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Pubblicazioni recenti - pediatric cardiac
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Fabrication of a pediatric torso phantom with multiple tissues represented using a dual nozzle thermoplastic 3D printer.
J Appl Clin Med Phys2020 Oct;():. doi: 10.1002/acm2.13064.
Mille Matthew M, Griffin Keith T, Maass-Moreno Roberto, Lee Choonsik,
Abstract
PURPOSE:
To demonstrate an on-demand and nearly automatic method for fabricating tissue-equivalent physical anthropomorphic phantoms for imaging and dosimetry applications using a dual nozzle thermoplastic three-dimensional (3D) printer and two types of plastic.
METHODS:
Two 3D printing plastics were investigated: (a) Normal polylactic acid (PLA) as a soft tissue simulant and (b) Iron PLA (PLA-Fe), a composite of PLA and iron powder, as a bone simulant. The plastics and geometry of a 1-yr-old computational phantom were combined with a dual extrusion 3D printer to fabricate an anthropomorphic imaging phantom. The volumetric fill density of the 3D-printed parts was varied to approximate tissues of different radiographic density using a calibration curve relating the printer infill density setting to measured CT number. As a demonstration of our method we printed a 10 cm axial cross-section of the computational phantom's torso at full scale. We imaged the phantom on a CT scanner and compared HU values to those of a 1-yr-old patient and a commercial 5-yr-old physical phantom.
RESULTS:
The phantom was printed in six parts over the course of a week. The printed phantom included 30 separate anatomical regions including soft tissue remainder, lungs (left and right), heart, esophagus, rib cage (left and right ribs 1 to 10), clavicles (left and right), scapulae (left and right), thoracic vertebrae (one solid object defining thoracic vertebrae T1 to T9). CT scanning of the phantom showed five distinct radiographic regions (heart, lung, soft tissue remainder, bone, and air cavity) despite using only two types of plastic. The 3D-printed phantom demonstrated excellent similarity to commercially available phantoms, although key limitations in the printer and printing materials leave opportunity for improvement.
CONCLUSION:
Patient-specific anthropomorphic phantoms can be 3D printed and assembled in sections for imaging and dosimetry applications. Such phantoms will be useful for dose verification purposes when commercial phantoms are unavailable for purchase in the specific anatomies of interest.
© 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.
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Preoperative echocardiographic parameters predict primary graft dysfunction following pediatric lung transplantation.
Pediatr Transplant2020 Oct;():e13858. doi: 10.1111/petr.13858.
Himebauch Adam S, Wong Wai, Wang Yan, McGowan Francis X, Berg Robert A, Mascio Christopher E, Kilbaugh Todd J, Lin Kimberly Y, Goldfarb Samuel B, Kawut Steven M, Mercer-Rosa Laura, Yehya Nadir,
Abstract
The importance of preoperative cardiac function in pediatric lung transplantation is unknown. We hypothesized that worse preoperative right ventricular (RV) systolic and worse left ventricular (LV) diastolic function would be associated with a higher risk of primary graft dysfunction grade 3 (PGD 3) between 48 and 72 hours. We performed a single center, retrospective pilot study of children (<18 years) who had echocardiograms <1 year prior to lung transplantation between 2006 and 2019. Conventional and strain echocardiography parameters were measured, and PGD was graded. Area under the receiver operating characteristic (AUROC) curves and logistic regression were performed. Forty-one patients were included; 14 (34%) developed PGD 3 and were more likely to have pulmonary hypertension (PH) as the indication for transplant (P = .005). PGD 3 patients had worse RV global longitudinal strain (P = .01), RV free wall strain (FWS) (P = .003), RV fractional area change (P = .005), E/e' (P = .01) and lateral e' velocity (P = .004) but not tricuspid annular plane systolic excursion (P = .61). RV FWS (AUROC 0.79, 95% CI 0.62-0.95) and lateral e' velocity (AUROC 0.87, 95% CI 0.68-1.00) best discriminated PGD 3 development and showed the strongest association with PGD 3 (RV FWS OR 3.87 [95% CI 1.59-9.43], P = .003; lateral e' velocity OR 0.10 [95% CI 0.01-0.70], P = .02). These associations remained when separately adjusting for age, weight, primary PH diagnosis, ischemic time, and bypass time. In this pilot study, worse preoperative RV systolic and worse LV diastolic function were associated with PGD 3 and may be modifiable recipient risk factors in pediatric lung transplantation.
