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Age-adjusted NT-proBNP could help in the early identification and follow-up of children at risk for severe multisystem inflammatory syndrome associated with COVID-19(MIS-C)

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World Journal of Clinical Cases 2022年第29期10卷 10435-10450页

作者： Moises Rodriguez-Gonzalez Ana Castellano-Martinez division of pediatric cardiology Puerta del Mar University HospitalCadiz 11009Spain division of pediatric Nephrology Puerta del Mar University HospitalCadiz 11009Spain

BACKGROUND Multisystem inflammatory syndrome in children(MIS-C) has emerged as a new disease associated with COVID-19 that presents in acute critically ill children with acute cardiovascular *** To determine whether the age-adjusted N-terminal pro-brain natriuretic peptide(NT-proBNP) value(Z-log-NT-proBNP) is associated with severe MIS-C and myocardial *** A retrospective study was conducted which included children with MIS-C managed at our institution between April 1,2020,and February 28,*** divided the population into groups depending on severity based on pediatric intensive care unit(PICU) *** compared Z-log-NT-proBNP values across these groups and analyzed Z-log-NT-proBNP dynamics during the onemonth *** We included 17 participants [median age 3(2-9) years] and seven(41%) required PICU ***(100%) of these cases presented very high(Z-log > 4) levels of NT-proBNP at the time of admission compared to only 5(50%) patients with non-severe MIS-C(P = 0.025).NT-proBNP was significantly correlated with highsensitive Troponin I levels(P = 0.045),Ross modified score(P = 0.003) and left ventricle ejection fraction(P = 0.021).CONCLUSION Raised NT-proBNP,specifically very high values(Z-log-NT-proBNP > 4) could help in the early identification of MIS-C patients with myocardial dysfunction requiring inotropic support and PICU admission.

关键词： Multisystem inflammatory syndrome associated with COVID-19 COVID-19 SARS-CoV-2 NT-proBNP Echocardiography Myocardial dysfunction Children

Radiomics and molecular analysis:Bridging the gap for predicting hepatocellular carcinoma prognosis

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World Journal of Clinical Cases 2025年第4期13卷 56-60页

作者： Chun-Han Cheng Wen-Rui Hao Tzu-Hurng Cheng Department of Medical Education Linkou Chang Gung Memorial HospitalTaoyuan 33305TaiwanChina division of cardiology Department of Internal MedicineShuang Ho HospitalMinistry of Health and WelfareTaipei Medical UniversityNew Taipei 23561TaiwanChina division of cardiology Department of Internal MedicineSchool of MedicineCollege of MedicineTaipei Medical UniversityTaipei 11002TaiwanChina Department of Biochemistry School of MedicineCollege of MedicineChina Medical UniversityTaichung 404333TaiwanChina

This editorial examines a recent study that used radiomics based on computed tomography(CT)to predict the expression of the fibroblast-related gene enhancer of zeste homolog 2(EZH2)and its correlation with the survival of patients with hepatocellular carcinoma(HCC).By integrating radiomics with molecular analysis,the study presented a strategy for accurately predicting the expression of EZH2 from CT *** findings demonstrated a strong link between the radiomics model,EZH2 expression,and patient *** noninvasive approach provides valuable insights into the therapeutic management of HCC.

关键词： Hepatocellular carcinoma Computed tomography Radiomics Enhancer of zeste homologue 2 expression Non-invasive imaging

Exercise Catheterization for Hemodynamic Evaluation of Adults with Coarctation of the Aorta

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Congenital Heart Disease 2022年第6期17卷 605-615页

作者： Irene Martin de Miguel C.Charles Jain Alexander C.Egbe Jason H.Anderson Heidi M.Connolly William R.Miranda Department of Cardiovascular Medicine Mayo ClinicRochesterMinnesotaUSA Department of pediatric and Adolescent Medicine Division of Pediatric CardiologyMayo ClinicRochesterMinnesotaUSA

