Mi Li

Background: Transcatheter closure has been widely used for the treatment of ventricular septal defect (VSD) in children. However, post-procedural hemolysis remains a clinically relevant complication, and its underlying mechanisms and risk factors have not been systematically investigated. Methods: In this single-center retrospective cohort study, children who underwent transcatheter VSD closure at the Children's Hospital of Chongqing Medical University between June 2015 and June 2024 were included. Perioperative clinical data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors. A prediction model was subsequently developed based on the selected variables and internally validated using bootstrap resampling with optimism correction. Results: Among 1,427 children who underwent transcatheter VSD closure, hemolysis occurred in 53 cases, yielding an incidence of 3.7%. After exclusions for missing key variables, a cohort of 196 patients (including all 53 hemolysis cases) was used for model development. Multivariable analysis identified occluder diameter, age, residual shunt, and pulmonary valve flow velocity as independent risk factors for post-procedural hemolysis. The model demonstrated good discrimination in the derivation cohort, with an apparent AUC of 0.914 and a bootstrap-corrected AUC of 0.913 (95% CI: 0.865–0.956). Calibration was also satisfactory according to the Hosmer–Lemeshow test. Decision curve analysis demonstrated a net clinical benefit across a threshold probability range of 0%–50%. Conclusions: Occluder diameter, age, residual shunt, and pulmonary valve flow velocity were identified as independent risk factors for hemolysis after transcatheter VSD closure in children. The developed model showed good discrimination and calibration and may serve as a useful tool for preprocedural risk stratification and postprocedural surveillance. Further external validation and prospective evaluation are warranted.

Congenital junctional ectopic tachycardia is a rare arrhythmia that poses significant management challenges. This report presents a case of neonatal-onset congenital junctional ectopic tachycardia treated with cedilanid, amiodarone, and propafenone but persisted in episodes. Sinus rhythm was restored following the initiation of ivabradine therapy. The review of the literature indicates that ivabradine demonstrates efficacy in the treatment of paediatric junctional ectopic tachycardia, particularly in refractory cases, without significant side effects. These findings suggest that ivabradine has broad applications in the treatment of refractory arrhythmias.

Nanoparticles have broad prospects and profound academic significance in cardiovascular diseases. This study aimed to comprehensively summarize the global scientific achievements of nanoparticles in cardiovascular diseases research. Articles on the application of nanoparticles in cardiovascular diseases published from 2002 to 2021 were retrieved from the science citation index expanded of the Web of Science Core Collection, and knowledge maps were generated by Cite Space, VOS viewer, and Hist Cite for further bibliometric analysis. A total of 4321 records were retrieved, and only reviews and articles were retained with a total of 4258 studies. The number of publications on nanoparticles in the cardiovascular field has steadily increased from 2002 to 2021. China and the US contribute the most to this field, producing nearly all the most influential authors and institutions in the top 10 list. The Chinese Academy of Medical Sciences and Harvard University have obtained many high-quality research results. Targeted drug delivery via nanoparticles, myocardial infarction and atherosclerosis are research hotspots. This is the first time to analyze the application of nanoparticles in the cardiovascular field by using multiple bibliometric software. This study provides evidence for researchers to understand the hotspots and directions in this area.

Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children.Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery.Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673–18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274–33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233–14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331–2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073–14.941, P = 0.039) were risk factors for unplanned surgery.Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.

Percutaneous balloon pulmonary valvuloplasty (PBPV) is the primary treatment for pulmonary valve stenosis (PVS). The study consisted of 228 children with PVS who underwent PBPV from January 2004 to October 2019 at a single center. The risk factors for ≥moderate pulmonary regurgitation (PR), residual stenosis, and restenosis were analyzed based on the baseline patient characteristics and measured value of corresponding inspection results. Among 228 patients, follow‐up results were obtained in 193 patients. The univariate analysis demonstrated that young age, low weight, small pulmonary annulus diameter, higher initial RV‐PA PSEG, increased RV/systemic pressure ratio, and severe PVS were associated with ≥moderate PR. The multivariate analysis demonstrated that higher initial RV‐PA PSEG and low weight were independently associated with ≥moderate PR, while higher initial RV‐PA PSEG was independently associated with residual stenosis and restenosis. PBPV is a preferred tre atment in PVS children with a higher success rate. Higher initial RV‐PA PSEG was a significant factor for ≥moderate PR, residual stenosis, and restenosis.

