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Background and Objectives: The purpose of this study was to investigate whether early surfactant administration affects the status of ductus arteriosus (DA) in preterm infants ≤ 32 weeks of gestational age (GA) within 24 h of birth. Materials and Methods: It is a prospective study conducted from 1 March 2022 to 31 December 2023 in a tertiary academic center. In-born infants ≤ 32 weeks of gestation (n = 88) were enrolled. The study group was further divided into surfactant (n = 44) and non-surfactant (n = 44) subgroups. Results: A total of 76% of the preterm infants who received surfactant therapy (RRR = 0.839) recorded an increase in Kindler score at 24 h of life (1 − RR = 1 − 0.24 = 76%). Surfactant administration was significantly associated with decreased pre-ductal diastolic pressure (29.9 mmHg vs. 34.8 mmHg, p = 0.0231), post-ductal diastolic pressure (28.7 mmHg vs. 32.2 mmHg, p = 0.0178), pre-ductal MAP (41.6 mmHg vs. 46.5 mmHg, p = 0.0210), and post-ductal MAP (41.0 mmHg vs. 45.3 mmHg, p = 0.0336). There were no significant changes in ductus arteriosus parameters at 24 h of life. Conclusions: Early surfactant administration does not affect the status of ductus arteriosus in preterm infants ≤ 32 weeks of gestational age at 24 h of life.

Introduction. Coarctation of the aorta (CoA) occurs in 6-8% of patients with congenital heart disease, with an incidence of 4/10,000 live births. It can be present with various clinical pictures, in an age range between newborn and adolescence. Infants with birth weights ≤ 2 kg with CoA have increased risk of severe intraventricular hemorrhage (IVH) compared to their birth weight-matched cohorts. Case presentation. We present a case of a premature, male newborn, with low birth weight, who at the age of 3 weeks developed signs and symptoms of cardiogenic shock. Clinical examination, echocardiography and angio-CT confirmed the diagnosis of a severe CoA, without any flow through the ductus arteriosus. Treatment with prostaglandin E1 was initiated, to promote ductal patency. The systolic blood pressures were above 99 percentile for his gestational age in the upper extremities, with a noninvasive pressure gradient around 86 mmHg between the arm and leg. Transfontanellar ultrasonography evaluation revealed a grade II/III bilateral IVH, in resorption, with cystic transformation. At the age of 6 weeks definitive surgical repair was performed. Postoperatively, at the 3 month follow-up, the clinical suspicion of recoarctation of the aorta arose, confirmed by echocardiography and angio-CT, with arterial hypertension and gradient around 37 mmHg between the arm and leg. Prosthetic patch aortoplasty was performed. The postoperative evolution was marked by the persistence of arterial hypertension, the infant requiring continued treatment with angiotensin-converting enzyme inhibitor. Conclusions. Premature neonates with low birth weight have always constituted a medical management challenge, with short and long term implications. A strong point in solving such cases is a multidisciplinary medical for assessment, management and outcomes.

In 2020, World Health Organization declared the infection with COVID-19 a pandemic. Even though the risk of infestation and mortality is lower in children than in adults, children are more prone to develop a hyperimmune state after COVID-19 infection called pediatric multi-system inflammatory syndrome or PIMS. In PIMS, cardiovascular involvement with myocardial injury is present in most patients. Due to the novelty of this pathology, little is known about the implication on the cardiovascular system. This review focuses on the most recent data published on the pediatric multi-system inflammatory syndrome associated with COVID-19 infection, pathophysiological mechanisms, and especially cardiovascular involvement. Furthermore, it emphasizes the role of pediatric cardiologists in its management.

Background and Objectives: We investigated the effect of optimal maternal glycemic control on neonatal outcomes among infants born to mothers with diabetes. Materials and Methods: In this prospective study, we assessed 88 eligible mothers admitted to the obstetrics department for pregnancy evaluation. Our analysis included 46 infants born to diabetic mothers (IDMs) and 138 infants born to unaffected mothers, all admitted to the Level II Neonatal Intensive Care Unit (NICU). Results: Mothers affected by diabetes were generally older and exhibited a higher body mass index (BMI) and a greater number of gestations, although parity did not differ significantly. Cesarean section emerged as the most frequently chosen mode of delivery. A significantly higher proportion of infants in the affected group presented with respiratory disease (3% vs. 19.5%), which required NICU admission (4.3% vs. 23.9%), phototherapy (18.1% vs. 43.5%), and had congenital heart defects or myocardial hypertrophy (15.2% and 26% vs. 3% and 4.3%) compared to matched controls (p < 0.05). Conclusions: This study underscores the persistence of adverse neonatal outcomes in IDMs, even when maternal glycemic control is optimized. It calls for further investigation into potential interventions and strategies aimed at enhancing neonatal outcomes in this population.

