Susan Taejung Kim

Background: Ventricular arrhythmias (VA) after percutaneous pulmonary valve implantation (PPVI) have been mainly reported with balloon‐expandable valves. Data on VA following self‐expandable valves, particularly the Pulsta valve, remain limited. Aims: To evaluate the incidence, clinical characteristics, and predictors of clinically significant VA after Pulsta valve implantation in patients with native right ventricular outflow tract (RVOT) disease. Methods: We retrospectively reviewed 129 consecutive patients who underwent PPVI with the Pulsta valve. All patients received continuous telemetry monitoring until discharge. Clinically significant VA was defined as VA requiring antiarrhythmic therapy. Clinical, electrocardiographic, RVOT morphological, and valve‐related variables were analyzed using univariable logistic regression. Results: The median age at PPVI was 27 years (interquartile range, 22.0–36.0). Over a median follow‐up of 3.3 years, any VA occurred in 42 patients (32.6%), predominantly transient premature ventricular complexes (PVCs; 16.3%) or non‐sustained ventricular tachycardia (VT; 16.3%). Among patients with non‐sustained VT, antiarrhythmic therapy was required in 5 patients (3.9%), with only 2 patients (1.6%) remaining on medication at discharge. No sustained VT, hemodynamic instability, or persistent arrhythmia requiring long‐term therapy was observed. Proximal RVOT implantation was the strongest predictor of VA (odds ratio 5.74, 95% confidence interval 1.08–30.57 vs. mid/distal RVOT, p = 0.039). Other clinical, electrocardiographic, anatomical, and valve‐related factors were not associated with VA. Conclusions: In patients with native RVOT disease treated with self‐expandable Pulsta valve, clinically significant VA was rare, and most VAs were benign and self‐limited. Pulsta valve implantation at proximal RVOT was the key determinant of VA risk.

Background: Hemodynamically significant patent ductus arteriosus (hsPDA) leads to left‐sided chamber dilatation and mitral valve (MV) annular stretching, potentially resulting in mitral regurgitation (MR). While transcatheter PDA closure often improves MR, persistent MR may be associated with adverse outcomes. This study aimed to identify echocardiographic predictors of persistent MR following transcatheter PDA closure in pediatric patients. Methods: We conducted a retrospective study of 183 pediatric patients (aged 1–18 years) who underwent transcatheter PDA closure at Seoul National University Hospital between 2004 and 2021. Echocardiographic parameters, including left ventricular internal diameter in diastole (LVIDd), MV annulus diameter, and MR severity were analyzed before and after the procedure. Cardiac catheterization data were also reviewed. Results: The mean age at the time of the procedure was 1.92 years, and the average pulmonic end diameter of PDA was 2.91 mm. After transcatheter PDA closure, LVIDd (Z‐score), LVIDd/BSA, and MV annulus (Z‐score) significantly decreased. The prevalence of MR decreased from 22.4% (preclosure) to 8.2% (postclosure). Multivariate analysis identified preclosure LVIDd (Z‐score), postclosure MV annulus diameter (mm), MV annulus (Z‐score), and the presence of MV prolapse as independent predictors of persistent MR. ROC analysis demonstrated that a preclosure LVIDd (Z‐score) ≥ 2.95 predicted persistent MR with a sensitivity of 66.7% and a specificity of 83.9%. Conclusions: Persistent MR after transcatheter PDA closure is predicted by preclosure LVIDd (Z‐score), postclosure MV annulus diameter, and the presence of MV prolapse. Recognizing these factors may help guide clinical management and improve outcomes for patients at the risk of persistent MR.

Pericardiocentesis serves both diagnostic and life-saving purposes across a range of clinical scenarios. Despite its importance, there remain limited data

Lee JH, et al. Korean Circ J. 2025 Sep;56:e12. https://doi.org/10.4070/kcj.2025.0035

We report a Kawasaki disease infant with a giant coronary artery aneurysm compressing the adjacent coronary artery causing significant stenosis. Our case suggests that a giant aneurysm at the left main coronary artery can cause severe left anterior descending (LAD) artery stenosis by mechanical compression, and coronary artery bypass grafting could be a useful rescue treatment option even in small infants in the acute phase.