Background: Arrhythmia is the most common complication after transcatheter closure of a ventricular septal defect (VSD). However, the effects of postprocedural left anterior fascicular block are not clear. This study presents the clinical characteristics, prognosis, and related risk factors of left anterior fascicular block after transcatheter closure of a VSD in children.Methods: The clinical and follow-up data of the patients in the Heart Center of Children's Hospital of Chongqing Medical University from June 2009 to October 2018 were reviewed. And 30 cases were eligible out of all 1,371 cases.Results: An electrocardiogram showed a left anterior fascicular block within 3 days, and most patients gradually returned to normal within 1–2 years, showing a dynamic change. Left ventricular end-diastolic dimension Z-score ranged from −2 to 2 in all children, and no decrease of left ventricular ejection fraction was found in all children. The high ratio between VSD size and body surface area [p < 0.05, odds ratio (OR) 2.6, 95% CI: 1.136–6.113] and large diameter difference between the occluder size and VSD size (p < 0.05, OR 2.1, 95% CI: 1.036–4.609) were independent risk factors for postprocedural left anterior fascicular block.Conclusions: The incidence of postprocedural left anterior fascicular block is not that low, and the overall prognosis is quite good at the current follow-up stage. No progressive severity has been found, such as complete left bundle branch block, double (triple) bundle branch block, and atrioventricular block, to have an influence on cardiac systolic and diastolic function.

While coronary artery abnormality (CAA) has been established as the most serious complication of Kawasaki disease (KD), there have been no detailed systematic reviews of the risk factors associated with this condition. We searched six databases and performed a systematic review and meta-analysis. Study-specific odds ratios (ORs) for each factor were pooled using a random effects model. We identified four risk factors for CAA children with KD: gender (OR, 1.75; 95% confidence interval [CI], 1.59–1.92), intravenous immunoglobulin (IVIG) resistance (OR, 3.43; 95% CI, 2.07–5.67), IVIG treatment beyond 10 days of onset of symptoms (OR, 3.65; 95% CI, 2.23–5.97), and increased C-reactive protein levels (OR, 1.02; 95% CI, 1.01–1.02). More number of the five typical symptoms of KD was identified as a protective factor against CAA (OR, 0.47; 95% CI, 0.33–0.66). Pediatric patients with IVIG resistant were more likely to develop CAA within 1 month of the onset of KD than the general population, even in patients with other risk factors for CAA. Thus, there is a potential risk of CAA misdiagnosis if echocardiography is not carried out frequently. In summary, we report four risk factors for CAA and a protective factor against CAA in children with KD. We recommend that pediatricians consider these factors much more closely. With accurate prediction and early preventive treatment in high-risk patients, we can expect a reduction in CAA rates. Further research is now required to investigate the associations between CAA and other factors including the interval between KD onset and IVIG administration, platelet count, and the duration of fever. We also need to confirm whether the frequency of echocardiography within a month of KD onset should be increased in IVIG-resistant patients.

To investigate the patterns of B-type natriuretic peptide (BNP) expression after arrhythmia, BNP was assessed at different time points (0 minute, 10 minutes, 30 minutes, 1 hour, 3 hours, and 6 hours) in CaCl₂-induced arrhythmia in rats through various methods such as immunohistochemistry, Western blotting, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay. Immunohistochemistry results showed that the expression of BNP in the endocardium was higher than that in the epicardium in rats undergoing sustained arrhythmias. The BNP-to-GAPDH (glyceraldehyde-3-phosphate dehydrogenase) ratios determined by Western blotting analysis revealed no change at 0 minute but increased at 10 minutes and reached the first peak (0.48 [0.03]) at 30 minutes. After a brief decline, the second peak was observed at 6 hours (0.54 [0.03]). Similar patterns of BNP messenger RNA expression were also observed by quantitative real-time polymerase chain reaction. The plasma BNP concentrations did not change after initial bouts of cardiac arrhythmias but significantly increased 30 minutes after CaCl₂ injections. The results demonstrate that arrhythmia causes an elevation of BNP in the myocardium and blood, and BNP messenger RNA increases in initial arrhythmia while its protein in myocardium and plasma does not; however, both of them were elevated after sustained arrhythmia. Such an elevated BNP expression, which is directly related to the severity and duration of the arrhythmias, may suggest the existence of fatal arrhythmia in sudden cardiac death.