Anthracyclines are indispensable in paediatric oncology but are associated with well-recognised dose-dependent cardiotoxicity that may result in progressive cardiomyopathy and late heart failure. Dexrazoxane has emerged as a potential primary cardioprotective strategy; however, concerns regarding safety, secondary malignancies, and possible interference with antitumour efficacy have historically limited its widespread adoption.

To critically review current evidence regarding the efficacy, safety, and clinical applicability of dexrazoxane in children receiving anthracycline-based chemotherapy, including region-specific implications for Latin America.

Narrative review of randomised controlled trials, observational studies, systematic reviews, meta-analyses, and international guideline statements evaluating cardiac outcomes, survival, toxicity profiles, and second primary malignancy risk.

Dexrazoxane consistently demonstrates cardioprotective effects, including reduced biomarkers of myocardial injury and improved preservation of left ventricular systolic function, particularly among patients exposed to higher cumulative anthracycline doses. Available data indicate no significant adverse impact on relapse rates, event-free survival, or overall survival. Although early studies raised concerns about increased second primary malignancies, subsequent investigations have yielded inconsistent results, leaving residual uncertainty.

Dexrazoxane represents an effective cardioprotective strategy in selected high-risk paediatric patients. A risk-adapted approach balancing cardioprotection, oncologic safety, and healthcare resources is warranted.

Heart failure induced by systemic ventricular dysfunction after the Norwood procedure may improve with medications. This study aimed to evaluate the incidence of heart failure, medication use, and subsequent improvement after the Norwood procedure.

Among the patients undergoing the Norwood procedure between 2001 and 2024, those who demonstrated heart failure (systemic ventricular dysfunction lasting > 30 days) were identified. Medical therapy and clinical outcomes were evaluated in relation to the recovery of systemic ventricular dysfunction.

Among 380 patients after the Norwood procedure, heart failure was observed in 55 patients. Recovery of systemic ventricular function occurred in 21 patients with a median duration of 187 (interquartile range: 77–354) days. The cumulative incidence of recovery was 60.9% at 5 years. Recovery was more frequently observed in patients whose onset was between stage II and III palliation than in other periods (58% vs. 28%, p = .029). Survival after the onset of heart failure was better in patients who showed recovery than in those who did not (88.8% vs. 26.7% at 5 years, p < .001). At the onset of heart failure, zlog-N-terminal prohormone of brain natriuretic peptide (4.2 ± 1.3 vs. 4.5 ± 1.3, p = .55) was similar but differed at the last follow-up (2.2 ± 1.3 vs. 5.1 ± 1.5, p = .01) in patients with and without recovery. A phosphodiesterase type 5 inhibitor was identified as a factor that promoted the recovery (hazard ratio: 5.89, p < .01).

In patients who developed heart failure after the Norwood procedure, survival was better in those with recovered function than in those with sustained dysfunction. Phosphodiesterase type 5 inhibitors were identified as a factor promoting the recovery.

The diagnosis of CHD not only affects the patient but also their entire environment, including parents, causing significant alterations in their mental health. This study was to assess the levels of anxiety and depression in parents of children with CHD at different stages of the disease.

The PMNCC and PMNCR questionnaires were administered to parents of children with CHD to measure levels of state anxiety (STAI-E) and trait anxiety (STAI-R).

A total of 459 questionnaires were administered. For the state anxiety questionnaire (STAI-E), the mean score was 36, with high anxiety levels observed in 81.3% of participants and above-average levels in 18.7%. Regarding the severity of state anxiety, 82.6% presented severe anxiety, followed by moderate anxiety in 17.2%. For the trait anxiety questionnaire (STAI-R), the mean score was 43, with high levels observed in 91.5% of participants and above-average levels in 7.2%. Severe anxiety predominated in 96.7% of cases.

The mental health of parents of children with CHD is often neither diagnosed nor adequately addressed in a timely manner by paediatric cardiology teams. Assessment and support from a multidisciplinary team are required for the early identification of these conditions.

Infants with CHD experience feeding disruptions during a critical phase in oral feeding development. Dependency on high respiratory supports interfere with oral feeding opportunities. There is little evidence guiding oral feeding practices for infants requiring high flow nasal cannula and nasal continuous positive airway pressure. The aim of this study was to describe current US institutional feeding practices for infants with CHD on non-invasive ventilation.

This was a cross-sectional survey of clinicians from primarily US institutions that were members of the Cardiac Neurodevelopmental Outcomes Collaborative.