© 2020 Wiley Periodicals LLC.
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Soluble factors released by dedifferentiated fat cells reduce the functional activity of iPS cell-derived cardiomyocytes.
Cell Biol Int2020 Oct;():. doi: 10.1002/cbin.11487.
Watanabe Hirofumi, Kanemaru Kazunori, Hagikura Kazuhiro, Matsumoto Taro, Ayusawa Mamoru, Morioka Ichiro,
Abstract
Interactions between tissues such as epicardial adipose (EAT), and myocardial tissues is important in the pathogenesis of heart failure. Changes in adipose tissues in obesity or diabetes impair preadipocyte differentiation. Furthermore, pro-inflammatory cytokine secretion is higher in preadipocytes than in mature adipocytes in diabetes and obesity. However, how undifferentiated cells committed to the adipose lineage directly influence cardiomyocytes is not yet understood. We used human-derived dedifferentiated fat (DFAT) cells as models of undifferentiated cells committed to an adipose lineage. Here, we evaluated the effects of soluble factor interactions in indirect cocultures of DFAT cells and induced pluripotent stem cell-derived cardiomyocytes (iPS-CM). Our RNA sequencing findings showed that these interactions were predominantly inflammatory responses. Furthermore, pro-inflammatory cytokines secreted by DFAT cells reduced myocardial functions such as contraction frequency and catecholamine sensitivity, and simultaneously increased apoptosis, decreased antioxidative stress tolerance and reduced oxygen consumption rates in cardiomyocytes. These adverse effects might be attributable to monocyte chemoattractant protein-1 (MCP1), chemokine (C-X-C motif) ligands 1 (CXCL1) and 12, granulocyte colony stimulating factor (GCSF), interleukins (IL) 6 and 8, macrophage migration inhibitory factor (MIF) and plasminogen activator inhibitor1-A (PAI1-A) among the pro-inflammatory mediators secreted by DFAT cells. Our results could be useful for understanding the pathogenesis of EAT-related heart failure in terms of the involvement of undifferentiated cells committed to the adipose lineage. Furthermore, we suggest the importance of focusing on surrounding adipose tissues as a strategy with which to maximize the survival and function of transplanted stem cell-derived cardiomyocytes. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Reversible Myocardial Injury Associated with SARS-CoV-2 in an Infant.
JACC Case Rep2020 Oct;():. doi: 10.1016/j.jaccas.2020.09.031.
Sharma Madhu, Gorstein Samuel, Aldrich Margaret L, Hsu Daphne T, Choueiter Nadine F,
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been associated with myocardial dysfunction and heart failure in adult patients. We report a case of reversible myocardial injury and heart failure in an infant with SARS-CoV-2 infection.
© 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.
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Newborn Screening for Pompe Disease.
Int J Neonatal Screen2020 Jun;6(2):31. doi: 10.3390/ijns6020031.
Sawada Takaaki, Kido Jun, Nakamura Kimitoshi,
Abstract
Glycogen storage disease type II (also known as Pompe disease (PD)) is an autosomal recessive disorder caused by defects in ?-glucosidase (A?Glu), resulting in lysosomal glycogen accumulation in skeletal and heart muscles. Accumulation and tissue damage rates depend on residual enzyme activity. Enzyme replacement therapy (ERT) should be started before symptoms are apparent in order to achieve optimal outcomes. Early initiation of ERT in infantile-onset PD improves survival, reduces the need for ventilation, results in earlier independent walking, and enhances patient quality of life. Newborn screening (NBS) is the optimal approach for early diagnosis and treatment of PD. In NBS for PD, measurement of A?Glu enzyme activity in dried blood spots (DBSs) is conducted using fluorometry, tandem mass spectrometry, or digital microfluidic fluorometry. The presence of pseudodeficiency alleles, which are frequent in Asian populations, interferes with NBS for PD, and current NBS systems cannot discriminate between pseudodeficiency and cases with PD or potential PD. The combination of gene analysis with NBS is essential for definitive diagnoses of PD. In this review, we introduce our experiences and discuss NBS programs for PD implemented in various countries.
© 2020 by the authors.
