Down syndrome and associated atrioventricular septal defects in a nationwide Norwegian cohort: Prevalence, time trends, and outcomes.

INTRODUCTION: The prevalence of Down syndrome (DS) is approximately 1 per 1000 births and is influenced by increasing maternal age over the last few decades. DS is strongly associated with congenital heart defects (CHDs), especially atrioventricular septal defect (AVSD). Our objectives were to investigate the prevalence of live-born infants with DS having a severe CHD in the Norwegian population over the last 20 years and compare outcomes in infants with AVSD with and without DS. MATERIAL AND METHODS: Information on all births from January 1, 2000 to December 31, 2019 was obtained from the Medical Birth Registry of Norway. We also obtained data on all infants with severe CHDs in Norway registered in Oslo University Hospital's Clinical Registry for Congenital Heart Defects during 2000-2019 and accessed individual-level patient data from the electronic hospital records of selected cases. Infants with AVSD and DS were compared to infants with AVSD without chromosomal defects. Crude and adjusted odds ratios (ORs) of infant mortality and need for surgery during the first year of life, with associated 95% confidence intervals (CIs), were estimated by logistic regression. RESULTS: A total of 1 177 926 infants were live-born in Norway during the study period. Among these, 1456 (0.1%) had DS. The prevalence of infants with DS having a severe CHDs was relatively stable, with a mean of 17 cases per year. The most common CHD associated with DS was AVSD (44.4%). Infants with AVSD and DS were more likely to have cardiac intervention during their first year of life compared to infants with AVSD without chromosomal defects (adjusted OR [aOR]: 2.52; 95% CI 1.27, 4.98). However, we observed no difference in infant mortality during first year of life between the two groups (aOR: 1.08; 95% CI 0.43, 2.70). CONCLUSIONS: The prevalence of live-born infants with severe CHDs and DS has been stable in Norway across 20 years. Infants with AVSD and DS did not have higher risk of mortality during their first year of life compared to infants with AVSD without chromosomal defects, despite a higher risk of operative intervention.

In the Catheterization Laboratory, Most Iatrogenic Cardiac Tamponades Require Only Pericardiocentesis: A Single-Center Experience.

Background: Cardiac tamponade (CT) is a rare but life-threatening complication of cardiac interventions, requiring immediate pericardial cavity pressure relief. While pericardiocentesis often suffices, and some cases necessitate open-chest surgery. This decision is frequently based on individual physician's experience. This study aims to identify high-risk CT patients following cardiac intervention, advocating for early, decisive surgical intervention. Methods: A retrospective analysis was conducted on 51 patients who developed iatrogenic CT at our center between October 2013 and October 2023. Patients were classified based on the necessity for open-chest surgery. The study evaluated a variety of factors, including baseline characteristics, therapeutic approaches, and outcomes. Results: Of the 51 patients with iatrogenic CT, 49 patients were successfully treated without open-chest surgery, with an average immediate drainage volume of 208.2 ± 173.8 mL. In contrast, the two patients requiring open-chest surgery had significantly higher drainage volumes, exceeding 500 mL, with over 300 mL drained in the first hour, indicating laceration injuries. Patients not requiring open-chest surgery demonstrated favorable outcomes. Conclusions: The majority of patients with iatrogenic CT and non-lacerated injuries experienced a favorable prognosis following pericardiocentesis. However, in cases of lacerated injuries with drainage volume was above 300 mL per hour, pericardiocentesis alone could not stabilize the hemodynamics due to persistent bleeding. Immediate surgery may be needed in these cases.

Patient-specific 3D in vitro modeling and fluid dynamic analysis of primary pulmonary vein stenosis.

Introduction: Primary pulmonary vein stenosis (PVS) is a rare congenital heart disease that proves to be a clinical challenge due to the rapidly progressive disease course and high rates of treatment complications. PVS intervention is frequently faced with in-stent restenosis and persistent disease progression despite initial venous recanalization with balloon angioplasty or stenting. Alterations in wall shear stress (WSS) have been previously associated with neointimal hyperplasia and venous stenosis underlying PVS progression. Thus, the development of patient-specific three-dimensional (3D) in vitro models is needed to further investigate the biomechanical outcomes of endovascular and surgical interventions. Methods: In this study, deidentified computed tomography images from three patients were segmented to generate perfusable phantom models of pulmonary veins before and after catheterization. These 3D reconstructions were 3D printed using a clear resin ink and used in a benchtop experimental setup. Computational fluid dynamic (CFD) analysis was performed on models in silico utilizing Doppler echocardiography data to represent the in vivo flow conditions at the inlets. Particle image velocimetry was conducted using the benchtop perfusion setup to analyze WSS and velocity profiles and the results were compared with those predicted by the CFD model. Results: Our findings indicated areas of undesirable alterations in WSS before and after catheterization, in comparison with the published baseline levels in the healthy in vivo tissues that may lead to regional disease progression. Discussion: The established patient-specific 3D in vitro models and the developed in vitro-in silico platform demonstrate great promise to refine interventional approaches and mitigate complications in treating patients with primary PVS.

