Cardiopulmonary exercise testing in children and adolescents at moderate altitude: New normative values.

Background: Cardiopulmonary exercise tests (CPETs) measure cardiovascular exercise response. Altitude alters exercise parameters, so standard normative datasets (Cooper, Bruce, Burstein) may not accurately predict exercise parameters for data collected at moderate altitude. This study aimed to: 1) establish modern normative exercise values for children/adolescents at moderate altitude and 2) compare these values against the Cooper, Burstein and Bruce models.

Increased Resting and Peak Exercise Systolic Blood Pressure in Children Throughout the COVID-19 Pandemic.

The COVID-19 pandemic created significant disruptions to daily life. Lockdown effects resulted in decreased exercise capacity and increased blood pressure in adults and adolescents in the first year of the pandemic. We examined changes in exercise capacity (peak workload, ventilatory anaerobic threshold-VAT, and VO peak), resting BP, and peak exercise BP in children before the COVID-19 pandemic and throughout five 6-month intervals of the pandemic.

Associations Between Socioeconomic Context and Congenital Heart Disease Related Outcomes in Adolescents and Adults.

Little is known about the relation between socioeconomic factors and health outcomes in adults and adolescents with congenital heart defects (CHD). Population-level data from the Colorado CHD surveillance system from 2011 to 2013 was used to examine the association between area deprivation and outcomes including hospitalizations, emergency department visits, cardiac procedures, all-cause and cardiac-related mortality, and major adverse cardiac events. Socioeconomic context was measured by the Area Deprivation Index at census tract level.

Patients with Fontan circulation have abnormal aortic wave propagation patterns: A wave intensity analysis study.

Background: Elevated systemic afterload in patients with Fontan circulation may lead to impaired single ventricular function. Wave intensity analysis (WIA) enables evaluation of compression and expansion waves traveling through vasculature. We aimed to investigate the unfavorable wave propagation causing excessive afterload may be an important contributor to the overall single ventricle function and to the limited functional capacity in this patient population.

Population-level surveillance of congenital heart defects among adolescents and adults in Colorado: Implications of record linkage.

Background: The objective was to describe the design of a population-level electronic health record (EHR) and insurance claims-based surveillance system of adolescents and adults with congenital heart defects (CHDs) in Colorado and to evaluate the bias introduced by duplicate cases across data sources.

Methods: The Colorado CHD Surveillance System ascertained individuals aged 11-64 years with a CHD based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic coding between 2011 and 2013 from a diverse network of health care systems and an All Payer Claims Database (APCD). A probability-based identity reconciliation algorithm identified duplicate cases.

Exercise Performance at Increased Altitude After Fontan Operation: Comparison to Normal Controls and Correlation with Cavopulmonary Hemodynamics.

Exercise performance declines as patients who have undergone Fontan operation enter adolescence. However, the effect of altitude on functional capacity after Fontan remains inadequately studied. Our aim was to describe exercise performance in a cohort of patients with Fontan physiology living at increased altitude and compare to a normal control group and relate these data to invasively derived hemodynamics.

Pulse Oximetry Values in Newborns with Critical Congenital Heart Disease upon ICU Admission at Altitude.

Pulse oximetry screening for critical congenital heart disease (CCHD) has been recommended by the American Academy of Pediatrics (AAP). The objectives of this study are to describe saturation data, and to evaluate the effectiveness of AAP-recommended pulse oximetry screening guidelines applied retrospectively to a cohort of newborns with known CCHD at moderate altitude (5557 feet, Aurora, Colorado). Data related to seven critical congenital heart disease diagnoses were extracted from electronic health records (pulse oximetry, prostaglandin administration, and oxygen supplementation).

Percutaneous thoracic duct intervention to treat plastic bronchitis related to Fontan palliation.