Turner syndrome (TS) is the most common chromosomal abnormality affecting females and cardiac abnormalities have been described in up to 50% of patients. Although coarctation represents one of the most frequent cardiac malformation, treatment options in these patients represent an area of debate, due to associated aortopathy and risk for aortic dissection. In addition to the contradictory data found in the literature, regarding the safety profile and utility of stenting of coarctation of the aorta in TS patients, we present the case of a patient of pediatric age, who successfully underwent the procedure, being free from periprocedural and short-term complications. Beside the presentation itself, we aimed to review and summarize the data available in the literature regarding this topic. As a conclusion, we emphasise the role of minimally invasive interventional therapy and wish to underline the need of further, larger scale studies and guidelines in this patient group. Given the related aortopathy, all preventive measures should be undertaken to avoid aortic dissection during stent implantation in this vulnerable population. Although the evolution of our patient was favorable, data found in the literature is somewhat contradictory and a close follow-up is indicated to help evaluate the risk of long-term complications.

Pediatric heart failure is a significant challenge in clinical practice, a global burden worldwide. Compared to adult population, heart failure in children has a variety of etiologies depending on the patients age. However, pediatric heart failure guidelines are still extrapolated from adult population. In infants and children, the pharmacological treatment is based on angiotensin-converting enzyme inhibitors, beta-blockers, aldosterone receptors antagonists, and other diuretics in the presence of congestion, with a lower use of device therapy. In end-stage heart failure, as a bridge to transplantation or recovery, ventricular assist devices or different palliative surgical interventions are used nowadays.This review focuses on the most important causes, pathophysiological mechanisms, clinical manifestation and management of pediatric heart faliure based on recent guidelines. Furthermore, it emphasize the newer pharmaco-logical or non-pharmacological therapies that have been recently approved in pediatric population.

Progresses to radiologic and molecular genetics fields created the premisses for the development of a new, descriptive classification system of cardiomyopathies, known under the MOGE (S) acronym, with the help of informations provided by molecular genetic testing that led to better knowledge regarding their physiopathogenic backgrounds, the implementation of a descriptive, nosologic phenotype-genotype and the establishment of an accurate clinic and genetic diagnosis. Dilated cardiomyopathy (DCM) in children remains the most frequent type of cardiomyopathy, representing an important cause of death in the first 2 years of life, and its impact at neonatal age is not fully understood, due to the low number of studies regarding its real incidence. Its death rate is high, 10 % of neonatal deaths of cardiac origin being caused by DCM. Ecocardiography helps in establishing the diagnosis and evolution and therapy monitoring. Modern ultrasound techniques (tissue Doppler or speckle tracking), as well as 3D ultrasound provide highly accurate data. Paraclinic assessments, such as neuropeptides (BNP, NT-proBNP), have both diagnostic and prognostic roles. Medical treatment recommended for congestive cardiac failure symptom relief consists of angiotensine converting enzyme inhibitors (the long acting ones are preffered – Lisinopril), mineralocorticoid receptors antagonists and beta-blockers (Bisoprolol), which act by decreasing the afterload, limiting the ventricular remodelation process and can easily be administered, in unique dose. Novel therapeutic approaches have aroused, such as regenerative therapy of cardiomyocytes. Cardiac transplant remains a therapeutic option limited by a small number of donors. Conclusions. Diagnostic and therapeutic approach of DCM have been substantially improved, integration in current practice of new diagnostic methods and regenerative therapeutic approaches can change the prognostic perspective of this disease.

