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Transplant Proc. 2025 Sep 20:S0041-1345(25)00427-0. doi: 10.1016/j.transproceed.2025.08.025. Online ahead of print.

ABSTRACT

BACKGROUND: Recently, marginal donor hearts have been applied to patients with end-stage heart failure due to rising waiting list mortality and increasing demand for donors. However, the principles of risk prevention and the usage of marginal donor hearts have yet to be clearly defined.

METHODS: A retrospective analysis was performed to investigate the outcomes of patients undergoing heart transplantation at our center between October 2019 and March 2024. Forty-four patients were enrolled and divided into the marginal donor heart group (n = 30) and the conventional donor heart group (n = 14) according to the classification criteria. The clinical data between the 2 groups were compared and analyzed.

RESULTS: There were no statistically significant differences in the postoperative length of hospitalization, ICU stay, left ventricular ejection fraction, or serum biochemical indicators between the 2 groups. Five patients died during the 3-month follow-up period. Notably, 1- and 3- month postoperative follow-up showed no significant differences in left ventricular ejection fraction, serum biochemical indicators, and mortality between the 2 groups CONCLUSION: The application of marginal donor hearts can partially alleviate the shortage of donor heart resources. It did not significantly affect patients' short-term survival or recovery.

PMID:40975674 | DOI:10.1016/j.transproceed.2025.08.025

Urol Oncol. 2025 Sep 19:S1078-1439(25)00254-6. doi: 10.1016/j.urolonc.2025.07.005. Online ahead of print.

ABSTRACT

INTRODUCTION: Transurethral resection of the bladder tumor (TURBT) followed by intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is a standard treatment for high-risk non muscle-invasive bladder cancer (NMIBC). However, due to potential risk of dissemination, current guidelines recommend caution when proposing BCG treatment in immunocompromised patients. Our aim was to assess the efficacy and safety of BCG treatment in immunocompromised patients.

MATERIALS AND METHODS: Patients aged ≥18 with a diagnosis of bladder cancer (BC) who underwent BCG therapy in 2007-2021, were identified in the MerativeTM Marketscan® Research Commercial and Medicare databases. Multivariable Cox proportion hazard regressions adjusted by relevant confounders were performed to investigate the influence of immunosuppression on the events associated with progression and recurrence of BC, both in the unmatched cohort and after 1:2 propensity score matching (PSM). Also, subgroup analysis on progression in patients without cancer other than BC was conducted.

RESULTS: Immunocompromised and immunocompetent patients had similar rates of disseminated BCG infection after intravesical immunotherapy. However, immunocompromised patients had shorter progression-free survival and higher probability of progression (aHR: 1.23, 95% CI: 1.11-1.38), as well as shorter recurrence-free survival and a higher probability of recurrence (aHR: 1.13, 95% CI: 1.05-1.20). Similar significant associations were observed in the PSM cohort. A subgroup analysis of patients without any additional oncological diagnoses beyond BC confirmed a higher likelihood of progression in the immunocompromised group (aHR: 1.34, 95% CI: 1.15-1.56).

CONCLUSIONS: BCG immunotherapy is safe in immunocompromised patients. Nevertheless, the efficacy of intravesical BCG in these patients might be suboptimal thus advocating the need for appropriate counselling and a possible lower threshold to consider radical treatment.

PMID:40975643 | DOI:10.1016/j.urolonc.2025.07.005

Bone. 2025 Sep 18;201:117653. doi: 10.1016/j.bone.2025.117653. Online ahead of print.

ABSTRACT

Chronic kidney disease-mineral and bone disorder (CKD-MBD) significantly contributes to cardiovascular morbidity and mortality in CKD patients, raising questions about the molecular mechanisms linking cardiac and bone abnormalities. In this study, adult male spontaneously hypertensive rats (SHRs) underwent 3/4 nephrectomy (Nx) to induce mild CKD-MBD, with sham-operated SHRs (SO) serving as controls. All animals were fed a standard diet containing 0.6 % phosphorus. Exhibiting renal dysfunction comparable to human CKD stage 2, Nx rats had higher levels of serum inorganic phosphate (Pi), calciprotein particles (CPPs), and myocardial phosphorus (P) without differences in serum PTH, FGF23, kidney and bone P content. Compared to controls, the experimental group showed features of lower bone turnover with reduced osteoblast and osteocyte numbers and decreased eroded perimeter, alongside myocardial hypertrophy and fibrosis. In bone and myocardium, reciprocal alterations of a tissue expression of Pi-transporters and MAPK-signals were found. Reduced bone turnover associated with a lower tissue expression of Slc20a1 (PiT1) and osteogenic Mapk1 (ERK2). In myocardium, Slc20a2 (PiT2) and phospho-ERK1/2 expression were upregulated at gene and protein levels in Nx rats versus controls. These findings suggest that, in the setting of CKD-associated Pi retention, maladaptive bone and myocardial responses are mediated by the dysregulation of Pi transporters and down-stream ERK1/2 signals.