From 35 institutions contacted, 20 (57%) feeding specialists responded. Most institutions (80%) did not utilise formal guidelines for oral feeding introduction on nasal continuous positive airway pressure or high flow nasal cannula. Most institutions (80%) did not allow full oral feeds on nasal continuous positive airway pressure, but 70% centres allowed full oral nutrition on high flow nasal cannula and (85%) allowed small volume oral feeding with specifications for the level of oxygen support. While most respondents (65%) reported feeding assessment completion on all infants both pre and postoperatively, few (30%) institutions utilised a formal cue-based assessment.

Responses indicate that institutions generally do not allow oral feeding on respiratory support above high flow nasal cannula. Most centres do not utilise formal respiratory/cue based assessments to determine infant feeding readiness while on non-invasive ventilation. Future multidisciplinary research and quality improvement initiatives are needed to examine the effects of feeding infants with CHD while on non-invasive ventilation and to develop centre-specific guidelines to direct feeding progression, with potential to improve oral feeding outcomes while supporting multisystem stability.

Hypertrophic cardiomyopathy is a life-threatening disease with limited studies in Middle Eastern populations. This pilot study (n = 8) aimed to identify rare genetic variants to enable future presymptomatic diagnosis and primary prevention. While the sample size precludes establishing population-level prevalence, our findings provide a springboard for generating testable hypotheses for future multicenter trials.

Whole-exome sequencing was performed on eight unrelated Egyptian patients. We prioritised variants using stringent criteria: allele frequency < 0.01 in gnomAD, combined annotation dependent depletion (CADD) score > 10, and focused analysis of 29 genes with definitive or moderate evidence for hypertrophic cardiomyopathy causation according to Clinical Genome Resource (ClinGen). Variants were ACMG/AMP-classified and correlated with detailed clinical phenotypes.

We identified 21 rare variants across 10 hypertrophic cardiomyopathy-associated genes. Core sarcomeric genes accounted for seven variants: MYBPC3 (n = 2; one likely pathogenic, p.Gly1206Asp), MYH7 (n = 2; one pathogenic, p.Phe252Ser), and TNNT2 (n = 3; all variants of uncertain significance). Additionally, likely pathogenic variants were found in PLN (p.Arg25Cys) and KLHL24 (p.Arg103*). Patients with pathogenic or likely pathogenic sarcomeric variants exhibited severe phenotypes, including septal thickness up to 30 mm, left ventricular outflow tract gradients up to 60 mmHg, and a high arrhythmic burden, influencing decisions like implantable cardioverter-defibrillator implantation and myectomy. Notably, all three TNNT2 carriers manifested atrial fibrillation or non-sustained ventricular tachycardia, reinforcing its arrhythmic risk. Four novel or likely pathogenic variants were submitted to ClinVar.

As the first genetic study of hypertrophic cardiomyopathy in an Egyptian population, this work expands the global mutational spectrum, demonstrates the utility of genetic testing for risk stratification and personalised management, and underscores the need to diversify genomic datasets for equitable precision medicine.

Journal editors play a central role in academic publishing. However, little is known about the experiences of editors within paediatric cardiology. This study aimed to explore the motivations, workload, peer review challenges, and sustainability of editorial roles in this specialty.

A cross-sectional, anonymous survey was conducted among paediatric cardiology journal editors and associate editors. Quantitative responses were analysed descriptively, and free-text responses underwent inductive thematic analysis.

A total of 28 editors participated. Most respondents (82.1%) identified education and mentorship as key motivations for editorial work. However, 78.6% reported that editorial roles are becoming increasingly difficult, and only 21.4% reported having sufficient protected time, highlighting substantial workload pressures. Reviewer fatigue was a major challenge, with 75.0% reporting difficulty securing timely, high-quality peer review. While 57.9% acknowledged that impact factor influences editorial considerations, 89.5% agreed that journals with lower impact factors remain highly valuable for education. Only 28.6% of respondents considered the current editorial model sustainable, with 46.4% expressing concern regarding long-term sustainability.

Paediatric cardiology journal editors demonstrate strong intrinsic motivation but face increasing workload, reviewer fatigue, and limited institutional support. These findings highlight a growing imbalance between editorial expectations and available support structures. Greater institutional recognition, provision of protected time, and pragmatic innovation in peer review processes may be required to sustain editorial engagement and maintain the educational and scientific mission of paediatric cardiology publishing.

Neurological injury is common in neonates undergoing cardiac surgery with cardiopulmonary bypass, yet perioperative neuroimaging and neuromonitoring practices vary across centres. We aimed to characterise current practices and provider perceptions across Pediatric Cardiac Intensive Care Society-affiliated centres.