Background: The relationship between non-reassuring fetal heart rate (FHR) pattern, acidemia at birth and neonatal morbidity remains unclear. Our aim was to compare low versus high pH cord blood infants of women detected with a Category II FHR pattern for which the impact is unclear. Methods: A prospective study of 185 low-risk pregnant women in labor at > 370/7 weeks of gestation with a singleton fetus was conducted at a single center. Category II trace was defined by the presence of tachycardia or bradycardia, variable and late decelerations, marked variability at least 30 minutes in the 120 minutes prior to delivery. The primary outcome included the need for resuscitation and Neonatal Intensive Care Unit (NICU) admission. The cohort was also stratified into three categories according to admission to NICU and pH threshold ([i] umbilical artery blood pH < 7.15 and admitted; [ii] pH > 7.15 and admitted; [iii] not admitted). Results: 23% (43/185) of infants of women detected with Category II FHR pattern needed NICU admission. Category II FHR pattern was associated with low pH at birth, and the need for resuscitation was more frequent among infants in the lower pH group (73% vs. 10%, p < 0.05). Indices of right (tricuspid annular plane systolic excursion [TAPSE]: 7.3 ± 0.9 mm) and left ventricular performance (fractional shortening: 31% ± 8.9%, transmitral E’/A’ 0.9 ± 0.3) were low compared to normative data for healthy infants. CK, CK-MB, and left-to-right/bidirectional shunts at PFO and PDA were higher overall at 72 hours of age. Conclusions: Category II FHR is associated with resuscitation at birth, NICU admission, and length of hospitalization.

Hypertrophic cardiomyopathy is the second most frequent cardiomyopathy in children and it counts as a genetic disorder for a high number of cases, with widely variable clinical presentation. The disease can be recognized in all age groups and has an unpredictable prognosis, especially if undiagnosed on time. We present the case of a two and a half years old male toddler diagnosed at territorial level with systolic heart murmur, who manifested mild fatigue, whose echocardiographic examination showed obstructive hypertrophic cardiomyopathy and restrictive atrial septal defect. Laboratory findings revealed a severe, progressive cytolysis syndrome, with negative genetic tests for Duchenne muscular dystrophy and type II glycogen storage disease – Pompe disease. Haematological tests excluded a pathology in this section and the serology for viruses with liver tropism was negative. The particularity of this case lies in the discrepancy between severe cytolysis syndrome and clinical oligosymptomatic presentation.

Background/Objectives: Bicuspid aortic valve (BAV) is a prevalent congenital heart defect that continues to present a significant challenge in the management of paediatric patients. The assessment of left ventricle systolic function is typically conducted through the measurement of the left ventricular ejection fraction. Currently, left ventricle global longitudinal strain (LV GLS) is regarded as a more sensitive indicator, enabling the quantitative assessment of global and segmental ventricular function through the determination of myocardial deformation. Methods: A prospective study was conducted between 10 January 2023 and 10 January 2024 in a tertiary paediatric cardiology referral centre. The study enrolled children aged 6 to 17 years with BAV who were undergoing periodic evaluation, as well as a control group. The primary objective was to analyse the systolic function (global and segmental LV) using the classical method (LV EF) and speckle tracking echocardiography (STE). Results: The study group comprised 73 patients with a mean age of 13 years and was predominantly male. The control group comprised 55 patients. The phenotype IB with aortic regurgitation (AR) was the most prevalent. The results of the STE evaluation in the control group demonstrated mean GLS values between −22.1% and −22.8%. A comparison of the BAV group and the control group revealed a significant difference in GLS for the apical four-chamber view (p = 0.022). Conclusions: Although the analysis of global LV function demonstrated normal values of EF in patients with BAV, the strain analysis revealed significantly reduced strain in the inferior segment and in the apical four-chamber view, as well as in the anterior segment. Further investigation is required to determine whether reduced LV GLS in paediatric patients with BAV will ultimately result in the development of clinical heart failure. Additionally, it is necessary to ascertain whether this can identify patients with subclinical heart failure and whether early detection can result in a reduction in morbidity.