PMID:40975510 | DOI:10.1016/j.bone.2025.117653

Radiologia (Engl Ed). 2025 Sep-Oct;67(5):101601. doi: 10.1016/j.rxeng.2025.101601. Epub 2025 Aug 5.

ABSTRACT

Valvular heart disease is a condition with increasing prevalence. Although the current treatment of choice is still valve repair or replacement surgery, percutaneous treatment techniques are valid alternatives for selected patients. Various non-invasive imaging techniques are currently available which can provide the information needed to select appropriate patients, planning procedures and techniques. This article reviews the usefulness of cardiac CT to assess patients who are candidates for percutaneous treatment of common valvular diseases. It also reviews the image acquisition protocol and its role in the pre-procedural study, as well as in the detection of the most common complications.

PMID:40975560 | DOI:10.1016/j.rxeng.2025.101601

Eur J Prev Cardiol. 2025 Sep 18:zwaf475. doi: 10.1093/eurjpc/zwaf475. Online ahead of print.

ABSTRACT

AIMS: Both lipoprotein(a) [Lp(a)] and peripheral artery disease (PAD) are associated with ischaemic events. We sought to assess the association between Lp(a) and major adverse cardiovascular events (MACE) and major lower extremity events (MALE) among patients with baseline PAD.

METHODS AND RESULTS: The Mass General Brigham (MGB) Lp(a) registry includes all individuals with Lp(a) measured at two tertiary care centres from 2000 to 2019. Those with PAD were grouped according to Lp(a) percentile: 1st-25th [Q1, Lp(a) ≤ 14 nmol/L], 26th-50th (Q2, 14-<42 nmol/L), 51st-75th (Q3, 42-<132 nmol/L), and 76th-100th (Q4, 132-855 nmol/L). Outcomes were MACE [composite of cardiovascular (CV) death, myocardial infarction, or coronary revascularization] and MALE (composite of peripheral revascularization, acute limb ischaemia, or major lower extremity amputation). Cox proportional hazard modelling was used to assess the association between Lp(a) and the outcomes of interest after adjusting for traditional risk factors. Among 3757 individuals with PAD [39% female, median age 68 (IQR: 58-77)], individuals with Lp(a) levels in the third and fourth quartiles had a 24 and 30% increased hazard of MACE, respectively [adj. hazard ratio (HR): 1.24, P = 0.005; adj. HR: 1.30, P = 0.001] when compared with those in the first quartile. Individuals in the fourth quartile had a 19% greater hazard of MALE (adj. HR: 1.19, P = 0.043).

CONCLUSION: Elevated Lp(a) in patients with PAD was associated with an increased risk of both MACE and MALE. Accordingly, measurement of Lp(a) may convey important prognostic value and allow for further risk stratification within this high-risk population.

PMID:40973195 | DOI:10.1093/eurjpc/zwaf475

Catheter Cardiovasc Interv. 2025 Sep 18. doi: 10.1002/ccd.70185. Online ahead of print.

ABSTRACT

BACKGROUND: Approximately half of individuals with acute coronary syndrome (ACS) are affected by multivessel coronary artery disease (CAD), and recent studies in the field have presented conflicting data on effective benefit of complete revascularization. The aim of this study was to investigate the efficacy and safety of multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI in individuals presenting with acute coronary syndrome and multivessel CAD.

