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BACKGROUND: Maladaptive remodelling mechanisms occur in patients with repaired tetralogy of Fallot (rToF) resulting in a cycle of metabolic and structural changes. Biventricular shape analysis may indicate mechanisms associated with adverse events independent of pulmonary regurgitant volume index (PRVI). We aimed to determine novel remodelling patterns associated with adverse events in patients with rToF using shape and function analysis. METHODS: Biventricular shape and function were studied in 192 patients with rToF (median time from TOF repair to baseline evaluation 13.5 years). Linear discriminant analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events. Adverse events included death, arrhythmias, and cardiac arrest with median follow-up of 10 years. RESULTS: LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular left ventricle (LV) (decreased eccentricity), dilated (increased sphericity) LV base, increased right ventricular (RV) apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.77). PRVI did not add value, and shape changes associated with increased PRVI were not predictive of adverse outcomes. CONCLUSION: Pathological remodelling patterns in patients with rToF are significantly associated with adverse events, independent of PRVI. Mechanisms related to incident events include LV basal dilation with a reduced RV apical ejection fraction.

The article "Early Rise of Inflammatory Mediators during Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Implications for Perioperative Management" discusses the significant increase in inflammatory mediators during pediatric cardiac surgery with CPB. The study found that 42 out of 50 cytokines measured increased significantly during surgery, with most showing a rapid rise early on, particularly during aortic cross-clamping. Strategies to manage these immune mediators, such as ultrafiltration, may need to be focused on the entire intraoperative period. [Extracted from the article]

This article discusses the use of large language models (LLMs) to provide answers to complex questions from parents in pediatric cardiology and pediatric cardiac surgery. The study evaluated the quality of responses from different LLMs based on factors such as relevance, factual accuracy, empathy, and understandability. While the LLMs provided detailed and convincing answers, there were challenges in addressing age-related aspects of questions and detecting errors that could be harmful to patients. The study suggests that with further development, LLMs could be valuable tools for patient education in the future. [Extracted from the article]

The article in the "Thoracic & Cardiovascular Surgeon" journal discusses two cases of sudden cardiac deaths in adolescents associated with vaping. The adolescents experienced ventricular fibrillation after using vaping products, with one case linked to Klinefelter's syndrome and the other to catecholaminergic polymorphic ventricular tachycardia (CPVT). The article highlights the potential risks of vaping triggering arrhythmogenic events in children, emphasizing the need for caution, especially in those with underlying arrhythmogenic disorders. [Extracted from the article]

The study published in the "Thoracic & Cardiovascular Surgeon" journal explores the impact of early heart surgery involving thymic tissue reduction on the immune response to measles and rubella vaccination in children with congenital heart disease (CHD). Findings indicate that children with CHD who underwent thymectomy during cardiac surgery had a reduced humoral immune response to rubella vaccination compared to healthy controls. While there was also a reduced response to measles vaccination in the CHD group, it was not statistically significant. Further research is needed to understand the implications of thymectomy and other factors on vaccination responses in this population. [Extracted from the article]

The article "Interventional Thrombectomy for Neonatal Spontaneous Aortic Thrombosis" discusses the rare but critical condition of neonatal aortic thrombosis, which can lead to severe morbidity and mortality. The case series explores the use of interventional therapy in neonates with spontaneous aortic thrombosis, focusing on those with reduced systolic function or organ failure. The study highlights the effectiveness of off-label thrombectomy devices in managing this condition, emphasizing the importance of early diagnosis and timely treatment in specialized centers for optimal outcomes. [Extracted from the article]

The article "Compliance of the Ascending Aorta After Aortic Root Replacement with a Decellularized Aortic Homograft—An MRI Study" explores the impact of decellularized aortic homografts (DAH) on aortic compliance compared to healthy controls. The study found that the proximal ascending aorta of the DAH group exhibited reduced compliance, indicated by lower relative area change (RAC) and higher maximum blood flow velocity (Vmax) compared to healthy controls. These findings suggest potential localized changes in the graft due to the decellularization process or degenerative effects, emphasizing the importance of long-term follow-up to understand the effects of decellularized human tissue. [Extracted from the article]

This article examines the risk factors for late adverse events following primary surgical repair of isolated aortic coarctation in patients under 18 years old. The study included 359 patients operated on between 1972 and 2020, with follow-up times averaging 22.7 years. Results showed that patients who underwent primary surgical patch aortoplasty had an increased risk of developing aortic aneurysms, while concomitant aortic valve anomalies were associated with earlier onset of hypertension. Regular follow-up exams are recommended due to the potential for complications even years after the initial repair. [Extracted from the article]

AIM: To assess intervendor agreement of cardiovascular magnetic resonance feature tracking (CMR-FT) and to study the impact of repeated measures on reproducibility. MATERIALS AND METHODS: Ten healthy volunteers underwent cine imaging in short-axis orientation at rest and with dobutamine stimulation (10 and 20 μg/kg/min). All images were analysed three times using two types of software (TomTec, Unterschleissheim, Germany and Circle, cvi(42), Calgary, Canada) to assess global left ventricular circumferential (Ecc) and radial (Err) strains and torsion. Differences in intra- and interobserver variability within and between software types were assessed based on single and averaged measurements (two and three repetitions with subsequent averaging of results, respectively) as determined by Bland-Altman analysis, intraclass correlation coefficients (ICC), and coefficient of variation (CoV). RESULTS: Myocardial strains and torsion significantly increased on dobutamine stimulation with both types of software (p

This article discusses the development of a rule-based clinical decision support system (CDSS) to detect and track acute kidney injury (AKI) in children after cardiac surgery. The CDSS uses electronic health records to compile data and provide support to physicians in detecting and staging AKI. The system was tested using retrospective data from 256 children who underwent cardiac surgery, and compared to diagnoses made by clinical experts. The preliminary version of the CDSS showed high sensitivity and specificity in detecting AKI. The authors emphasize the need for standardized, high-quality data for the proper functioning of the automated AKI detection system. The next step is to develop a prediction model for AKI after cardiac surgery using a larger dataset. [Extracted from the article]