IntroductionAssessment of myocardial function through speckle tracking echocardiography (STE) can bring benefits to conventional echocardiography in premature newborns, a particular vulnerable group in terms of adaptation to extra-uterine life. Furthermore, it represents a non-invasive imagistic method which can guide therapeutic approach in the hemodynamically unstable newborn. This study aims to highlight the particularities of myocardial function in late premature newborns, by conducting a comparison with a group of healthy neonates, by using STE.MethodsConducted over a timespan of two years, this prospective study enrolled 64 term neonates and 21 premature newborns, with gestational ages ranging between 28 and 36 weeks, who prior to discharge underwent a cardiac ultrasound, involving two-dimensional image acquisitions of the apical four-chamber view of both ventricles. Afterwards, the images were offline analyzed, by using the autostrain function.ResultsAfter segmental strain analysis, no significant discrepancies between the two groups in terms of interventricular values were found. However, left ventricle and right ventricle strain measurements differed significantly (p

Recent research has increased focus and interest in characterizing the physiology of the transition circulation using echocardiography. Critique of published normative neonatal echocardiography data among healthy term neonates has not been performed. We have performed a comprehensive literature review using the key terms: cardiac adaptation, hemodynamics, neonatal transition, term newborns. Studies were included if they had reported echocardiography indices of cardiovascular function in the presence of maternal diabetes, intrauterine growth restricted newborns and prematurity and had a comparison group of healthy term newborns within first seven postnatal days. Sixteen published studies evaluating transitional circulation in healthy newborns were included. There was marked heterogeneity in the methodologies used; specifically, inconsistency in time of evaluation and imaging techniques used makes it challenging to determine specific trends of expected physiologic changes. Some studies revealed nomograms for echocardiography indices, though limitations persist in terms of sample size, number of reported parameters and consistency of measurement technique. A comprehensive standardized echocardiography framework which includes consistent techniques for assessment dimensions, function, blood flow, pulmonary/systemic vascular resistance, and shunts pattern is warranted to ensure consistency in the use of echocardiography to guide care of healthy and sick newborns.

ObjectivesTo study changes in heart function and hemodynamics during the transitional period in small for gestational (SGA) infants and appropriate (AGA) healthier counterparts.DesignA hospital based prospective observational study was performed at a perinatal center. Echocardiograms were performed on the first postnatal day and again at 48 h age. Term SGA infants were compared with those AGA newborns matched for the GA and mode of delivery.ResultsEighteen SGA infants were compared with 18 AGA infants [gestation 38 ± 1.5 vs. 38 ± 1.2 weeks, p > 0.05 and birthweight 2331 ± 345 vs. 3332 ± 405 grams, p

IntroductionGeneralized arterial calcification of infancy (GACI) is a rare cause of infantile heart failure and systemic hypertension with a poor prognosis, characterized by extensive calcification and proliferation of the intimal layer of large and medium sized arteries.Case reportWe present the first case report of successful surgical treatment of severe aortic arch obstruction by calcified plaques mimicking severe coarctation of the aorta and the outcome (of bisphosphonate therapy) in a newborn with GACI. Furthermore, we report the identification of a variant in ATP Binding Cassette Subfamily C, Member 6 (ABCC6) gene, possibly associated with severe early-onset manifestations of GACI.ConclusionThis case report highlights the importance of considering GACI in an infant with heart failure, systemic hypertension, and evidence of increased echogenicity of the arterial vessels. We noted the favorable outcome in improving the aortic calcification in our patient after surgical treatment and bisphosphonates therapy. Early diagnosis and treatment improve the long-term prognosis. A better understanding of this rare genetic disease could lead to new therapeutic strategies.

Insuficiența cardiacă pediatrică reprezintă o provocare în practica clinică și o povară la nivel mondial. În comparație cu populația adultă, etiologia insuficienței cardiace la copii este dependentă de vârsta pacienților. Cu toate acestea, ghidurile referitoare la insuficiența cardiacă pediatrică sunt extrapolate din ghidurile pentru adulți. În cazul sugarilor și al copiilor, tratamentul farmacologic este bazat pe inhibitori de enzimă de conversie, betablocante, antagoniști ai receptorilor de aldosteron și alte diuretice (în prezența congestiei). În insuficiența cardiacă terminală, dispozitivele de asistare ventriculară sau diferite intervenții chirurgicale paliative sunt utilizate ca o punte pentru transplant sau recuperare. Prezenta lucrare se concentrează pe cele mai importante cauze, mecanisme fiziopatologice, manifestări clinice și managementul în insuficiența cardiacă pediatrică, bazate pe cele mai recente ghiduri. În plus, subliniază cele mai noi tratamente farmacologice și nonfarmacologice recent aprobate pentru populația pediatrică