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CCHD Screening Implementation Efforts in Latin American Countries by the Ibero American Society of Neonatology (SIBEN).
Int J Neonatal Screen2020 Mar;6(1):21. doi: 10.3390/ijns6010021.
Sola Augusto, Rodríguez Susana, Young Alejandro, Lemus Varela Lourdes, Villamayor Ramón Mir, Cardetti Marcelo, Pleitez Navarrete Jorge, Favareto María Verónica, Lima Victoria, Baquero Hernando, Velandia Forero Lorena, Venegas María Elena, Davila Carmen, Dominguez Dieppa Fernando, Germosén Taína Malena, Oviedo Barrantes Ada Nidia, Alvarez Castañeda Ana Lorena, Morgues Mónica, Avila Aldana, Fariña Diana, Oliva Jose Luis, Sosa Erika, Golombek Sergio,
Abstract
Congenital heart disease (CHD) is among the four most common causes of infant mortality in Latin America. Pulse oximetry screening (POS) is useful for early diagnosis and improved outcomes of critical CHD. Here, we describe POS implementation efforts in Latin American countries guided and/or coordinated by the Ibero American Society of Neonatology (SIBEN), as well as the unique challenges that are faced for universal implementation. SIBEN collaborates to improve the neonatal quality of care and outcomes. A few years ago, a Clinical Consensus on POS was finalized. Since then, we have participated in 12 Latin American countries to educate neonatal nurses and neonatologists on POS and to help with its implementation. The findings reveal that despite wide disparities in care that exist between and within countries, and the difficulties and challenges in implementing POS, significant progress has been made. We conclude that universal POS is not easy to implement in Latin America but, when executed, has not only been of significant value for babies with CHD, but also for many with other hypoxemic conditions. The successful and universal implementation of POS in the future is essential for reducing the mortality associated with CHD and other hypoxemic conditions and will ultimately lead to the survival of many more Latin American babies. POS saves newborns' lives in Latin America.
© 2020 by the authors.
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Universal Screening for CCHD in Saudi Arabia: The Road to a 'State of the Art' Program.
Int J Neonatal Screen2020 Mar;6(1):13. doi: 10.3390/ijns6010013.
AlAql Fahad, Khaleel Huda, Peter Vetha,
Abstract
Critical congenital heart disease (CCHD) has been defined as structural heart defects that are usually associated with hypoxia in the newborn period and have potential for significant morbidity and mortality early in life. CCHD has been estimated to be present in ?3 in 1000 live births, including Saudi Arabia. Pulse Oximetry Screening (POS) is a highly specific and moderately sensitive test for detecting CCHD with very low false-positive rates. The Kingdom of Saudi Arabia is among high-income countries with a population of more than 33 million and more than 600,000 annual live births. In 2015, the Universal Screening Program for CCHD using Pulse Oximetry was approved in Saudi Arabia. It is expected that any new national program will undergo a learning curve and face many challenges. We believe that developing countries may face different challenges during implementation of such national projects, but the success achieved by Saudi Arabia in implementing the program was mainly due to good preparation before launching the project and advancements in the use of the technology involved in this project. Since starting the universal CCHD screening in 2016, more than 900,000 babies have been screened in Saudi Arabia and many lives have been saved using this safe, non-invasive, inexpensive, and reasonably sensitive test.
© 2020 by the authors.
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Transcatheter Closure of Patent Ductus Arteriosus in Infants With Weight Under 1,500 Grams.
Front Pediatr2020 ;8():558256. doi: 10.3389/fped.2020.558256.
Fraisse Alain, Bautista-Rodriguez Carles, Burmester Margarita, Lane Mary, Singh Yogen,
Abstract
Persistent patent ductus arteriosus (PDA) is very common in preterm infants, especially in extremely preterm infants. Despite significant advances in management of these vulnerable infants, there has been no consensus on management of PDA-when should we treat, who should we treat, how should we treat and in fact there is no agreement on how we should define a hemodynamically significant PDA. Medical management with non-steroidal anti-inflammatory drugs (NSAIDs) remains the first line of therapy with moderate success rate in closing the PDA. Paracetamol has been reported to be a safe and equally effective medical therapy for closure of PDA. However, additional studies on its long-term safety and efficacy in extremely low birth weight infants are needed before paracetamol can be recommended as standard treatment for a PDA in preterm infants. Surgical ligation of PDA is not without an increased risk of mortality and co-morbidities. Recently, there has been a significant interest in percutaneous transcatheter closure of PDA in preterm infants, including extremely low birth weight infants. Transcatheter PDA closure in preterm ELBW infants is technically feasible with high PDA occlusion success rates and acceptable complication rates as compared to surgical ligation. Many centers have reported promising early- and mid-term follow-up results. However, they need to be further tested in the prospective well-designed studies and randomized controlled trials comparing the results and outcomes of this technique with current treatment strategies including medical treatment before they can be used as the new standard of care for PDA closure in extremely low birth weight infants.