Current Understanding of Indications, Technical Aspects and Outcomes of Fetal Cardiac Interventions.

With the improvement in the detection of congenital heart disease in fetal life, fetal cardiac interventions are pushing the envelope in hopes of either altering the natural history of disease or improving survival in certain high-risk lesions. These interventions include fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome, fetal atrial septoplasty with or without atrial septal stenting for hypoplastic left heart syndrome and variants with intact or severely restrictive atrial septum, and fetal pulmonary valvuloplasty for severe pulmonary stenosis or pulmonary atresia with intact ventricular septum. This review discusses their indications, technical aspects, and outcomes based on available literature.

Catheter-Based Fetal Cardiac Interventions.

Fetal cardiac intervention (FCI) is an emerging and rapidly advancing group of interventions designed to improve outcomes for fetuses with cardiovascular disease. Currently, FCI is comprised of pharmacologic therapies (e.g., trans-placental antiarrhythmics for fetal arrhythmia), open surgical procedures (e.g., surgical resection of pericardial teratoma), and catheter-based procedures (e.g., fetal aortic valvuloplasty for aortic stenosis). This review focuses on the rationale, criteria for inclusion, technical details, and current outcomes of the three most frequently performed catheter-based FCI procedures: (1) aortic valvuloplasty for critical aortic stenosis (AS) associated with evolving hypoplastic left heart syndrome (HLHS), (2) atrial septal intervention for HLHS with severely restrictive or intact atrial septum (R/IAS), and (3) pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum (PA/IVS).

Virtual reality modelling for planning of percutaneous first step palliation in a newborn with heterotaxy syndrome.

We report the first-stage percutaneous palliation in a newborn with a rare heterotaxy syndrome variant including interrupted inferior vena cava, partial anomalous pulmonary venous drainage, and restrictive interatrial communication. Virtual reality imaging aided visualisation, decision-making, and planning. Successful atrial septoplasty performed via the internal jugular vein and anomalous pulmonary vein was followed by stenting of ductus arteriosus.

Morbidity and mortality in premature or low birth weight patients with congenital heart disease in three European pediatric heart centers between 2016 and 2020.

Background: The treatment of preterm and low birth weight (LBW) neonates born with congenital heart disease (CHD) requiring early cardiac intervention remains challenging. We aimed to analyze morbidity and mortality in this combined high-risk patient group. Methods: A retrospective cohort study was conducted of preterm [<37 weeks gestational age (GA)] and/or LBW neonates (<2,500 g) born with a diagnosis of CHD, which requires invasive cardiac intervention (surgery or catheter) within their first year of life. Patients born between 2016 and 2020 and treated in three European pediatric heart centers were included. Results: A total of 308 neonates (51% male) with CHD were included. Of those, 237 (77%) were born preterm, 259 (84%) were LBW, and 188 (61%) were both. The median GA was 35.4 weeks (interquartile range 33.3-36.9) and the mean birth weight was 2,016 ± 580 g. CHD was categorized as simple (12%), moderate (64%), or severe (24%). The overall complication rate was 45% and was highest in patients with severe CHD (p = 0.002). One-year mortality (19%) was associated with severe CHD, low relative birth weight in patients with genetic diagnoses, and low GA at birth, whereas GA at birth significantly impacted survival only after 3 months of life. Conclusions: The high morbidity and mortality in preterm and LBW neonates with CHD reflect their complexity and consequent limited treatment feasibility.

Efficacy of Trimetazidine in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Contrast Coronary Intervention: A Systematic Review and Meta-Analysis (PRISMA).