METHODS AND RESULTS: Randomized trials on ACS comparing multivessel PCI versus culprit-only PCI were included. The primary efficacy outcome was all-cause death. The primary safety outcomes were major bleeding and contrast induced nephropathy. Secondary ischemic and safety outcomes were also investigated. Subgroup analyses were conducted to investigate the consistency of the effect sizes as a function of age (younger vs older individuals, using a cut-off of 65 years) and of a higher or lower prevalence of diabetic patients (using a cut-off of 20% for each study). A total of 11 randomized trials including 10,150 individuals with a mean follow-up of 21.7 months were included. Compared with cluprit-only PCI, multivessel PCI significantly reduced the risk of all-cause death (risk ratio 0.86, [0.74-1.00], p = 0.047), mainly due to a significant reduction in cardiovascular mortality by 26%. Similarly, the rates of new myocardial infarction and unplanned revascularization were significantly reduced. No increases in major bleeding, contrast induced nephropathy or stroke were observed, with a significantly higher rate of stent thrombosis in complete revascularization group, even if with a low absolute risk (risk ratio 1.69 [1.10, 2.59], p = 0.027). Subgroup analyses revealed a significant interaction for death in studies with higher prevalence of diabetics (p for interaction = 0.029), but no interaction for death with regards of age.

CONCLUSION: In individuals presenting with ACS and multivessel CAD, complete revascularization was associated with a significant reduction in all-cause mortality, with a lower rate of major ischemic events and no significant increase in major complications. The benefit was particularly evident in diabetic patients.

PMID:40968459 | DOI:10.1002/ccd.70185

Curr Cardiol Rev. 2025 Sep 17. doi: 10.2174/011573403X396917250910215747. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVE: This systematic review and meta-analysis compares percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) as revascularization strategies for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD).

METHODS: A comprehensive search of PubMed, Embase, and CENTRAL was conducted, with a pre-registered study protocol registered on PROSPERO (ID: CRD42024496529). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of allcause mortality, myocardial infarction (MI), stroke, or ischemia-driven revascularization. Secondary endpoints included each component of MACCE and 30-day all-cause mortality.

RESULTS: Seven studies were analyzed, including five cohort studies and two subanalyses of randomized clinical trials, encompassing 3,475 patients. PCI was associated with a higher incidence of MACCE (hazard ratio [HR]: 1.50; 95% confidence interval [CI] 1.26-1.79), driven by allcause mortality (HR: 1.38; 95% CI 1.07-1.78), MI (HR: 1.75; 95% CI 1.17-2.62), and ischemiadriven revascularization (HR: 3.22; 95% CI 2.10-4.93). There were no differences in stroke rates (HR: 0.70; 95% CI 0.40-1.22) or 30-day all-cause mortality (odds ratio [OR]: 0.92; 95% CI 0.35-2.41).

DISCUSSION: While previous studies have reported conflicting evidence regarding the noninferiority of PCI to CABG in patients with LMCAD, our pooled analysis demonstrates an increased incidence of MACCE in the PCI group, primarily driven by higher rates of all-cause mortality, myocardial infarction, and ischemia-driven revascularization. The findings suggest that CKD may play a role in clinical outcomes comparable to diabetes in multivessel disease and should be a key factor in revascularization decisions.

CONCLUSION: CABG is associated with superior long-term outcomes compared to PCI in patients with LMCAD and CKD. However, dedicated randomized controlled trials stratified by CKD stage are essential to guide optimal treatment strategies in this high-risk population.

PMID:40968418 | DOI:10.2174/011573403X396917250910215747

Cardiol Rev. 2025 Sep 19. doi: 10.1097/CRD.0000000000001057. Online ahead of print.

ABSTRACT

Cardiovascular complications remain the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM), despite substantial advances in pharmacologic management. Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown potential in reducing cardiovascular events through its multifaceted metabolic and anti-inflammatory effects. This systematic review and meta-analysis aimed to assess the efficacy and safety of semaglutide in improving cardiovascular outcomes among patients with T2DM. A comprehensive literature search was conducted across multiple databases up to March 30, 2025. Randomized controlled trials comparing semaglutide with placebo in adults with T2DM were included. Five randomized controlled trials with a total of 19,717 participants were included. Semaglutide was associated with a significant reduction in major adverse cardiovascular events [risk ratios (RR), 0.82; P < 0.00001], cardiovascular death (RR, 0.81; P = 0.05), and need for coronary revascularization (RR, 0.74; P < 0.0001). A significant reduction in cardiac disorder-related adverse events was also observed (RR = 0.80; P = 0.03). No significant difference was noted in all-cause mortality (RR = 0.83; P = 0.16), hospitalization for heart failure (RR = 0.86; P = 0.10) or unstable angina (RR = 0.94; P = 0.63), nonfatal myocardial infarction (RR = 0.82; P = 0.10) or stroke (RR = 0.83; P = 0.06), and vascular disorders (RR = 1.03; P = 0.73). These findings highlight semaglutide's role as a cardioprotective agent, supporting its integration into standard care for high-risk T2DM patients.