Copyright © 2020 Fraisse, Bautista-Rodriguez, Burmester, Lane and Singh.
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Coronary Revascularization of Giant Aneurysms in Children With Kawasaki Disease: A Report of Two Cases.
Front Pediatr2020 ;8():547369. doi: 10.3389/fped.2020.547369.
Akimoto Katsumi, Harada Mana, Oda Hisayuki, Furukawa Takeshi, Takahashi Ken, Kishiro Masahiko, Shimizu Toshiaki, Nakanishi Keisuke, Kawasaki Shiori, Amano Atsushi,
Abstract
In recent years, >100 cases of coronary artery stenotic lesions due to Kawasaki disease were treated with coronary artery bypass grafting (CABG). Surgical indications include stenosis of >75%, myocardial infarction history, electrocardiographic changes, and ischemia, as detected by myocardial scintigraphy and electrocardiography, due to drugs or exercise. Some centers have reported good patency rates, even in infants. The advantages of CABG in younger patients are minimal loss of left ventricular function, early elimination of post-operative ischemia risk, and improved quality of life. However, the disadvantage of performing CABG in younger patients is the small coronary artery diameter and the thin vessel wall, which can lead to post-operative occlusion, especially when performed by inexperienced surgeons. The optimal timing of CABG varies by institution and case, which depends on the presence or absence of complications, such as left ventricular dysfunction or valve regurgitation, and surgeon's experience. Importantly, unlike adult surgery, childhood CABG needs to be kept open for the very longest possible period of time to determine the optimal conditions for surgery. We report two pediatric cases of giant coronary artery aneurysms diagnosed in infancy. During school age, the patients had a mild decline of left ventricular ejection function. In one case, there were no clinical symptoms because of the development of collateral vessels and limitation of exercise. Both patients underwent surgery with good results. The gastric gastroepiploic artery could be anastomosed owing to the development of collateral blood vessels, although it was obstructed. At 1 year after surgery, both patients had a good post-operative course without complications of anastomotic stenosis or myocardial damage due to aneurysm resection. If conditions are favorable, bypass surgery can be postponed to several years until the coronary arteries are sufficiently large to warrant a delay in coronary artery stenosis in cases of infantile Kawasaki disease.
Copyright © 2020 Akimoto, Harada, Oda, Furukawa, Takahashi, Kishiro, Shimizu, Nakanishi, Kawasaki and Amano.
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Polarized Light Imaging of the Myoarchitecture in Tetralogy of Fallot in the Perinatal Period.
Front Pediatr2020 ;8():503054. doi: 10.3389/fped.2020.503054.
Truong Ba Luu, Jouk Pierre-Simon, Auriau Johanne, Michalowicz Gabrielle, Usson Yves,
Abstract
The pathognomonic feature of tetralogy of Fallot (ToF) is the antero-cephalad deviation of the outlet septum in combination with an abnormal arrangement of the septoparietal trabeculations. The aim of this article was to study perinatal hearts using Polarized Light Imaging (PLI) in order to investigate the deep alignment of cardiomyocytes that bond the different components of the ventricular outflow tracts both together and to the rest of the ventricular mass, thus furthering the classic description of ToF. 10 perinatal hearts with ToF and 10 perinatal hearts with no detectable cardiac anomalies (control) were studied using PLI. The orientation of the myocardial cells was extracted and studied at high resolution. Virtual dissections in multiple section planes were used to explore each ventricular structure. Contrary to the specimens of the control group, for all ToF specimens studied, the deep latitudinal alignment of the cardiomyocytes bonds together the left part of the Outlet septum (OS) S to the anterior wall of the left ventricle. In addition, the right end of the muscular OS bonds directly on the right ventricular wall (RVW) superior to the attachment of the ventriculo infundibular fold (VIF). Thus, the OS is a bridge between the lateral RVW and the anterior left ventricular wall. The VIF, RVW, and OS define an "inverted U" that roofs the cone between the interventricular communication and the overriding aorta. The opening angle and the length of the branches of this "inverted U" depend however on three components: the size of the OS, the size of the VIF, and the distance between the points of insertion of the OS and VIF into the RVW. The variation of these three components accounts for a significant part of the diversity observed in the anatomical presentations of ToF in the perinatal period.