Background: Coarctation of the aorta (CoA) is associated with a generalized arteriopathy and long-term complicationsdespite repair. Data on invasive exercise hemodynamics in this population are lacking. Accordingly, wereviewed adults with CoA undergoing exercise catheterization to assess 1. hemodynamic profile;2. feasibilityfor assessment of CoA severity. Methods: Twenty patients undergoing exercise cardiac catheterization (12 armadduction and 8 supine cycle ergometry) at a quaternary care center between 2004 and 2021 were identified. Restingand exercise hemodynamic data were abstracted from the procedure logs. Results: Mean age was 43.6 ±12.0 years. Eleven patients (55%) had resting pulmonary arterial wedge pressure (PAWP) >15 mmHg;amongthose undergoing arterial catheterization, left ventricular end-diastolic pressure was >15 mmHg in 63%. Elevenpatients (55%) had pulmonary hypertension: 7 (35%) combined and 4 (20%) isolated post-capillary. At peak exercise,ΔPAWP/Δcardiac output (CO) ≥2 and Δmean pulmonary artery pressure/ΔCO ≥3 mmHg/l/min were foundin 7 (78%) and 6 (67%) patients, respectively;the composite of exercise PAWP ≥25 mmHg or ΔPAWP/ΔCO>2 was seen in 12 (86%). CoA peak-to-peak gradients at baseline (n = 14) and during exercise (n = 9) were 12(3–16) and 16 mmHg (9–28), respectively. Only 2 patients had an increase in CoA gradient to >20 mmHg withexercise. Conclusions: Diastolic dysfunction and pulmonary hypertension were highly prevalent, with exerciseunmasking abnormal diastolic and pulmonary vascular reserve in some individuals. Most patients failed to showsignificant increases in CoA peak-to-peak gradients with exercise. Further studies are warranted to establish thebest diagnostic method for CoA severity assessment.

关键词： Coarctation of the aorta exercise heart catheterization diastolic dysfunction hypertension

Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

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Congenital Heart Disease 2023年第4期18卷 431-445页

作者： Yuki Kawasaki Takeshi Sasaki Daisuke Kobayashi division of pediatric cardiology Osaka City General Hospital Pediatric Medical CenterOsaka5340021Japan division of cardiology St.Louis Children’s HospitalDepartment of PediatricsWashington University in St.LouisSt.LouisMO 63130USA

Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized thathemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinicalfeatures and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients whounderwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVRindex (SVRI) ≥ 20;B, CI < 3, SVRI ≥ 20;C, CI ≥ 3, SVRI < 20;and D, CI < 3, SVRI < 20. The primary outcome wasfreedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart transplant,and death. Clinical and hemodynamic variables and freedom from the endpoint were compared betweenthe hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients wereincluded. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. Allthe patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascularresistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category Dhad a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category Dwere outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamicprofiling.

关键词： Cardiac index systemic vascular resistance perfusion pressure hemodynamic category fontan circulation prognosis

Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy

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World Journal of Clinical Cases 2016年第8期4卷 219-222页

作者： Ashish P Saini Stephen E Cyran Steven M Ettinger Linda B Pauliks division of pediatric cardiology Department of Pediatrics Penn State Hershey Medical College division of cardiology Heart and Vascular InstitutePenn State Hershey College of Medicine

A 15-year-old boy with transposition of the great arteries(TGA) and neonatal arterial switch operation(ASO) presented with complete occlusion of the left main coronary artery(LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram(CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies.

关键词： Transposition of the great vessels Arterial switch operation Coronary angiography Ergometry Coronary occlusion

Multi-Institutional US Experience of the Occlutech AFR Device in Congenital and Acquired Heart Disease

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Congenital Heart Disease 2022年第1期17卷 107-116页

作者： Barry O’Callaghan Jenny Zablah Joseph Vettukattil Daniel Levi Morris Salem Allison Cabalka Jason Anderson Makram Ebeid Ryan Alexy Gareth J.Morgan The Heart Institute Children’s Hospital ColoradoAuroraUSA pediatric cardiology Helen DeVos Children’s HospitalGrand RapidsUSA pediatric cardiology UCLA HealthMattel Children’s HospitalLos AngelesUSA pediatric cardiology UCLA Medical CentreLos AngelesUSA pediatric cardiology Mayo ClinicRochesterUSA pediatric cardiology University of Mississippi Medical CenterJacksonUSA pediatric cardiology Riley Hospital for Children at Indiana University HealthIndianapolisUSA

Objectives:To detail the US multi-institutional experience with the Occlutech©(Occlutech International AB,Helsingborg,Sweden)atrial flow regulator(AFR)in children and adults with acquired or congenital heart ***:The creation of a long-term atrial communication is desirable in several cardiovascular disease phenotypes,most notably pulmonary arterial hypertension,disorders of increased left ventricular filling and increased cavopulmonary pressures in patients with a Fontan type ***:Patients were identified for inclusion from the AFR device manufacturer *** was collected using a RedCap database following IRB approval.8 weeks of follow up data was sought for each patient based on available *** was analyzed and summarized using ***:We report the experience of 6 US centers in the implantation of AFR devices in 15 patients,across a wide age range,with different disease phenotypes and a variety of *** was technically successful in all patients and improvement was noted in both clinical and hemodynamic *** were no immediate or intermediate term complications reported.3 patients died remote from *** deaths were not felt to be related to the AFR device or related procedural ***:Compassionate use of the AFR device in children and adults with congenital&acquired heart disease is technically feasible and produces beneficial short term hemodynamic and symptomatic *** uptake of this technique and treatment at specialist centers has the potential to provide significant benefits to a variety of complex patients with currently limited treatment options and indeterminate prognosis.

