Renal replacement therapy is sometimes utilised after paediatric heart transplant, although current data on this are extremely limited. We sought to identify incidence of renal replacement therapy and patient characteristics, comorbidities, and outcomes when renal replacement therapy was needed around paediatric heart transplant.

The Pediatric Health Information System database was queried for paediatric intensive care patients who underwent a heart transplant from 2018 to 2021. Demographic and clinical data were analysed. Only patients admitted for heart transplant with heart transplant occurring on day 0 of admission were included to ensure that renal replacement therapy was postoperative.

A total of 235 patients who underwent heart transplant were included. Of these, 22 (9.3%) required renal replacement therapy. Mortality during admission was 3.8% in those without renal replacement therapy and 40.9% of patients requiring renal replacement therapy. Renal replacement therapy was associated with cardiomyopathy, infection, rejection, acute kidney injury, acute hepatic failure, and fluid overload.

Renal replacement therapy was utilised in 9.3% of paediatric heart transplant admissions and is associated with increased mortality. Postoperative need for renal replacement therapy is associated with increased mortality and adverse transplant outcomes.

Left ventricular assist devices are increasingly used in paediatric patients with end-stage heart failure. Although they improve survival and functional capacity, serious complications can occur.

We report an 11-year-old girl with dilated cardiomyopathy supported by a left ventricular assist device (HeartMate 3) as a bridge to transplant. Despite periodic education about the use of a left ventricular assist device, she entered the sea, leading to driveline and battery seawater exposure. She presented with device alarms but was initially stable. Given the risk of corrosion, emergent battery and lead replacement were performed under intensive monitoring with inotropic support. She experienced transient hypotension during left ventricular assist device cessation but recovered uneventfully.

This is the first paediatric case describing left ventricular assist device seawater exposure. The case highlights the importance of repeated education, psychological support, and preparedness for high-risk interventions. This case also underlines potential infectious and corrosive risks following seawater exposure.

Our study aimed to explore risk factors for medium–giant coronary artery aneurysms in children with Kawasaki disease.

6,540 eligible children with Kawasaki disease who were diagnosed in Wuhan Children’s Hospital from January 2011 to December 2023 were retrospectively analysed. The clinical and laboratory data were compared between medium–giant group and non–medium–giant group.

A total of 6,540 patients with Kawasaki disease were included, and 162 (2.5%) developed medium–giant coronary artery aneurysms, of whom 56 (0.9%) were giant. Univariate analysis showed a statistically significant difference between the two groups in 22 variables (P< 0.05). The least absolute shrinkage and selection operator regression analysis revealed that intravenous immunoglobulin resistance, haemoglobin, platelet count, and albumin were the most significant risk factors for medium–giant coronary artery aneurysms. The result of binary logistic regression analysis showed that intravenous immunoglobulin resistance (OR = 6.474, 95%CI = 4.399 ∼ 9.528, P< 0.001), platelet count elevation (OR = 1.003, 95%CI = 1.002 ∼ 1.004, P< 0.001), and albumin reduction (OR = 0.912, 95%CI = 0.879 ∼ 0.946, P< 0.001) were independent risk factors affecting the occurrence of medium–giant coronary artery aneurysms, and the area under the curve of the regression model was 0.75, with a sensitivity of 62.3% and a specificity of 79.2%.

Intravenous immunoglobulin resistance, platelet counts elevation, and albumin levels reduction may be significant predictors of medium–giant coronary artery aneurysms and can serve as a reference for early diagnosis of medium–giant coronary artery aneurysms.

This study aimed to identify echocardiographic predictors of successful weaning from extracorporeal membrane oxygenation in paediatric and congenital heart disease patients.

We retrospectively analyzed pediatric patients who underwent venoarterial extracorporeal membrane oxygenation for cardiogenic shock or postoperative support between March 2018 and September 2023. Clinical and echocardiographic variables assessed at the time of weaning evaluation were compared between patients who were successfully weaned and those who were not.

Among the 46 enrolled patients, 31 were successfully weaned from extracorporeal membrane oxygenation. The mean age at extracorporeal membrane oxygenation initiation was 9.6 ± 13.9 years, and the mean duration of support was 12.3 ± 12.1 days. Patients in the successfully weaned group had significantly higher left ventricular ejection fraction (50.9 ± 16.4% vs. 27.3 ± 18.7%, p < 0.001) and higher velocity time integral at the left ventricular outflow tract (12.3 ± 8.0 cm vs. 4.1 ± 3.6 cm, p = 0.001) compared with the unsuccessfully weaned group. The cutoff values for predicting successful weaning were a left ventricular ejection fraction of 43.03% (sensitivity, 74.2%; specificity, 86.7%) and a velocity time integral of 4.45 cm (sensitivity, 92.0%; specificity, 66.7%).