PMID:40968407 | DOI:10.1097/CRD.0000000000001057

Crit Rev Eukaryot Gene Expr. 2025;35(6):1-10. doi: 10.1615/CritRevEukaryotGeneExpr.v35.i6.10.

ABSTRACT

Myocardial fibrosis is a critical pathological process in the progression of heart failure and other cardiovascular diseases. Kaempferol (KMP), a natural flavonoid, has antioxidant and anti-inflammatory properties. This study investigates the effects of KMP on myocardial fibrosis. Isoproterenol injection was used to establish myocardial fibrosis mouse model. Cardiac function was assessed by echocardiography. Histology analysis was conducted using Masson assay and Sirius red staining. The expression of survival of motor neuron 1 (α-SMA) and Collagen III was detected using immunohistochemistry. RNA expression was detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Cytokine release was detected using enzyme-linked immunosorbent assay. Protein expression was detected using Western blot. We found that KMP treatment improved cardiac function as well as suppressed myocardial fibrosis. Moreover, KMP treatment decreased expression of fibrosis-related genes and attenuated inflammation in fibrotic hearts. Furthermore, KMP treatment inhibited the expression of coagulation factor VII (FVII), the overexpression of which promoted inflammation response and myocardial fibrosis. In summary, KMP exerts protective effects against myocardial fibrosis via downregulating FVII. These findings suggest that KMP may be a promising therapeutic candidate for myocardial fibrosis.

PMID:40972093 | DOI:10.1615/CritRevEukaryotGeneExpr.v35.i6.10

FASEB J. 2025 Sep 30;39(18):e71046. doi: 10.1096/fj.202502567RR.

ABSTRACT

Sepsis-induced cardiomyopathy (SICM) is a severe complication of sepsis, characterized by myocardial inflammation, oxidative stress, and cardiac dysfunction. Chlorogenic acid (CGA), a natural polyphenol with known anti-inflammatory and antioxidant properties, is abundant in many traditional medicinal plants used for cardiovascular and inflammatory disorders. However, its cardioprotective effects in SICM and the underlying mechanisms remain unclear. An in vivo cecal ligation and puncture (CLP) model was used to induce SICM in rats, followed by CGA treatment. Cardiac function and myocardial injury markers were assessed, while NLRP3 inflammasome activation and CaMKIIα involvement were investigated using molecular docking, gene overexpression, and site-directed mutagenesis. H9c2 cardiomyocytes were treated with lipopolysaccharide (LPS) and hypoxia/reoxygenation (H/R) to establish an in vitro SICM model. Mitochondrial function and pyroptosis were evaluated using oxygen consumption rate (OCR), extracellular acidification rate (ECAR), scanning electron microscopy (SEM), and key protein expression analysis. CGA improved cardiac function, reduced myocardial injury markers, and alleviated inflammation and fibrosis in SICM rats. CGA (25 μM) improved H9c2 cell viability in LPS + H/R-induced SICM by reducing LDH, CK-MB, and cTnT levels and suppressing inflammation, oxidative stress, and pyroptosis. It preserved mitochondrial function and cristae structure. Molecular docking and functional studies confirmed CGA binds to CaMKIIα and NLRP3, inhibiting inflammasome activation via the Ca2+/CaMKIIα pathway. Mutation of the GLU60 binding site abolished CGA's protective effects both in vitro and in vivo. CGA ameliorates SICM by suppressing NLRP3 inflammasome activation and pyroptosis through the Ca2+/CaMKIIα pathway. These findings offer new insights into CGA's cardioprotective effects and highlight its potential as a therapeutic agent for SICM.

PMID:40970598 | DOI:10.1096/fj.202502567RR

JACC Case Rep. 2025 Sep 17;30(28):105413. doi: 10.1016/j.jaccas.2025.105413.