关键词： Congenital heart disease pulmonary hypertension left atrial hypertension single ventricle palliation diastolic heart failure

3D Non-Fluoroscopic Cryoablation of Right-Sided Accessory Pathways in Children:Monocentric Study and Literature Review

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Congenital Heart Disease 2021年第6期16卷 561-572页

作者： Fabrizio Drago Irma Battipaglia Pietro Paolo Tamborrino Luigina Porco Camilla Calvieri Mario Salvatore Russo Vincenzo Pazzano Romolo Remoli Massimo Stefano Silvetti pediatric cardiology and Cardiac Arrhythmias Unit Department of Pediatric Cardiology and Cardiac SurgeryBambino GesùChildren’s HospitalIRCCSRomeItaly

Background:Cryoablation of accessory pathways(APs)is effective and very safe in children,as previously reported by our *** aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children,comparing results obtained with the Ensite VelocityTM and the more recent Ensite PrecisionTM 3D mapping *** and Results:From January 2016 to December 2019,102 pediatric patients[mean age 12.5±2.8,62 males(61%of total cohort)]with right APs underwent 3D non-fluoroscopic transcatheter cryoablation at our ***(14.7%)patients had previously undergone catheter *** procedural success rate was 95.1%(n=97).No significant differences were detected in acute success rates achieved with Ensite Velocity^(TM)or Ensite PrecisionTM systems nor between manifest(94%)and concealed APs(100%).No permanent complications *** follow-up(428±286 days,median 396 days[interquartile range 179-713]),19 patients(19.6%)had *** were more frequent for parahissian/anterior APs compared to midseptal/posterior and lateral APs(p=0.043).Recurrences were not related to the Ensite system used.A redo ablation procedure was attempted in 13 cases,11 cryoablation and 2 radiofrequency ablations:the former was successful in 10 cases out of 11(90.9%).Conclusion:3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy,resulting in great benefit to the *** rates are not high and patients can be retreated with cryo-energy with higher success rates.

关键词： 3D Mapping accessory pathway children cryoablation pediatric tachyarrhythmias

Congenital coronary artery anomalies:what about the young?

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Journal of Geriatric cardiology 2004年第1期1卷 15-16页

作者： Phillip Moore division of pediatric cardiology University of California San FranciscoUSA

Drs. Rigatem, Rigatelli, and Trivellato present a complete retrospective review of the prevalence of congenital coronary abnormalities in a cohort of consecutive adult patients catheterized at their institution and compare them to younger patients ＜ 65 years of *** review in detail the clinical implications of these findings and then offer an algorithm for management. This article is particularly timely and significant as we move into an era of non-invasive coronary imaging with CT,MRI, and improved echo that will allow ns to make these diagnoses more often and with greater accuracy in younger patients. This will have a significant impact on the nanagement of symptomatic patients diagnosed at catheterization but also on asymptomatic patients diagnosed on screening evaluations.

关键词： retrospective young prevalence cohort fistula 曲加 abnormal tonic 玄石 sinus

When the Blood Pressure Misleads You:A Diagnostic Conundrum in an Unusual Case of Coarctation

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Congenital Heart Disease 2021年第6期16卷 675-680页

作者： Eva Kapravelou Hugo Issa Gordon Culham Martin Hosking Sanjiv K.Gandhi Shubhayan Sanatani Department of pediatrics Division of CardiologyUniversity of British ColumbiaVancouverCanada division of pediatric Cardiothoracic Surgery University of British ColumbiaVancouverCanada Department of pediatric Radiology British Columbia Children’s HospitalVancouverCanada

A 4-month-old previously healthy baby was found to be in congestive heart failure with LV dysfunction and a right aortic arch with severe coarctation,undetectable by blood pressure measurements.A cardiac CT and central blood pressure led to the diagnosis of a unique anatomic variant of aortic *** diagnosed the patient underwent surgery with an uncomplicated recovery.

关键词： Aorta coarctation right arch congenital heart disease