Left ventricular ejection fraction and velocity time integral provide valuable echocardiographic information for predicting successful weaning from extracorporeal membrane oxygenation in pediatric patients and may support clinical decision-making during weaning assessments.

Critical CHD often requires surgical intervention or results in infant mortality. We aimed to determine the association between critical CHD categories and exposure levels to pollutants.

A retrospective study of n = 1484 infants who underwent complex cardiac surgery in early infancy from 1996 to 2021. The association between critical CHD categories (compared to a reference category with chromosomal abnormality) and exposure levels during early pregnancy to nitrogen dioxide, ozone, fine particulate matter (<2.5 micrometers diameter), and air quality from smoke was determined. Spatial heterogeneity was accounted for using geographically weighted multinomial logistic regression.

For fine particulate matter exposure, 0.34% of locations displayed statistically significant negative associations with critical CHD categories, clustered in Saskatchewan and Manitoba. These regions exhibited small spatial extents. For ozone exposure, 15.1% of locations exhibited statistically significant negative associations with critical CHD categories, with the majority originating from Alberta and a smaller fraction in Saskatchewan. Differences in significant associations with locations were observed before and after spatial adjustment. Air quality from smoke and nitrogen dioxide exposure demonstrated no statistically significant associations with critical CHD categories.

Differences before and after geographic spatial adjustment underscored the importance of accounting for spatial heterogeneity to uncover patterns of association between environmental pollutants and critical CHD categories. The negative associations likely reflected pollution acting as a second hit to markedly increase the risk for critical CHD in those with genetic predisposition.

This study investigates the impact of patent ductus arteriosus (PDA) status and treatment response on myocardial adaptation in preterm infants by comparing serial echocardiographic trajectories across three groups: high-risk infants with treatment success, high-risk infants with treatment failure, and low-risk infants not requiring treatment.

In this prospective cohort study, preterm infants born < 29 weeks’ gestation were stratified using the EL-Khuffash PDA Severity Score and subsequent response to medical therapy. Echocardiographic assessments were performed at three timepoints: day 2, 2 weeks, and 36 weeks corrected gestational age. A range of structural and functional parameters was analysed.

Of 184 included infants, 58 were high risk with treatment success, 52 were high risk with treatment failure, and 74 were low risk. High-risk infants with treatment failure had persistent myocardial and haemodynamic alterations, including higher left ventricular wall thickness and lower coeliac artery velocities at follow-up. Treatment success was associated with improvements in strain metrics, systemic perfusion, and structural indices. Low-risk infants demonstrated spontaneous PDA closure and overall stable haemodynamics. Distinct differences in the evolution of myocardial trajectories between groups were apparent between day 2 and week 2 echocardiograms.

Serial echocardiographic assessments highlight the dynamic impact of PDA treatment response on myocardial adaptation. Persistent ductal patency despite treatment is associated with sustained structural and functional changes. Early definitive ductal closure may promote haemodynamic stability and mitigate maladaptive remodelling in a subgroup of high-risk infants.

To evaluate car seat tolerance screening failure rate in infants with CHD, clinical factors associated with test failure, and the impact of a failed test.

Single-centre retrospective study of 193 infants with CHD discharged from a general cardiology service between November 2020 and November 2024. Characteristics were compared between patients who passed and failed car seat testing using Wilcoxon-Mann–Whitney tests for continuous variables, and chi-square or Fisher’s exact tests for categorical variables.

Car seat test failure rate was 6.2% (12 of 193 patients). Neither median birthweight (3.2 kg vs. 3.3 kg, p = 0.68) nor the rate of prematurity (13.8% vs. 16.7%, p = 0.68) differed significantly between passing and failing groups. There was no relationship between cardiac physiology and car seat test failure (p = 0.39). There were no differences in rates of seizure (p = 0.29), stroke (p = 1.00), gastroesophageal reflux disease (p = 0.84), vocal cord dysfunction (p = 1.00), or pulmonary hypertension (p = 1.00) between passing and failing groups. Infants who failed had significantly higher rates of DiGeorge Syndrome (25.0%) compared to those who passed (2.2%) (p = 0.006). Readmission within 30 days of discharge was not different between failing (16.7%) and passing (17.1%) groups (p = 1.00). A failed test delayed discharge by a median of 1.5 days [IQR: 1.0–2.5 days].