ABSTRACT

Baffle stenosis and thrombus formation are recognized complications of atrial switch operation (ASO), with no concurrent cases documented. A 23-year-old man with dextro-transposition of the great arteries who had previously undergone Mustard ASO presented with progressive dyspnea, peripheral edema, and abdominal distension. Cardiac computed tomography (CT) showed severe bicaval baffle stenosis and 2 superior vena cava baffle thrombi, one occluding the stenosed segment. Mechanical thrombus fragmentation, systemic thrombolysis, and sequential stent implantation in both baffles achieved complete recovery. Follow-up cardiac CT confirmed patency of the stent and the absence of thrombi. The patient was discharged symptom free and on a daily regimen of acenocoumarin, with close follow-up. This case report emphasizes the value of cardiac CT in assessing baffle-related complications and guiding precise interventional strategies. In patients with a history of ASO and baffle complications, percutaneous stenting provides an effective alternative to surgical intervention.

PMID:40973326 | DOI:10.1016/j.jaccas.2025.105413

Biochim Biophys Acta Mol Basis Dis. 2025 Sep 17;1872(1):168052. doi: 10.1016/j.bbadis.2025.168052. Online ahead of print.

ABSTRACT

Bicuspid aortic valve (BAV) is a congenital malformation that predisposes individuals to thoracic aortic aneurysm (TAA), with endothelial dysfunction playing a pivotal role in its pathogenesis. Endothelial cell senescence is a hallmark of endothelial dysfunction, yet direct evidence linking endothelial senescence to BAV-TAA has not been established. In this study, we generated induced pluripotent stem cells (iPSCs) from both BAV-TAA patients and healthy controls, subsequently differentiating them into endothelial cells (iECs). Our findings revealed that BAV-TAA-iECs exhibited senescence phenotype, including impaired proliferation, diminished migratory capacity, upregulated senescence markers (p53, p21, p16), and a pronounced senescence-associated secretory phenotype (SASP). Transcriptomic analysis through RNA sequencing indicated aberrant activation of the FOXO signaling pathway in BAV-TAA-iECs which might contribute to BAV-TAA-iEC senescence. Inhibition of FOXO1 signaling using AS1842856 effectively reversed the senescence phenotype, restored endothelial nitric oxide synthase (eNOS) expression, attenuated SASP cytokine levels, and mitigated inflammation through the p65 and p38 signaling pathways. These findings suggest that endothelial cell senescence plays a critical role in the pathogenesis of BAV-TAA, and targeting FOXO1 signaling may represent a promising therapeutic strategy for BAV-associated aortic diseases.

PMID:40972881 | DOI:10.1016/j.bbadis.2025.168052

Int J Surg Case Rep. 2025 Sep 4;136:111915. doi: 10.1016/j.ijscr.2025.111915. Online ahead of print.

ABSTRACT

INTRODUCTION: Moebius syndrome is a rare congenital condition involving underdevelopment of cranial nerves VI and VII, often causing facial palsy. Also rare, bronchial stenosis may cause recurrent respiratory infections. There is scarce evidence on the outcomes of pediatric patients undergoing open surgical repair for congenital bronchial stenosis.

PRESENTATION OF CASE: An eight-year-old male with Moebius syndrome and tracheostomy-dependent since infancy, presented with fever, severe respiratory compromise and left lung atelectasis. Bronchoscopy revealed severe stenosis of the left main bronchus and the right upper lobe bronchus. Despite two bronchoscopic balloon dilations, the obstruction recurred. The patient successfully underwent bronchoplasty under extracorporeal membrane oxygenation (ECMO) with resection of the stenotic segment and end-to-end anastomosis. After 97 inpatient days, he was discharged home with usual nocturnal ventilation support.

DISCUSSION: The diagnosis of congenital bronchial stenosis (CBS) is difficult because of its rarity and nonspecific presentation. Severe cases may warrant definitive surgical repair and ECMO provides critical support to ensue oxygenation and hemodynamic stability while the airway procedure takes place. Open bronchoplasty offers a safe and effective option when bronchoscopic management fails.

CONCLUSION: Early recognition of CBS in children with complex comorbidities such as Moebius syndrome is key for prompt management. Multidisciplinary efforts are crucial for optimal patient outcomes.

PMID:40972128 | DOI:10.1016/j.ijscr.2025.111915

Interdiscip Cardiovasc Thorac Surg. 2025 Sep 15:ivaf207. doi: 10.1093/icvts/ivaf207. Online ahead of print.