Background: Heart transplantation is often limited by the availability of transplantable donor heart and understanding of donor aspects that would influence transplant outcomes becomes important. In this study, donor characteristics and their impact on the outcomes of pediatric heart transplantations performed in South Korea were investigated.Methods: We reviewed the medical records of patients less than 18 years old who received heart transplantation between 2002 and 2022 in three tertiary hospitals located in South Korea.Results: A total of 139 cases were enrolled. One‐year mortality was 10.4% and total mortality was 33.8%. Forty‐nine recipients (35.3%) showed biopsy‐proven rejections and 20 (14.4%) showed cardiac allograft vasculopathy during mean follow‐up of 6.4 ± 4.9 years. Six recipients (4.5%) showed left ventricle ejection fraction of less than 55% post‐transplantation. The mean age of the donors was 23.0 ± 15.4 years. The most common cause of death of the donors was unspecified illness (46.4%). Donors with a history of diabetes, hypertension, smoking, and alcohol consumption were 0%, 3.1%, 32.1%, and 34.4%, respectively. Mean total ischemic time was 191.6 ± 72.7 min, while total ischemic time was over 4 h in 37 patients (26.6%). There were no significant relationship between donor factors and survival. However, donor's history of drinking or cardiopulmonary resuscitation was significantly associated with acute rejection and donor's age with cardiac allograft vasculopathy.Conclusion: Donor factors did not show significant impact on post‐transplant survival but some factors were predictive of post‐transplant rejection and cardiac allograft vasculopathy.

As the number of hypertension cases in the pediatric population is growing, we aimed to investigate the parent-offspring association of hypertension in Korea. We performed a cross-sectional analysis using the data of children and adolescents aged 10–18 years and their parents extracted from the Korea National Health and Nutrition Examination Survey (2008–2018). We analyzed the correlation of blood pressure (BP) between offspring and their parents and investigated the odds ratio (OR) of having hypertension in offspring based on parental hypertensive status. A total of 3996 children and adolescents (2224 boys and 1772 girls) aged 10–18 years and their parents (3197 fathers and 3197 mothers) were evaluated. Both boys and girls had positive associations with both parents for systolic and diastolic BP. When neither parent, only the father, only the mother, or both parents were hypertensive, 6.6%, 10.4%, 13.3%, and 25.3% of boys and 6%, 12%, 12.7%, and 22.1% of girls had hypertension, respectively. The risk of having hypertension among offspring was approximately two times higher when one parent was hypertensive and over four times higher when both parents were hypertensive compared to that among controls whose parents were not hypertensive (OR: 2.230, 1.655, and 5.021 in boys with hypertension and 2.321, 2.169, and 4.554 in girls with hypertension in the mother only, the father only, and both parents, respectively). We identified familial aggregation of hypertension in Korea. As there was an increased likelihood of having hypertension in children with parental hypertension, parental hypertension may be utilized as a screening tool for hypertension in children.

We aimed to investigate the association between nutrition and blood pressure and the role that body composition plays in this relationship. Korea National Health and Nutrition Examination Survey data from the years 2008–2020 were reviewed. A total of 11,234 subjects (5974 boys and 5260 girls) aged 10–18 years of age were selected. We analyzed the correlation between nutrition (intakes of energy, protein, fat, carbohydrate, sodium, saturated fatty acid (SFA), unsaturated fatty acid (USFA), and dietary fiber (DF)) and body composition (height, weight, waist circumference (WC), body mass index (BMI), and waist to height ratio (WHtR)), and performed multiple regression analysis to find the independent correlation between body composition and blood pressure (BP). We then compared the correlation between nutrition and BP, with or without adjustment for body composition. The intakes of energy, protein, fat, carbohydrate, sodium, and USFA had positive associations with height, weight, WC, and BMI. Systolic BP (SBP) and diastolic BP (DBP) were independently positively correlated with height and BMI. The intakes of energy, protein, fat, carbohydrate, sodium, and SFA had positive correlations with SBP and DBP, which disappeared when additionally adjusted for BMI and height. In conclusion, nutrition seems to affect BP via height and BMI in Korean children and adolescents.

Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure. However, in pediatric and congenital heart disease (CHD) patients, current adult indications cannot be directly applied because of heterogeneity in anatomy and diagnosis. Therefore, CRT responses and clinical outcomes in these patients were investigated to derive possible candidates for CRT. This study retrospectively analyzed 16 pediatric and CHD patients who underwent CRT implantation at a single center in early (0.7±0.2 year) and late (4.7±0.3 years) follow-up period after CRT. The median age at CRT implantation was 2.5 (0.3-37.2) years, and median follow-up duration was 6.3 (0.1-13.6) years. Thirteen had non-transvenous CRT. Two had congenital complete atrioventricular (AV) block with previous right ventricular pacing, 5 had dilated cardiomyopathy (DCM) with left bundle branch block, and 9 had CHD. The mean ejection fraction of the systemic ventricle increased from 28.1±10.0% to 44.3±21.0% (p=0.003) in early and 51.8±16.3% (p=0.012) in late outcome. The mean functional class improved from 3.1±0.9 to 1.8±1.1 after CRT (p=0.003). Twelve patients (75%) showed improvement in ventricular function or functional class after CRT. Proportion of responders differed between patients without CHD (2/2 patients with complete AV block and 5/5 with DCM, 100%) and those with CHD (5/9, 56%), although statistical significance was not reached (p=0.088). CRT improved ventricular function and functional status according to the underlying condition in pediatric and CHD patients. However, further large and longer-term studies are needed to establish the guideline for the patient selection of CRT in these patients.