The car seat test failure rate of our CHD cohort is higher than the published failure rate for premature infants. There was no relationship between cardiac physiology and test failure. DiGeorge Syndrome was the only comorbidity associated with increased failure rate. Failed car seat tests delay hospital discharge.

Utilisation of nicardipine in the neonatal and infant period has been historically avoided due to a concern for a more calcium-sensitive myocardium. The aim of this study was to characterise the association between nicardipine and systolic blood pressure in neonates and infants after cardiac surgery.

In this single-centre, retrospective study, patients under 12 months of age who underwent cardiac surgery and received nicardipine for at least one hour were included (September 2022 to January 2024). Patients were monitored with Etiometry. Variables of interest included haemodynamic parameters, ionised calcium, serum lactate, vasoactive infusion score, and nicardipine dose. A time series regression was conducted with each patient having 5 distinct time points.

One hundred and eighty-five time points were collected across 37 patients with a mean age of 3 months. Of these patients, 22% were neonates and 32% were functionally univentricular. With nicardipine utilisation, a decrease in systolic blood pressure of 14 mmHg after an 8-hour time period was noted (p = 0.017). Heart rate, diastolic blood pressure, cerebral and renal oxygen extraction, ionised calcium, serum lactate, and vasoactive inotrope score did not significantly change over the study period.

Nicardipine utilisation in neonates and infants after cardiac surgery was associated with decreased systolic blood pressure. Indirect markers demonstrate no change in cardiac function. Additional studies are needed to better elucidate nicardipine’s role in this patient population.

This study compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD and identified predictors of special education or early intervention plan.

Data were analysed from the 2022 National Survey of Children’s Health using complex weighted survey data procedures. Chi-square tests compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD. Multivariate logistic regression identified predictors of the need for special education or early intervention plan.

11,097 National Survey of Children’s Health responses pertained to children aged 3–5 years. Children aged 3–5 years with CHD were more likely than heart-healthy peers to be born prematurely, have special healthcare needs, have parent-reported health as “fair” or “poor,” be diagnosed with anxiety, depression, or a developmental disorder, and receive special education or an early intervention plan. Children aged 3–5 years with CHD were less likely to have acquired communication, fine motor, personal social, and problem-solving skills than comparators at the time of the survey, even after adjustment for special healthcare needs. Having public plus private insurance, special healthcare needs designation, and a developmental disorder predicted children aged 3–5 years needing special education or an early intervention plan.

Children with predictors of receiving special education or an early intervention plan may benefit from early identification and support. Further research should investigate the impact of systemic disparities on developmental skill acquisition in children with CHD.

The bidirectional Glenn surgery is an important staging procedure for patients with single ventricle physiology. Approximately 1000 children are born each year in the United States with this subset of CHD. There is limited data regarding optimal post-operative management for these children. We surveyed paediatric cardiac intensive care providers surrounding their management strategies after the bidirectional Glenn surgery.

An anonymous survey was distributed via email to paediatric cardiac intensive care providers. The survey included anonymised demographic data and focused on post-operative physiologic targets for patients recovering after the bidirectional Glenn surgery.

Thirty-five paediatric cardiac intensive care providers responded to an anonymous 12-question survey. Subjects were mostly comprised of paediatric cardiac intensive care attendings (80%), with an average of 7.86 years of training. The respondents primarily practised in settings with medical trainees, and all practised in settings with extracorporeal membrane oxygenation capabilities.

Respondents were asked to complete a web-based survey. Five of the survey questions were devoted to background demographic data, and seven questions were aimed at identifying physiologic targets. Two of the seven questions were in relation to a provided clinical vignette.

This survey demonstrated that there is a lack of consensus in the management of patients after the bidirectional Glenn surgery. Specifically, granular SpO2, mean arterial pressure, and pH Goals were all less than 75% consensus. This survey highlights the variable practice patterns in providers taking care of patients after the bidirectional Glenn surgery, and further demonstrates the need for physiologic and outcome-driven targets to optimise the post-operative care.

Lung ultrasound findings in cardiac patients correlate with mortality, hospital length of stay, and rehospitalisation after surgery. We report a lung ultrasound protocol integrated with echocardiography and its ability to predict adverse events in children after discharge following congenital heart surgery.