We conducted an online, cross-sectional survey of Pediatric Cardiac Intensive Care Society members between August and October 2024. Part 1, completed by medical directors, assessed institutional characteristics and perioperative practices. Part 2, completed by multidisciplinary providers, evaluated perceptions of utility and sufficiency.

A total of 143 responses from 60 institutions were analysed, including 38 medical directors. Most centres had a dedicated cardiac ICU (87%) and were academically affiliated (76%). Routine neuroimaging was more common preoperatively than postoperatively (87% vs. 32%), with head ultrasound most frequently used. Near-infrared spectroscopy was the most common neuromonitoring modality, while routine electroencephalography was reported at 18% of centres preoperatively and 50% postoperatively. Physicians were more likely than advanced practice providers and nurses to report practices as sufficient. Neurocritical care teams were present at 42% of centres but were not associated with greater use of neuroimaging or monitoring.

Significant variability exists in perioperative practices and provider perceptions, highlighting the need for multidisciplinary alignment and standardised guidelines.

Caregivers of children with CHD frequently experience psychological distress related to the chronic and unpredictable demands of their child’s diagnosis. Peer support can mitigate distress and promote resilience, but few studies have explored factors affecting its implementation or the experiences of those who provide or facilitate peer support. This study aimed to identify barriers, facilitators, and recommendations for optimising peer support from the unique perspectives of leaders of patient/family organisations within the CHD community.

Using online crowdsourcing methods, qualitative data on the implementation of peer support was collected from 16 leaders representing five patient/family organisations. Crowdsourced data were coded and analysed using thematic analysis, with themes categorised as barriers, facilitators, and recommendations.

Four overarching themes were constructed: 1) Training and Expertise, highlighting the value of lived experience alongside the need for structured training in mental health and bereavement; 2) Peer Mentor Wellbeing, including burnout, secondary traumatic stress, and the importance of clear role boundaries and expectations; 3) Partnerships and Collaboration, emphasising relationships with clinical care centres; and (4) Support for all Families and Family Members, including fathers, siblings, and bereaved families.

The results provide insight into the implementation of peer support, with recommendations for next steps including hospital-community partnerships to improve access and intentional programme design to protect peer mentor wellbeing. Further understanding of caregiver and peer mentor needs is critical for elucidating ways to develop and implement optimal models of peer support.

To describe the rare combination of findings where a left aortic arch and aberrant right subclavian artery are associated with a vascular ring, which is in the setting of a right-sided arterial duct.

Analysis of all prenatally diagnosed cases of left aortic arch and right-sided arterial duct (between 2016 and 2025) at three fetal cardiac centres (2 UK and 1 Austrian) with documentation of aortic arch branching pattern.

In 5/6 cases, aberrant right subclavian artery was identified. Genetic abnormality was identified in 50% of cases (22q11 microdeletion). Three fetuses had a ventricular septal defects, and two cases had vascular abnormalities (with further characterisation on postnatal CT). No fetuses had extracardiac abnormalities.

Left aortic arch with aberrant right subclavian artery is not uncommon in the general population but when associated with other abnormalities may also be a marker for chromosomal and genetic abnormalities. If not fully understood, patients may be incorrectly counselled regarding the likelihood of respiratory and swallowing symptoms of a vascular ring. An understanding of the circumstances in which a ring can arise is needed. Our study adds to the limited published data on this condition, with a view to improving clinician understanding and guiding accurate prenatal counselling.

This study investigated the effects of therapeutic play on angiography in children aged 4–10.

Our study was conducted as a randomised controlled experimental trial with 70 (experimental: 35, control: 35) children undergoing angiography at the paediatric cardiology clinic of a university hospital between 1 January 2022 and 31 August 2022. The “Child Information Form”, “Wong-Baker Faces Pain Rating Scale”, “Children’s Fear Scale”, “Children’s Anxiety Meter-State” and “Doll Model” were used for data collection. Percentage, mean, pearson correlation, ANOVA were used in the evaluation of the data.

It was found that 57.1% of the children who participated in our study were female, their mean age was 6.48±2.36 years, 45.7% had the diagnosis of Atrial Septal Defect (ASD), 78.6% had not undergone any surgery before and 60% were hospitalised for follow-up. It was found that the difference between pain, fear and anxiety scores of the children after the therapeutic play programme was statistically significant (p ˂ 0.05).

Our study found that therapeutic play programmes can reduce pain, fear and anxiety in children. These findings demonstrate that negative experiences during invasive procedures affect children not only physiologically, but also psychologically and behaviourally. Therapeutic play can therefore be a powerful supportive intervention. Therefore, we recommend integrating therapeutic play into nursing clinical guidelines and care protocols, and providing paediatric nurses with training in this area.