Introducere. Coarctația de aortă (CoA) este prezentă la 6-8% dintre pacienții cu boală congenitală cardiacă, cu o incidență de 4/10.000 nou-născuți vii. Poate fi prezentă cu diferite tablouri clinice, de la vârsta de nou-născut până la adolescență. Nou-născuții cu greutate la naștere sub 2 kg și cu CoA au risc crescut de a dezvolta hemoragie intraventriculară (HIV) severă, comparativ cu cei din cohorta cu greutate normală la naștere. Prezentare de caz. Prezentăm cazul unui prematur de sex masculin, cu greutate mică la naștere, care la vârsta de 3 săptămâni dezvoltă semne și simptome de șoc cardiogen. Examenul clinic, ecocardiografia și examenul angio-CT confirmă diagnosticul de CoA severă, fără flux vizibil în canalul arterial. A fost inițiat imediat tratament cu prostaglandină E1, pentru permeabilizarea canalului arterial. Tensiunea arterială sistolică a fost peste percentila 99 pentru vârsta gestațională, iar gradientul nonivaziv între membrul superior și cel inferior a fost de circa 86 mmHg. Ecografia transfontanelară decelează hemoragie intraventriculară grad II/III, bilateral, în resorbție, cu transformare chistică. La vârsta de 6 săptămâni, sugarul a beneficiat de corecția chirurgicală a CoA. La reevaluarea de 3 luni postoperator, pe baza semnelor clinice, s-a ridicat suspiciunea de recoarctație de aortă, confirmată prin ecocardiografie și angio-CT. Pacientul prezenta hipertensiune arterială, cu diferență de tensiune între membrele superioare și cele inferioare de circa 37 mmHg. A fost realizată corecție chirurgicală, de această dată prin angioplastie de lărgire cu petec. Evoluția postoperatorie a fost grevată de prezența hipertensiunii arteriale, pentru care a necesitat tratament continuu cu inhibitor de enzimă de conversie. Concluzii. Prematurii cu greutate mică asociată cu CoA corectată chirurgical au un risc ridicat de recoarctare, hipertensiune arterială secundară și hemoragie cerebrală. Un punct important în soluționarea acestor cazuri îl reprezintă echipa medicală multidisciplinară, pentru evaluarea, managementul, dar și prognosticul pacienților.

Pulmonary arterial hypertension is a severe, progressive disease in children, that causes right ventricular dysfunction over time. Tissue motion annular displacement is a novel speckle-tracking derived echocardiographic parameter used in assessing ventricular function. The aim of our study was to determine the prognostic value of this echocardiographic parameter in children with pulmonary arterial hypertension. We conducted a case-control study by assessing twenty children with pulmonary arterial hypertension (idiopathic or secondary) and twenty age- and sex-matched controls, using clinical (WHO functional class, 6-min walking test), laboratory (brain natriuretic peptide level) and echocardiographic parameters (conventional and speckle-tracking derived tissue motion annular displacement) at enrolment and after one year of follow-up. According to their WHO functional class altering after one year, the pulmonary arterial hypertension patients were divided into two groups: non-worsening (eleven) and worsening (nine). The conventional echocardiographic parameters and all measured tricuspid tissue motion annular displacement indices (lateral, septal, midpoint and midpoint fractional displacement—TMADm%) were significantly lower in both pulmonary arterial hypertension groups (non-worsening and worsening) compared to controls. Comparing the worsening and non-worsening groups, only the TMADm% and brain natriuretic peptide level was significantly lower in worsening in comparison with non-worsening pulmonary arterial hypertension children (p = 0.010 and p = 0.018, respectively). In receiver-operating characteristic curve analysis, we found a cut-off value of 16.15% for TMADm% and a cut-off value of 34.35 pg/mL for the brain natriuretic peptide level that can predict worsening in pulmonary arterial hypertension children. In conclusion, tricuspid annulus midpoint fractional displacement, an angle-dependent speckle-tracking derived parameter, could be a good additional parameter in the assessment of the longitudinal right ventricular systolic function and in prediction of clinical worsening in children with pulmonary arterial hypertension.