A prospective, single-blinded observational trial was performed. Subjects were consecutively identified after Fontan or septal defect repairs. Performed by cardiac sonographers at discharge, lung ultrasound scores were based on the number of B-lines. The primary outcome was subsequent development of new pericardial (≥small) or pleural (>small) effusion.

A total of 86 subjects were identified with adequate imaging for enrolment. Median age was 53 months. Procedures included Fontan (n = 23) and atrial (n = 30), ventricular (n = 28), and atrioventricular (n = 5) septal defect repairs. Lung ultrasound score was correlated with hospital length of stay (ρ = 0.29, p = 0.0066), discharge diuretic score (ρ = 0.38, p < 0.001), and chest tube duration (ρ = 0.25, p = 0.021); score was not correlated with age or weight. Primary outcome occurred in 12 subjects (atrial septal defect = 4, Fontan = 8). A lung ultrasound score ≥3 had a negative predictive value of 93% and an odds ratio of 24.5 (95%CI 5.3–113, p < 0.0001) for the primary outcome. Subjects following Fontan with the lung ultrasound score ≥3 had an odds ratio of 8.3 (95%CI 1.2–59.0, p < 0.036).

Our results suggest that lung ultrasound during discharge echocardiography has encouraging prognostic value for post-operative complications in patients deemed suitable for discharge after congenital heart surgery. Further research is needed to discern how lung ultrasound can be used for goal-directed medical therapy.

Mahaim ablation poses a significant challenge among accessory pathway ablations. This study aims to present our findings on Mahaim ablation performed using a contact force catheter, emphasizing both the effectiveness and safety of this technique.

This is a single-centre retrospective cohort study. Twenty-two consecutive patients who underwent Mahaim pathway ablation procedures between January 2017 and January 2025 were included in the study. The EnSite Precision System (Abbott, St. Paul, MN, USA) was used to facilitate mapping and to reduce or eliminate the need for fluoroscopy. Ablation was performed using the TactiCath catheter.

The median age was 11 years (range: 7–18). Antidromic tachycardia was induced in all patients with the left bundle block. All patients underwent successful ablation with the TactiCath catheter. Ablation was performed via the jugular approach in 11 patients and via the femoral region in another 11 patients. Ablation procedures were performed under atrial pacing in four patients regarding catheter stabilization. Locations of the Mahaim signals were at the right anterolateral (n = 6), right lateral (n = 7), and right posterolateral (n = 9) tricuspid annulus. The acute success rate was 100% (22/22). Fluoroscopy was not used on any patient. The median procedure time was 132 minutes (range: 72–411). No major complications were observed. One recurrent patient who presented with a tachycardia attack one month later had Ebstein’s anomaly. An ablation procedure was successfully performed from the right lateral region.

In paediatric Mahaim tachycardia ablations, the use of a contact force catheter can be safe and successful.

Patients with 22q11.2 deletion are known to have immune abnormalities. Data on the immune profile of non-syndromic patients with conotruncal heart defects are limited.

A prospective study evaluated the genetic and immunological profiles and early to mid-term postoperative outcomes of patients with conotruncal heart defects.

Infants with 22q11.2 deletion had low leukocyte counts, while low total lymphocyte counts were observed in all patients except infants without a genetic syndrome. Reduced CD3+, CD4+, and CD8+ cells were found in 22q11.2 deletion neonates and infants, as well as in infants without a genetic syndrome. Immunoglobulin G, M, and A abnormalities occurred across all groups. T cell receptor excision circle levels were lowest in patients with complex heart defects. Kappa-deleting recombination excision circle levels were increased in patients without a genetic syndrome. Early postoperative infections were frequent in all groups. Neonates with 22q11.2 deletion had longer ICU stay and higher need for antibiotics and hospital readmission at 3 and 6 months of follow-up.

Neonates and infants with conotruncal heart defects have low preoperative T lymphocyte counts, reduced T cell receptor excision circle and immunoglobulin levels, and high incidence of postoperative infections. Higher kappa-deleting recombination excision circle levels compensated the T cell disbalances in patients without a genetic syndrome. The presence of a 22q11.2 deletion with conotruncal heart defects was associated with prolonged mechanical ventilation, longer ICU length of stay, higher need for antibiotic treatment after discharge from the hospital, and readmission risk in neonates after cardiac surgery.