Advances in cardiology and cardiac surgery have significantly improved survival rates among children with CHD, but these gains come with the need for long-term care that heavily involves parents. Understanding their life situation is essential for delivering effective family-centred and holistic healthcare. The study aimed to assess the life situation of parents of children with CHD in relation to sociodemographic factors and to explore their sources of support, emotional experiences, and the role of spirituality in coping.

A web-based cross-sectional survey was conducted among 117 parents of children with CHD in the Slovak Republic. Data was collected between December 2024 and January 2025 using the standardised questionnaire Life Situation of Caregivers/Parents of Children with CHD and/or Other Cardiac Diseases.

Multivariable linear regression analysis revealed that lower parental education and a history of cardiac surgeries in the child were associated with lower scores on the life situation scale. Conversely, a higher number of previous hospitalisations was linked to higher scores (p < 0.05). The most reported emotions related to the child’s illness were fear (94.87%), sadness (67.52%), and anger (38.46%). Family members were identified as the primary source of support.

These results highlight the need to identify parents at heightened psychosocial risk, particularly those with lower education and those whose children have undergone cardiac surgeries. In clinical practice, family support should be supplemented with structured psychological interventions as part of comprehensive care for families of children with CHD.

Enhanced recovery after surgery has an established evidence base in paediatric cardiac surgery, but formal programmes are infrequently implemented in Europe. Before implementing a programme, it is essential to assess current performance for benchmarking and to identify potential pitfalls.

A retrospective single-centre cohort study was performed to assess the peri-operative course of a low-risk group of children undergoing congenital cardiac surgery. Patient data were collected for the entire post-operative course before discharge home or to a different centre. Data regarding respiratory and haemodynamic support, invasive devices, length of stay, and analgesia were extracted from electronic intensive care records and paper ward records.

The search criteria yielded 1042 operations. Following a detailed assessment of inclusion and exclusion criteria, 73 patients were included in the study. Included patients had a median age of 3.1 years and a median weight of 13 kg. Seventy-one per cent (52/73) of patients underwent early extubation within six hours. Some children without contraindications did not receive non-opioid analgesia. Most invasive devices (pacing wires, drains, and central venous catheters) were removed on the ward. The median length of stay was 1.1 days in critical care and 4.3 in hospital.

Early extubation and duration of stay were comparable to outcomes published by some established enhanced recovery after surgery programmes, although shorter stays are achievable. Areas for improvement were identified. A centre’s specific context must be considered when implementing aspects of an enhanced recovery after surgery programme.

Minimally invasive vertical right axillary thoracotomy offers an excellent cosmetic and functional alternative to standard median sternotomy for congenital heart repairs in children. We report the steps taken and challenges involved in building an emerging programmes and outcomes in repairing diverse CHDs.

We performed a retrospective review of the first 152 paediatric patients who underwent repair of selected CHDs using the minimal invasive vertical right axillary thoracotomy approach between April 2022 and December 2025 at our institution and outline our multi-disciplinary team-building protocol.

Pre-commencement protocolar team teaching was implicated 2 months prior to the first case, using information gained through a combination of surgical site visits abroad by the surgeons, protocolar experience exchange with foreign experts, and multimedia educational platforms. The median age was 4.9 years (range: 4 months–13 years), and median weight was 16 kg (6–41 kg). The median lengths of ICU stay and hospital stay were 1.2 and 4.6 days, respectively. No in-hospital deaths or conversions to median sternotomy occurred. No late deaths or reoperations occurred during a median follow-up of 16 months (range 5 months–4 years).

The minimal invasive vertical right axillary thoracotomy can be safely introduced for a broad spectrum of CHDs. Educating all team members is critical to achieving excellent outcomes in a short-time frame. This approach provides excellent cosmetic results with a small “hidden” scar and stands as a good alternative to median sternotomy in selected paediatric patients.

Knowledge of one’s defect is fundamental in optimising outcomes in adults with CHD. We aimed to assess factors associated with defect knowledge and how that knowledge may impact outcomes.

We performed a cross-sectional cohort study of adults with CHDs aged 18–82 years with intervention between 1982 and 2003 at one of 11 US centres in the Pediatric Cardiac Care Consortium. Participants completed a survey in 2021–2023 regarding disease knowledge and various health and quality of life outcomes. After comparing participants’ self-identification of their defect to that recorded in the medical record, we identified demographic factors associated with correct identification and assessed the association of correct identification with outcomes.