Copyright © 2020 Truong, Jouk, Auriau, Michalowicz and Usson.
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The Impact of a History of Pre-maturity on Viral Respiratory Infections in Children Under 2 Years of Age: A Propensity Score-Matching Analysis of in-hospital Complications and Mortality.
Front Pediatr2020 ;8():499013. doi: 10.3389/fped.2020.499013.
Zurita-Cruz Jessie, Gutierrez-Gonzalez Alejandro, Manuel-Apolinar Leticia, Fernández-Gárate José Esteban, Arellano-Flores María Luisa, Correa Gonzalez Roberto Alejandro, Vázquez-Rosales Guillermo, Pérez Vieyra Patricia, Sanchez-Armas Rocio, Cisneros-González Nelly,
Abstract
A history of pre-maturity may be a risk factor for complications in patients under 24 months of age hospitalized for viral respiratory infections (VRIs). To identify the impact of a history of pre-maturity on in-hospital complications and mortality in patients under 24 months of age who were hospitalized for VRIs over a period of 5 years. This was a propensity score-matched study. The database was compiled by physicians, electronically validated by engineers, and analyzed by statisticians. Patients diagnosed with VRIs (based on International Classification of Diseases [ICD-10]) codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219, J22X, and J189) from 2013 to 2017 were enrolled in the study. The subjects were classified into two groups according to the absence or presence of a history of pre-maturity (P070, P072, P073). Patients with congenital heart disease (CHD) (Q20-Q26) were excluded. Length of hospital stay, in-hospital complications, surgical procedures, and mortality were analyzed. Patients were matched according to age. For comparisons between groups, Student's -tests and chi tests were applied. A logistic regression model was constructed to identify factors related to in-hospital complications and mortality. In total, 5,880 patients were eligible for inclusion in the analysis. The average patient age was 14.25 weeks. The presence of pre-maturity (coefficient = 1.16), male sex, bronchopulmonary dysplasia (BPD), in-hospital infectious complications (coefficient = 11.31), and invasive medical procedures (coefficient = 18.4) increased the number of days of hospitalization. Invasive medical procedures (OR = 6.13), a history of pre-maturity (OR = 2.54), and male sex (OR = 1.78) increased the risk for in-hospital complications. In-hospital infectious complications (OR = 84.2) and invasive medical procedures (OR = 58.4) were risk factors for mortality. A history of pre-maturity increased the length of hospital stay and the rate of in-hospital complications but did not increase mortality in patients under 24 months of age hospitalized for VRIs.
Copyright © 2020 Zurita-Cruz, Gutierrez-Gonzalez, Manuel-Apolinar, Fernández-Gárate, Arellano-Flores, Correa Gonzalez, Vázquez-Rosales, Pérez Vieyra, Sanchez-Armas and Cisneros-González.
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Green Synthesis to Develop Iron-Nano Formulations and Its Toxicity Assays.
J Pharmacopuncture2020 Sep;23(3):165-172. doi: 10.3831/KPI.2020.23.3.165.
Kulkarni Smital, Mohanty Nimain, Kadam Nitin N, Swain Niharika, Thakur Mansee,
Abstract
Objectives:
In the past few years, herbal medicines have gained popularity over synthetic drugs because of their natural source and minimal side effects which has led to a tremendous growth of phytopharmaceuticals usage. With the development of nanotechnology, it provides alternative approaches to overcome several limitations using nano-formulations. In spite of considerable quantity of antianemic preparations with different iron forms available, currently additives are used and represented in modern pharmaceutical market. Iron deficiency anemia is a major global public health problem which particularly affects pregnant women, children and elderly persons. The situation is complicated because of disadvantages and drug side effects from existing antianemic medicines. There is a great demand for the development of new antianemic preparations. Green synthesis of iron oxide nanoparticles, possess high potential in this field.