Objective: The present systematic review assessed the efficacy of peri-procedurally administered trimetazidine in the prevention of contrast-induced nephropathy (CIN) in patients undergoing coronary interventions with contrast agents. Methods: We performed a systematic literature review of articles published in PubMed and Google Scholar by 7 December 2023 and included articles from the last 15 years that evaluated the efficacy of trimetazidine in preventing CIN in cardiac patients undergoing coronary intervention. Results: After title/abstract and full-text screening, this systematic review included 9 randomized controlled trials (N = 2158 patients) with two groups: Trimetazidine (60-70 mg/day 24 to 48 h before and up to 72 h after the procedure) with hydration and the control group with only hydration. A total of 234/2158 patients developed CIN (Incidence rate [IR], 10.8%) as per the CIN definition of the Contrast Media Safety Committee of the European Society of Urogenital Radiology. The incidence of CIN in the trimetazidine vs. control group was 6.4% (69/1083) vs. 15.4% (165/1075), and the odds ratio (95% CI) was 0.3753 (0.279-0.504). Conclusions: In conclusion, the trimetazidine group had a lower incidence of CIN. Trimetazidine offers a reno-protective effect and helps in reducing the CIN incidence in patients undergoing cardiac intervention. Peri-procedure administration of trimetazidine significantly decreases the risk of CIN in patients despite comorbidities.

Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol.

AIMS: Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a standardized protocol. METHODS AND RESULTS: As a dedicated SDD coordinator, a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient flow, in-hospital logistics, patient education, and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were considered eligible if they had a left ventricular ejection fraction (LVEF) ≥35%, with basic support at home and accessibility of the hospital within 60 min also forming a part of the eligibility criteria. A total of 420 consecutive patients were screened by the SDD coordinator, of whom 331 were eligible for SDD. The reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%), or LVEF <35% (17, 4.0%). Of the eligible patients, 300 (91%) were successfully discharged the same day. There were no major post-SDD complications. Rates of unplanned medical attention (19, 6.3%) and 30-day readmission (5, 1.6%) were extremely low and driven by femoral access-site complications. These were significantly reduced upon the introduction of compulsory ultrasound-guided punctures after the initial 150 SDD patients (P = 0.0145). Standardized SDD coordination resulted in efficient workflows and reduced the total workload of the medical staff. CONCLUSION: Same-day discharge after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the future transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access-site complications in our cohort and should therefore be a prerequisite for SDD.

Application of CICARE communication model in patient communication in the waiting room for cardiac interventional therapy / 中国医学伦理学

ObjectiveTo explore the application effect of the CICARE communication model in patient communication in the waiting room for cardiac interventional therapy. MethodsThe 108 patients in the waiting room for cardiac interventional therapy at a hospital from January 2023 to May 2023 were selected as the study subjects. Among them， 55 patients from January to March 2023 were assigned to the control group， and 53 patients from April to May 2023 were assigned to the intervention group. The control group received the traditional communication model for communication and health education， and the intervention group received the CICARE communication model for communication and health education. The intervention effects were compared between the two groups. ResultsAfter implementing the CICARE communication model， the preoperative anxiety level of patients in the intervention group was significantly lower than that in the control group ［（12.30±4.30） Vs. （15.41±2.35）， P<0.01］. The intervention group had a significantly better understanding of surgical objectives and procedures ［（4.70±0.54） Vs. （3.66±0.67）， P<0.001］， preoperative preparation （P<0.001）， intra-operative position and communication ［（3.89±0.32） Vs. （3.03±0.57）， P<0.001］， and post-operative precautions ［（5.26±0.71） Vs. （4.17±0.71）， P<0.001］ than the control group. In addition， the number of people in the intervention group who was satisfied with the evaluation of nursing work （χ2=23.923， P<0.001） and the overall satisfaction score were significantly higher than those in the control group ［（68.48±6.42） Vs. （45.79±12.56）， P<0.001］. ConclusionPatient education based on the CICARE communication model can effectively inprove communication efficiency， improve the body stress response， enhance patient satisfaction with nursing work， and promote a harmonious nurse-patient relationship.

Health Literacy Analytics of Accessible Patient Resources in Cardiovascular Medicine: What are Patients Wanting to Know?

Introduction: There remains an increasing utilization of internet-based resources as a first line of medical knowledge. Among patients with cardiovascular disease, these resources often are relied upon for numerous diagnostic and therapeutic modalities. However, the reliability of this information is not fully understood. The aim of this study was to provide a descriptive profile on the literacy quality, readability, and transparency of publicly available educational resources in cardiology. Methods: The frequently asked questions and associated online educational articles on common cardiovascular diagnostic and therapeutic interventions were investigated using publicly available data from the Google RankBrain machine learning algorithm after applying inclusion and exclusion criteria. Independent raters evaluated questions for Rothwell's Classification and readability calculations. Results: Collectively, 520 questions and articles were evaluated across 13 cardiac interventions, resulting in 3,120 readability scores. The sources of articles were most frequently from academic institutions followed by commercial sources. Most questions were classified as "Fact" at 76.0% (n = 395), and questions regarding "Technical Details" of each intervention were the most common subclassification at 56.3% (n = 293). Conclusions: Our data show that patients most often are using online search query programs to seek information regarding specific knowledge of each cardiovascular intervention rather than form an evaluation of the intervention. Additionally, these online patient educational resources continue to not meet grade-level reading recommendations.

