cardiomyopathy was present in 45.5%, left ventricular non-compaction in 15.2%, and dilated cardiomyopathy in 39.4%. Left ventricular ejection fraction >45% increased from 39.4% to 72.7%. Mean N-terminal pro B-type natriuretic peptide decreased from 6309 to 3137 pg/mL ( < 0.001). NYHA class improved or remained stable in 93.3% of patients, with greater improvement in left ventricular dysfunction. During a median 17.3-months follow-up, rehospitalisation occurred in 42.4%, and 5 patients died or underwent heart transplantation/listing. Hypotension occurred in 18.2% but was manageable. CONCLUSION: Sacubitril/valsartan was generally well tolerated and associated with improved ventricular function, biomarkers, and functional status in paediatric cardiomyopathy, particularly in left ventricular dysfunction.
Severe rheumatic carditis in children: clinical profile and outcomes from a prospective Indian cohort.
Kasturi S, Marimuthu V, Arunakumar P … +2 more , Subramanian A, Mahimarangaiah J
Cardiol Young · 2026 Jun · PMID 42333764 · Publisher ↗
BACKGROUND: Acute rheumatic fever (ARF) with severe carditis remains a major cause of non-procedural pediatric cardiology admissions in low- and middle-income countries. Data describing the clinical profile and outcomes...
BACKGROUND: Acute rheumatic fever (ARF) with severe carditis remains a major cause of non-procedural pediatric cardiology admissions in low- and middle-income countries. Data describing the clinical profile and outcomes of children with severe carditis are limited. METHODS: This prospective study included 100 children admitted with ARF and severe carditis between 2015 and 2022. Clinical presentation, severity of shock, valvular involvement, ventricular function and management strategies were documented. Outcomes studied included requirement of inotropes, mechanical ventilation, duration of intensive care and hospital stay, intractable heart failure, mortality and need for surgery. RESULTS: Children were categorized into three groups according to hemodynamic severity. The duration of anti inflammatory treatment was 12 weeks. Group A included 18 children with decompensated shock, severe regurgitation of at least two valves and biventricular dysfunction. These children received pulse methylprednisolone followed by oral prednisolone, inotropes, diuretics and afterload reduction. Intractable heart failure was noted in 9 (50%) with a mortality of 4 (24%) and 5 (28%) requiring emergency surgery. Group B included 32 children with compensated shock and preserved ventricular function. They were treated with oral prednisolone tapered with addition of aspirin. Group C included 50 children without shock or ventricular dysfunction and treated with aspirin. Sixteen and ten children underwent surgery during one year follow-up in groups B and C respectively. CONCLUSION: Severe rheumatic carditis continues to cause substantial morbidity and mortality in children. Recurrent disease and multivalvular involvement are associated with poor outcomes. Early recognition, strict secondary prophylaxis and strengthened public health strategies are essential to reduce disease burden.
Hydrogel coils are associated with reduced post-embolisation fever and inflammation in paediatric aortopulmonary collateral embolisation.
Kojima T, Kobayashi T, Yoshiba S
Cardiol Young · 2026 Jun · PMID 42333760 · Publisher ↗
In patients with cyanotic congenital heart disease (CHD), aortopulmonary collateral arteries (APCAs) commonly develop as a compensatory source of pulmonary blood flow. However, APCAs increase pulmonary vascular resistanc...
In patients with cyanotic congenital heart disease (CHD), aortopulmonary collateral arteries (APCAs) commonly develop as a compensatory source of pulmonary blood flow. However, APCAs increase pulmonary vascular resistance and ventricular preload, potentially complicating the establishment of Fontan circulation. Coil embolisation of APCAs is routinely performed before Fontan completion, but post-procedural fever is frequently observed and may delay subsequent surgery. This study aimed to identify factors associated with post-embolisation fever, with a particular focus on the influence of coil type. We retrospectively reviewed 97 paediatric patients who underwent APCA coil embolisation between 2007 and 2023. Patients were categorised according to coil type: platinum coils only (P group, = 52), both platinum and hydrogel coils (P-H group, = 29), or hydrogel coils only (H group, = 16). The incidence of post-embolisation fever (≥38°C) and inflammatory markers were compared among groups. Histopathological characteristics of embolised vessels were also assessed. Overall, post-embolisation fever occurred in 64% of patients. The incidence of fever was significantly lower in the H group (25.0%) than in the P group (73.0%) and P-H group (68.9%) ( < 0.01). C-reactive protein levels increased significantly after fever onset, whereas white blood cell counts showed no meaningful change. Histopathological evaluation demonstrated prominent fibrin deposition and inflammatory cell infiltration in vessels embolised with platinum coils, while vessels treated with hydrogel coils exhibited only mild inflammatory changes. Hydrogel coils were associated with a lower incidence of post-embolisation fever and a milder inflammatory response than platinum coils. These findings suggest that coil selection may play an important role in minimising post-procedural inflammation and facilitating perioperative management in children preparing for the Fontan procedure.
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