Methods:
Our study focuses on developing green synthesis of iron oxide nanoparticles (IONPs) of 10-50 nm with spherical shape where different dosages were used -1 mg/kg, 10 mg/kg and 100 mg/kg for exposure in Wistar albino female rats for 28 days. The toxicity was assessed using various parameters such as measurements of the rat body and organ mass, hematology, biochemical evaluation and histopathological examinations.
Results:
No significant differences were observed in body and organ weights. Hematological indices also indicated no significant differences whereas biochemical factors showed increase in levels of direct bilirubin and globulin of medium as well as high dose and SGPT levels were increased only in high dose. The major organs (heart, kidney and liver) showed histopathological alterations in 10 and 100 mg/kg whereas brain showed only in 100 mg/kg.
Conclusion:
The toxicity of IONPs was found to be more significant when the concentration was increased; however, low doses can be used for further investigation as an antianemic preparation.
© 2020 Korean Pharmacopuncture Institute.
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Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review.
Front Neurosci2020 ;14():561186. doi: 10.3389/fnins.2020.561186.
Chiera Marco, Cerritelli Francesco, Casini Alessandro, Barsotti Nicola, Boschiero Dario, Cavigioli Francesco, Corti Carla G, Manzotti Andrea,
Abstract
Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby's overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby's stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant's HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant's clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients' health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.
Copyright © 2020 Chiera, Cerritelli, Casini, Barsotti, Boschiero, Cavigioli, Corti and Manzotti.
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The Hard Talk: Managing conflict in the cardiac intensive care unit.
Prog Pediatr Cardiol2020 Oct;():101306. doi: 10.1016/j.ppedcard.2020.101306.
Allen Kiona Y, Davis Audra,
Abstract
Conflict between parents and providers is common in the cardiac intensive care setting, particularly in patients with prolonged length of stay. Poor communication is the most commonly cited reason for conflict and is exacerbated when providers and families cannot find common ground and develop mutual trust. It is critically important that healthcare providers learn strategies to better partner with families in order to optimize patient medical and psychosocial outcomes. This requires providers to avoid falling prey to their own implicit (or unconscious) biases, including those towards families labeled as "difficult". Building a healthy family-provider relationship is part of a healthcare provider's duty to treat, has a measurable effect on patient outcomes, and sets up a foundation for the provider-family dyad to more easily navigate any conflicts that do develop. Once a relationship is built, providers and families can talk through their conflicts. They are more likely to have open and transparent communication and are more able to give each other the benefit of the doubt when navigating difficult situations and/or behaviors, rather than labeling each other as intrinsically "difficult" people.
© 2020 Elsevier B.V. All rights reserved.
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Medical Education in Pediatric and Congenital Heart Disease: A Focus on Generational Learning and Technology in Education.
Prog Pediatr Cardiol2020 Oct;():101305. doi: 10.1016/j.ppedcard.2020.101305.
Rogers Lindsay, Cohen Meryl S,
Abstract
Medical education is a complex interplay between teacher and trainee with the ultimate goal of producing competent physicians who provide excellent patient care. Physician education has evolved over centuries, from the apprenticeship of barber-surgeon through generations of bedside teachers and now evolving use of technology based instruction. All of these educational practices are based on expert assessment of effective techniques for imparting experience and knowledge on a new group of learners, the young doctor. In the past several decades, exponential growth in both medical innovation and technology development has occurred, leaving the current landscape of medical education with a substantial amount of medical data as well as innovative platforms for information access and distribution. These rapid changes have led to a stark differences between medical educators and learners in their world views and preferences relating to teaching and learning. Therefore, understanding how the current generation of medical trainees perceives the world, accesses and retains information is imperative to effective education. The concept of generational learning can be used as a framework to identify teaching and learning preferences and help build relevant and effective education content. This review article aims to outline our current understanding of generational characteristics, learning styles and preferences. Using this framework, we will explore innovative educational content relevant to pediatric cardiology. Finally, we propose that a methodical approach to curriculum development will forge this generational gap and lead to even more effective and sharable educational content within our field.