Introduction: Coarctation of the aorta represents a narrowing of the thoracic aorta. Hypertensive patients with blood pressure differences ≥20 millimetres of mercury have an indication for surgical or interventional treatment. Implantation of a covered stent became the preferred therapy for the management of this pathology in adolescents/adults. Case report: We report the case of a 14-year-old male sportsman, who presented in the emergency room with headache, dizziness, and tinnitus. The clinical exam revealed blood pressure differences between the upper and lower limbs of up to 50 mmHg. Based on the clinical and paraclinical data, we established the diagnosis of coarctation of the aorta and severe secondary arterial hypertension. The case was discussed by a multidisciplinary team and accepted for covered stent implantation. The 24 h blood pressure Holter monitoring after the procedure indicated the persistence of stage I arterial hypertension. Conclusions: Coarctation of the aorta is a congenital cardiovascular anomaly with high morbidity and mortality rates. Arterial hypertension, heart failure, and aortic dissection are complications of this pathology, some of them being sometimes direct consequences of secondary hypertension. Periodic cardiology follow up after the procedure is mandatory to assess the hemodynamic response, to identify potential complications, and to stratify the cardiovascular risk.

Cardiomiopatia hipertrofică ocupă locul doi ca incidenţă între cardiomiopatiile copilului şi reprezintă o boală cu substrat genetic într-un procent semnificativ de cazuri, cu mare variabilitate în tabloul clinic. Boala apare la toate grupele de vârstă şi, nediagnosticată în timp util, poate avea prognostic imprevizibil. Prezentăm cazul unui copil mic, de sex masculin, de doi ani şi jumătate, depistat la nivel teritorial cu suflu sistolic, afirmativ cu oboseală minimă, la care examenul ecocardiografic a decelat o cardiomiopatie hipertrofică obstructivă şi un mic defect septal atrial. Analizele de laborator au arătat un sindrom de citoliză sever, progresiv, testele genetice efectuate infirmând o distrofie musculară Duchenne sau boli de stocaj a glicogenului, de tip II – Boala Pompe. Testele serologice pentru virusuri cu tropism hepatic au fost negative, iar examinările hematologice au infirmat o patologie din sfera hemato-oncologică. Particularitatea acestui caz constă în discrepanţa dintre sindromul de citoliză sever şi prezentarea clinică oligosimptomatică.

Introducere. Infecţiile respiratorii cauzate de virusul sinciţial respirator la copiii cu malformaţii cardiace congenitale reprezintă o importantă cauză de decompensare, care determină spitalizări repetate, cu durată prelungită. Prezentăm experienţa centrului nostru privind utilizarea profi lactică a Palivizumab la copiii sub 24 de luni, internaţi cu malformaţii cardiace congenitale semnifi cative hemodinamic. Material şi metodă. În conformitate cu recomandările ghidurilor privind profi laxia cu Palivizumab, 28 de copii cu vârsta medie de 2,6 luni, internaţi în Clinica Cardiologie II Copii a Spitalului Clinic Judeţean de Urgenţă Târgu-Mureş, au fost incluşi în programul de vaccinare, în perioada octombrie 2010 – februarie 2012. Pe perioada spitalizării s-au monitorizat parametrii hemodinamici, s-a notat orice reacţie adversă apărută, precum şi rata infecţiilor respiratorii. Părinţii au semnat un consimţământ informat privind acordul pentru vaccinare. A fost selectat un grup control care nu a benefi ciat de vaccin (28 copii, vârsta medie 4,3 luni), urmărindu-se rata infecţiilor respiratorii pe perioada derulării programului. La lotul imunizat am monitorizat rata îmbolnăvirilor respiratorii 6 luni postimunizare. Rezultate. Rata îmbolnăvirilor respiratorii la lotul imunizat a fost de 3,57%, iar la lotul control 32%. Efectele secundare postvaccinare: 18% au prezentat subfebrilitate şi uşoară iritabilitate, iar 4% febră şi diaree la 24 de ore după administrare. La lotul imunizat nu au apărut decompensări hemodinamice. Concluzii. Efectele secundare postvaccinare au fost minore, nu au apărut decompensări hemodinamice, iar rata de îmbolnăvire postimunizare a fost redusă.