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The objective of this study was to assess the relationship of prenatal diagnosis of critical congenital heart disease (CHD) to preoperative and postoperative patient findings. Retrospective analysis of neonates with critical CHD who underwent cardiothoracic surgery at one of four centers in North Carolina between 2008 and 2013. Surgical data collected by sites for submission to the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and the North Carolina CHD Lifespan Database were queried. There were 715 patients with STS records; 558 linked to the NC-CHD database. Patients with prenatal diagnosis had a lower incidence of preoperative risk factors, including need for mechanical ventilation and presence of shock. However, prenatally diagnosed patients had worse short-term outcomes, including higher operative mortality, higher incidence of select postoperative complications, and longer LOS. There was no difference in one-year mortality. Our findings are consistent with current literature which suggests that prenatal diagnosis of critical CHD is associated with a more optimized preoperative clinical status. However, we found that patients with prenatal diagnoses had less favorable postoperative outcomes. This needs to be investigated further, but may be secondary to patient-specific factors, such as CHD disease severity., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

With improved surgical outcomes, infants and children with congenital heart disease (CHD) may die from other causes of death (COD) other than CHD. We sought to describe the COD in youth with CHD in North Carolina (NC). Patients from birth to 20 years of age with a healthcare encounter between 2008 and 2013 in NC were identified by ICD-9 code. Patients who could be linked to a NC death certificate between 2008 and 2016 were included. Patients were divided by CHD subtypes (severe, shunt, valve, other). COD was compared between groups. Records of 35,542 patients < 20 years old were evaluated. There were 15,277 infants with an annual mortality rate of 3.5 deaths per 100 live births. The most frequent COD in infants (age < 1 year) were CHD (31.7%), lung disease (16.1%), and infection (11.4%). In 20,265 children (age 1 to < 20 years), there was annual mortality rate of 9.7 deaths per 1000 at risk. The most frequent COD in children were CHD (34.2%), neurologic disease (10.2%), and infection (9.5%). In the severe subtype, CHD was the most common COD. In infants with shunt-type CHD disease, lung disease (19.5%) was the most common COD. The mortality rate in infants was three times higher when compared to children. CHD is the most common underlying COD, but in those with shunt-type lesions, extra-cardiac COD is more common. A multidisciplinary approach in CHD patients, where development of best practice models regarding comorbid conditions such as lung disease and neurologic disease could improve outcomes in this patient population., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Ascoviruses are members of a recently described new family (Ascoviridae) of large double-stranded DNA viruses that attack immature stages of insects belonging to the order Lepidoptera, in which they cause a chronic, fatal disease. Ascoviruses have several unusual characteristics not found among other viruses, the most novel of which are their transmission by endoparasitic wasps and a unique cytopathology that resembles apoptosis. Cell infection induces apoptosis and in some species is associated with synthesis of a virus-encoded executioner caspase and several lipid-metabolizing enzymes. Rather than leading directly to cell death, synthesis of viral proteins results in the rescue of developing apoptotic bodies that are converted into large vesicles in which virions accumulate and continue to assemble. In infected larvae, millions of these virion-containing vesicles begin to disperse from infected tissues 48-72 h after infection into the blood, making it milky white, a major characteristic of the disease. Circulation of virions and vesicles in the blood facilitates mechanical transmission by parasitic wasps. Although ascoviruses appear to be very common, only five species are currently recognized, with the type species being the Spodoptera frugiperda ascovirus 1a. Ascovirus virions are large, enveloped, typically bacilliform or reniform in shape, and, depending on the species, have genomes that range from 119 to 186 kbp. Molecular phylogenetic evidence indicates that ascoviruses evolved from iridoviruses (family Iridoviridae) that attack lepidopteran larvae and are likely the evolutionary source of ichnoviruses (family Polydnaviridae), which assist endoparasitic hymenopterans in overcoming the defense responses of their insect hosts. Thus, as other molecular evidence suggests that iridoviruses evolved from phycodnaviruses (family Phycodnaviridae), an evolutionary pathway is apparent from phycodnaviruses via iridoviruses and ascoviruses to ichnoviruses.