Advances in intervention for fetal congenital heart disease / 中国实用内科杂志

Intervention therapy for congenital heart diseases has made great progress over the past 50 years, and fetal cardiac intervention therapy, which has saved lives and improved the postnatal prognosis, has thrived with the rapid development of the fetal echocardiography. The safety and effectiveness of fetal cardiac intervention have been acknowledged.

Discussion on theEthical Issues Involved in Cardiac Interventional Therapy / 中国医学伦理学

This paper introduced the current situation of cardiac interventional therapy and put forward the fol-lowing points that medical staffs should pay attention to:the patient's right to know, right to be informed, right of communication, right of privacy, and etc. On this basis, it is suggested to solve the ethical issues in cardiac inter-ventional therapy through the implementation of clinical pathway, effective communication, humanistic care, the construction of occupational ethics, strict feedback and supervision.

Influence of nursing intervention on sleep quality of patients after cardiac intervention / 中国实用护理杂志

ObjectiveTo investigate the effect of nursing intervention on sleep quality of patients after cardiac intervention. Methods140 patients undergoing cardiac interventional surgery in our hospital from January 2010 to January 2011 were chosen as the research object.They were divided into the observation group and the control group in accordance with the principle of randomization with 70 cases in each group.The control group was treated with conventional methods of nursing care of cardiology.The observation group was given with sleep- related nursing interventions on the basis of the routine care.The sleep quality score (PSQI)24 h and 1 week,2 weeks postoperation and treatment compliance 2 weeks postoperation were compared between the two groups. ResultsThe study showed that the PSQI score 24h postoperation showed no significant difference,but 1 week and 2 weeks after the operation,the score of the observation group was significantly lower than the control group.The full compliance rate in the observation group was significantly higher than the control group.The non-full compliance rate was significantly lower than the control group,the differences were statistically significantConclusionsNursing intervention can improve treatment compliance of patients,improve sleep quality of patients after cardiac intervention.It is conducive to the rehabilitation of patients and is worthy of clinical application.

Postcardiac Injury Syndrome after Percutaneous Coronary Intervention

The post cardiac injury syndrome is characterized by the development of a fever, pleuropericarditis, and parenchymal pulmonary infiltrates in the weeks following trauma to the pericardium or myocardium. According to previous reports, almost all cases develop after major cardiac surgery or a myocardial infarction. Recently, a few reports have described post cardiac injury syndrome as a complication of endovascular procedures such as percutaneous cardiac intervention. Here we describe an unusual case of post cardiac injury syndrome after a percutaneous coronary intervention.

Survey on patient dose in cardiac intervention / 介入放射学杂志

Objective To collect information of patient doses of interventional radiology in Beijing Xuanwu Hospital,and investigate correlation between the peak skin dose(PSD) and dose-area product(DAP).Methods Radiation doses from 135 patients have been studied including 84 coronary angiographies(CAG) and 51 percutaneous transluminal coronary angioplasties(PCI).Dose-area product(DAP) values,cumulative dose(CD) at interventional reference points,fluoroscopy times,total number of cine frames were collected for each patient.Skin dose measurements were made with thermoluminescent dosimeters(TLD) placed as a 10 ? 9 arrays of TLDs on the body.The grid of TLDs arrays was 5 ? 4 cm.Results Mean values for dose-area product were 2690.84 ?Gym2 for CAG and 7946.91 ?Gym2 for PCI.Mean values for CD were 431.6 mGy cm2 for CAG and 1395.3 mGy for PCI.Mean fluoroscopy times were 2.9 min for CAG and 10.9 min for PCI and mean number of frames were 544 and 945 for CAG and PCI,respectively.PSD values ranged from 26.18 to 120.37 mGy for CAG and 38.91 to 184.79 mGy for PCI.The relationship between DAP and PSD was r = 0.52 for CAG and r = 0.54 for PCI.The correlation of PSD with CD was r = 0.45 for CAG and r = 0.53 for PCI.Conclusion Comparison shows that patients DAP,CD and fluoroscopy time values were comparable with other publications.Skin dose values of investigated patients are below the threshold dose for radiation skin injury(2 Gy).There is no good relationship between DAP and PSD.So calculation of individual maximum skin dose based on DAP data is not reliable and needs to find a new reference value for skin dose.(J Intervent Radiol,2007,16:222-225)