ABSTRACT

OBJECTIVES: When tricuspid valve repair is unfeasible due to extensive damage or a complex congenital malformation, surgeons consider tricuspid valve replacement (TVR). However, it is still controversial and challenging to choose the best substitute. We aimed to introduce the innovative intra-operatively valve construction using the native right atrial appendage (RAA) tissue for TVR and investigate the short-term outcomes.

METHODS: This study recruited paediatric and adult patients with unrepairable severe tricuspid regurgitation (TR) who needed TVR. The patient's right atrial appendage tissue was harvested and used to reconstruct a native bileaflet valve during surgery. Trans-thoracic echocardiography was conducted before operation, 6, and 12 months after surgery.

RESULTS: The procedure was successfully executed on three patients with valve destruction as a result of infective endocarditis (IE), and three patients who had severe TR due to congenital anomalies. There was no mortality or related morbidity. All the constructed valves had proper function with no complications after the surgery. Follow-up echocardiographic studies showed stable and satisfactory valve function with no regurgitation or significant stenosis.

CONCLUSIONS: The novel tricuspid valve operation using native RAA tissue demonstrates promising short-term results. Further studies with larger cohorts and longer follow-ups are required to confirm the technique's reliability and long-term effectiveness.

PMID:40971856 | DOI:10.1093/icvts/ivaf207

Pediatr Cardiol. 2025 Sep 19. doi: 10.1007/s00246-025-04028-8. Online ahead of print.

NO ABSTRACT

PMID:40970946 | DOI:10.1007/s00246-025-04028-8

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):105-111. doi: 10.4103/apc.apc_79_25. Epub 2025 Aug 29.

ABSTRACT

OBJECTIVE: Ventricular assist device (VAD) implantation is an established treatment for infants with severe heart failure (HF), serving as a bridge to heart transplantation or enabling myocardial recovery. This study aims to evaluate the probability of ventricular recovery following VAD support in infants with severe HF secondary to myocarditis. In addition, we analyze clinical experiences focusing on the weaning process, challenges during explantation, and outcomes, with special attention to a small cohort (n = 4) to highlight specific findings.

PATIENTS AND METHODS: From 1988 to 2024, 63 consecutive pediatric HF patients were supported with VAD systems. This retrospective descriptive study includes four patients (2016-2024) who achieved myocardial recovery and underwent VAD explantation. Weaning assessments included heart catheterization and echocardiography to determine suitability for VAD removal. One patient with congenital heart disease and severe HF was excluded due to prior reporting.

RESULTS: Four patients diagnosed with cardiomyopathy - three with parvovirus B19 confirmed by polymerase chain reaction and one with arrhythmogenic cardiomyopathy - received Berlin Heart® Excor left VADs. Two children developed frequent valve thrombosis requiring pump replacement. All patients experienced mild-to-moderate neurological complications postimplantation. Renal and hepatic functions normalized by follow-up.

CONCLUSIONS: Myocardial recovery during VAD support is possible, particularly in children with severe myocarditis and cardiomyopathy. Concurrent HF medications alongside VAD support appear to promote recovery. Furthermore, VAD therapy improves systemic hemodynamics, contributing to normalization of renal and hepatic functions. These findings support the use of VADs for recovery in selected pediatric patients.

PMID:40969969 | PMC:PMC12443395 | DOI:10.4103/apc.apc_79_25

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):151-154. doi: 10.4103/apc.apc_227_24. Epub 2025 Aug 29.

ABSTRACT

We describe a 7-day-old newborn who presented with arterial desaturation and respiratory distress. The evaluation showed a duct with a continuous right-to-left shunt and an anomalous origin of the right pulmonary artery from the aorta. We discuss the hemodynamics leading to continuous right-to-left ductal flow and the subsequent intraoperative evaluation that resulted in a successful single-stage surgical repair of this interesting case.

PMID:40969962 | PMC:PMC12443391 | DOI:10.4103/apc.apc_227_24

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):87-92. doi: 10.4103/apc.apc_223_25. Epub 2025 Aug 29.