© 2020 Published by Elsevier B.V.
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Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity.
Surg Obes Relat Dis2020 Sep;():. doi: S1550-7289(20)30509-8.
Ryder Justin R, Xu Peixin, Nadeau Kristen J, Kelsey Megan M, Xie Changchun, Jenkins Todd, Inge Thomas H, Bjornstad Petter,
Abstract
BACKGROUND:
Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D.
OBJECTIVE:
To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D.
SETTING:
Longitudinal multicenter studies at University hospitals.
METHODS:
A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up.
RESULTS:
Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001).
CONCLUSION:
Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity.
Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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Cardiac stem cell therapy: Does a newborn infant's heart have infinite potential for stem cell therapy?
J Thorac Cardiovasc Surg2020 Sep;():. doi: S0022-5223(20)32623-4.
Sano Shunji, Sano Toshikazu, Ishigami Shuta, Ito Tatsuo,
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Aorto-left ventricular tunnel: case series of a rare disease.
Cardiol Young2020 Oct;():1-5. doi: 10.1017/S1047951120003273.
Diraneyya Obayda M, Alhabshan Fahad, Alghamdi Abdullah, Moafa Hussein, Alnasef Mohammed, Kabbani Mohamed S,
Abstract
INTRODUCTION:
Aorto-left ventricular tunnel is a rare disease that can cause significant morbidity early in life due to volume overload and left ventricular failure. Surgical intervention is usually curative with minimal early complications. However, long-term effects and outcome are not fully determined.
OBJECTIVE:
We are reporting a case series of this rare CHD with its long-term outcome.
METHODS:
We conducted a retrospective analysis of all children from birth to 14 years of age who were admitted between 2001 and 2020 with the diagnosis of aorto-left ventricular tunnel. Demographic, echocardiographic, and perioperative data were collected and reviewed. The pre-operative data were compared with data reviewed on the last outpatient follow-up.
RESULTS:
Total of five patients fulfilled our inclusion criteria. Three patients were diagnosed after auscultating an incidental murmur, one had symptoms of congestive heart failure, and one had an abnormal fetal echocardiogram. Echocardiography demonstrated stenotic and regurgitant aortic valve with severely depressed left ventricle function in two patients, one of them with also single left coronary artery. The other three patients had normal aortic valve structure and normal ventricular function. All five patients had surgical repair, two by patch closure at aortic end of aorto-left ventricular tunnel, two by patch closure at both aortic and left ventricular ends, and one by aortic root replacement using a homograft. During follow-up, there was no residual aorto-left ventricular tunnel in any of our five cases, two had moderate aortic regurgitation and one had moderate residual aortic stenosis.
CONCLUSIONS:
Spectrum of presentation for aorto-left ventricular tunnel varies from an occult lesion to frank left heart failure due to volume or less commonly, pressure overload. Early surgical repair is recommended and is usually associated with complete resolution. Long-term follow-up is recommended for aortic root dilatation and aortic valve competency, as valve function need to be addressed in a timely manner to avoid further complications.
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Perforated posterior mitral leaflet aneurysm in an 8-month-old infant.
Cardiol Young2020 Oct;():1-2. doi: 10.1017/S1047951120003340.
Nagaoka Kota, Ibuki Keijiro, Miyahara Yoshinori,
Abstract
Mitral valve aneurysm not associated with infective endocarditis is rarely reported in children. We report a case of perforated posterior mitral leaflet aneurysm in an infant with reference to surgical and histopathological findings. Although its aetiology remains unclear, we suggest to include mitral valve aneurysm in differential diagnosis as a cause of mitral regurgitation in children.
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ATRIAL FIBRILLATION IN A PEDIATRIC PATIENT WITH COVID-19 INFECTION.
Cardiol Young2020 Oct;():1-9. doi: 10.1017/S1047951120003893.
Santi Aura Daniella, Aquino Paolo, Dorfman Molly,
Abstract
The SARS-CoV-2 (COVID-19) pandemic has challenged our initial predictions of its ramifications, both short and long term. Cardiovascular manifestations of COVID-19 in pediatric patients remains a topic of investigation as literature is lacking. We describe new onset atrial fibrillation in a pediatric patient with a history of COVID-19 infection. Understanding of cardiogenic effects of COVID-19 can help minimize delay in diagnosis.
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