Among 2747 respondents with one of the 18 types of CHDs on the survey, 2271 (83%) correctly identified their defect. Those who correctly identified their defect were more likely to be non-Hispanic White (84% correct), were <25 years of age (89%), have a higher level of education (86% for a bachelor’s degree and 87% for a graduate degree), and have higher household income (85% for income ≥$60,000). Those with severe two-ventricle disease were most likely to correctly identify their defect (88% correct); those with moderate disease were least likely (80% correct). Correct identification was associated with seeing a cardiologist in the last 5 years (74% vs. 63%, p < 0.001) but was mixed for other outcomes.

Improving a person’s knowledge of their CHD may be an effective strategy for maintaining continuity of care.

Case-based learning (CBL) is increasingly used across health professions education to promote clinical reasoning and professional competencies. In paediatric cardiology, rapid advances in diagnostics, interventions, and multidisciplinary care have intensified the need for educational approaches that integrate complex knowledge with real-world problem-solving.

This narrative review outlines the theoretical foundations of CBL and examines the available literature on its implementation and effectiveness in medical education generally and paediatric cardiology specifically. Emerging applications of CBL, including simulation, virtual reality, and international collaborative case conferences, were also reviewed. Key design principles for effective CBL were explored, including case selection, alignment with competency-based curricula, faculty development, and assessment strategies.

Evidence suggests that CBL enhances clinical reasoning, knowledge integration, learner engagement, and the development of professional competencies. In paediatric cardiology, CBL supports the application of complex diagnostic and management principles within authentic clinical contexts. Emerging technology-enhanced approaches and international collaborative learning initiatives further expand opportunities for interactive and multidisciplinary education. However, challenges remain, including significant time and resource requirements, digital inequities, and the need for more rigorous evaluation of educational outcomes.

Well-designed CBL appears to be a powerful educational strategy for preparing paediatric cardiology clinicians to deliver increasingly complex, team-based care. Future directions include greater integration of technology-enhanced learning, simulation-based approaches, and global educational networks to support trainees and practitioners across diverse practice settings while strengthening evidence for educational effectiveness.

The apical impulse palpation is a key component of cardiac physical examination, which offers insights into ventricular size and function. Its diagnostic accuracy in detecting cardiac enlargement in infants is unknown.

This cross-sectional observational study was done in infants 1 month to 1 year of age visiting a tertiary care hospital. The apical impulse was palpated and marked in supine position and its location in terms of the intercostal space and distance from mid-sternal line was noted. Echocardiography was performed to assess cardiac chamber enlargement. Z score of echo parameters was calculated. z score > 2 was considered to be an enlarged cardiac chamber. The diagnostic accuracy of a displaced apical impulse in detecting ventricular enlargement was evaluated using echocardiography as the reference standard.

309 infants were enrolled in the study. 22 % of the study subjects had a structurally normal heart. A displaced apical impulse had a diagnostic accuracy of 71.5%. Using another definition to define a displaced apical impulse, namely, horizontal displacement of > 4 cm from the mid-sternal line (regardless of the level of intercostal space), increased the diagnostic accuracy to 79.0 % with sensitivity and specificity of 76.4% and 81.1 %, respectively.

Horizontal displacement of the apical impulse 4 cm or more from the mid-sternal line (regardless of the level of intercostal space) is a simple and fairly accurate method to identify left ventricular enlargement in infants.

Children with CHD who have undergone corrective or palliative surgery are at increased risk for developmental delays. One important aspect is the development of emotional intelligence. Although emotional intelligence is not explicitly included in the current neurodevelopmental battery testing, increasing evidence supports the inclusion of it.

In this prospective, single-centre, cross-sectional pilot study, we analysed emotional intelligence in a broad spectrum of English-speaking paediatric patients, aged 7 to 17 years old, with a confirmed CHD and without moderate-to-severe developmental delay. We evaluated emotional intelligence using the Bar-On Emotional Quotient Inventory: Youth Version questionnaire, administered parent questionnaires, and reviewed medical records. We determined associations between components of the Emotional Quotient Inventory: Youth Version and pertinent demographic and clinical variables using one-way ANOVA and multivariable regression.

A total of 67 patients were included in this study; 68.7% underwent cardiac surgery in infancy, 74.2% with cardiopulmonary bypass. Children with greater CHD severity had lower emotional quotient scores, and there was a significant inverse relationship between social vulnerability index scores and emotional quotient scores. Multivariable modelling showed that social vulnerability scores explained 25.1% of emotional quotient total variance. Higher CHD severity, surgical complexity, multiple operations, and higher social vulnerability scores were associated with lower emotional quotient stress and adaptability.

Emotional intelligence is a modifiable component of developmental progression of children with CHD and can provide a complementary perspective of neurodevelopmental functioning. Addition of the Emotional Quotient Inventory: Youth Version to the battery of testing may be considered.