ABSTRACT

Grown-up with congenital heart disease (GUCH) represents an emerging but under-recognized public health challenge in India. With an estimated 3.5 million adults living with congenital heart disease (CHD), the country has one of the world's largest GUCH populations. Despite improving pediatric cardiac surgery outcomes, adult CHD care remains fragmented, with critical gaps in infrastructure, training, transition protocols, and national policy. This editorial explores the epidemiological burden, systemic challenges, and recent progress, including the growth of pediatric cardiac programs, the emergence of GUCH clinics, and increased use of transcatheter interventions for the Indian GUCH patients. We need a structured, level-based care model, development of specialized centers, dedicated GUCH training, and the creation of national registries and India-specific guidelines. Bridging the divide between pediatric and adult cardiology is essential to ensure lifelong, coordinated care for this vulnerable population.

PMID:40969956 | PMC:PMC12443409 | DOI:10.4103/apc.apc_223_25

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):119-123. doi: 10.4103/apc.apc_248_24. Epub 2025 Aug 29.

ABSTRACT

CONTEXT AND AIM: Absent pulmonary valve syndrome (APVS) in association with tetralogy of Fallot (TOF) is a rare congenital heart disease characterized by the aneurysmal dilatation of pulmonary arteries and associated major airway anomalies. Postoperative outcomes have been suboptimal, especially concerning dependency on positive pressure ventilation and the need for repeated cardiac reinterventions. This study aims to describe the postoperative course of these patients and to identify the risk factors associated with poor outcomes.

METHODS AND RESULTS: A retrospective review of 38 patients who underwent surgery for TOF with APVS between 2001 and 2021 at a single cardiac center was conducted. There were 16 (42%) patients in the young infants group. They required longer postoperative mechanical ventilation, 77 (interquartile ranges [IQR] 22-306) versus 17 (IQR 6-67) hours for the older children (P-0.009); longer inotropic support, 127 (103-285) versus 60 (20-108) hours for older children (P-0.000); longer intensive care unit (ICU) stay, 12 (4-29) versus 4 (2-7) days (P-0.01), and longer hospital stay 23 (14-64) versus 15 (11-20) days (P-0.02). Seven (43%) of the younger infants' group required readmission, whereas 4 (18%) of the older children needed to be readmitted (P < 0.04). Bloodstream infections (BSIs) occurred more frequently in the infants' group (31%) compared to older children (4.5%) (P < 0.03). The need for redo surgeries and the incidence of hospital-acquired infections other than BSIs did not show differences between the groups.

CONCLUSIONS: Age <3 months or weight <4 kg is associated with a more difficult postoperative course, characterized by longer ventilation days, a higher inotropic score, longer ICU and hospital stays, and more readmissions.

PMID:40969954 | PMC:PMC12443394 | DOI:10.4103/apc.apc_248_24

Ann Pediatr Cardiol. 2025 Mar-Apr;18(2):131-141. doi: 10.4103/apc.apc_58_25. Epub 2025 Aug 29.

ABSTRACT

BACKGROUND: Breastfeeding is recognized as optimal for infants with congenital heart disease (CHD). We sought to evaluate breastfeeding practices among mothers of infants with CHD and identify key modifiable barriers to breastfeeding.

METHODS: Initially, a cross-sectional telephone survey was conducted among 100 mothers whose infants had undergone cardiac surgery in the past year. Based on the results of this survey, a structured interview questionnaire was designed and administered to 50 mother-infant dyads who were prospectively recruited from the inpatient population and followed postoperatively.

RESULTS: Fifty infants were included (median age: 4.5 months [interquartile range (IQR): 2-7]; weight: 4.01 kg [IQR: 3.5-5.1]). Before surgery, 40 mothers (80%) were breastfeeding, whereas ten mothers (20%) were not. Notably, 17 mothers (34%) had stopped breastfeeding at some point before surgery, primarily due to perceived inadequate milk supply (82%). Additional reasons for the interruption of breastfeeding included difficulties with infant sucking or latching (35%), the belief that breast milk alone was insufficient (23%), and sore or cracked nipples (17%). Postoperatively, 39 mothers (78%) resumed breastfeeding after 3 days (IQR: 2-4). A postoperative feeding delay, defined as a delay in resuming breastfeeding beyond the anticipated timeframe of 4 days (as determined by the initial telephonic survey), was observed in 8 (16%) cases.

CONCLUSION: This study identifies the gaps and challenges in breastfeeding practices among mothers of infants with CHD. Targeted interventions are needed to support and sustain breastfeeding practices in these infants, addressing challenges and promoting continued breastfeeding during the postoperative period and beyond.

PMID:40969951 | PMC:PMC12443399 | DOI:10.4103/apc.apc_58_25