Plastic bronchitis is a life-threatening condition of airway obstructive cast formation. This pediatric case series from a high altitude center details the course of three patients after percutaneous thoracic duct interventions for refractory plastic bronchitis, with a follow-up interval of 3.5 years.

Evaluation of predictive models for six minute walk test among children with pulmonary hypertension.

Background: Existing six minute walk distance (6MWD) prediction equations were developed using healthy children and include relatively small sample sizes. Children with congenital heart disease and pulmonary hypertension (PH) are often small-for-age, so the existing pediatric prediction equations are likely a poor fit for children with PH. Currently, there are no equations for 6MWD among children with PH.

Feasibility of critical congenital heart disease newborn screening at moderate altitude.

Background And Objective: Consensus guidelines have recommended newborn pulse oximetry screening for critical congenital heart disease (CCHD). Given that newborn oxygen saturations are generally lower at higher altitudes, the American Academy of Pediatrics and others recommend additional evaluation of the screening algorithm at altitude. Our objective was to evaluate the feasibility of newborn pulse-oximetry CCHD screening at moderate altitude (Aurora, CO; 1694 m).

Ventilatory efficiency slope correlates with functional capacity, outcomes, and disease severity in pediatric patients with pulmonary hypertension.

Background: Cardiopulmonary exercise testing is widely used in a variety of cardiovascular conditions. Ventilatory efficiency slope can be derived from submaximal exercise testing. The present study sought to evaluate the relationship between ventilatory efficiency slope and functional capacity, outcomes, and disease severity in pediatric patients with pulmonary hypertension.

Restrictive lung function in pediatric patients with structural congenital heart disease.

Objectives: We sought to describe the prevalence of restrictive lung function in structural congenital heart disease and to determine the effect of cardiothoracic surgical intervention.

Methods: The data from a retrospective review of the spirometry findings from pediatric patients with structural congenital heart disease were compared with the data from 220 matched controls. Restrictive lung function was defined as a forced vital capacity of <80%, with a preserved ratio of the forced expiratory volume in the first second to forced vital capacity of >80%.

Constrictive pericarditis secondary to infection with Mycoplasma pneumoniae.

Pericardial effusions can be insidious, variable in presentation, and may result from a wide variety of causes. We report here a rare case of pericardial effusion in a pediatric patient secondary to infection with Mycoplasma pneumoniae that progressed to cardiac tamponade and constrictive pericarditis. The differential diagnosis of pericardial effusion is reviewed as well as current treatments for pericardial effusions and constrictive pericarditis.

Ventricular ectopy following successful cryoablation for Wolff-Parkinson-White syndrome in the right posterior septum: a case report.

We report a case of new onset ventricular ectopy following cryothermal ablation of a right posterior septal accessory pathway. To our knowledge, this is the first report of secondary arrhythmias from cryothermal ablation of atrial arrhythmias.

Octreotide treatment of chylothorax in pediatric patients following cardiothoracic surgery.

Objective: To analyze the efficacy and safety of octreotide treatment of persistent chylothorax in pediatric patients following cardiothoracic surgery.

Design: Retrospective chart review of patients admitted to the cardiac intensive care unit of a tertiary care center over a 10-year period (1998-2008). Nineteen patients were identified who underwent treatment with octreotide for persistent chylothorax following cardiothoracic surgery.

Axillary versus infraclavicular placement for endocardial heart rhythm devices in patients with pediatric and congenital heart disease.

Our objective was to evaluate the implant and mid-term outcomes of transvenous pacemaker or internal cardioverter-defibrillator placement by alternative axillary approaches compared to the infraclavicular approach in a pediatric and congenital heart disease population. We conducted a retrospective review of all patients with new endocardial heart rhythm devices placed at 4 pediatric arrhythmia centers. A total of 317 patients were included, 63 had undergone a 2-incision axillary approach, 51 a retropectoral axillary approach, and 203 an infraclavicular approach.

Cryothermal catheter ablation of atrioventricular nodal reentrant tachycardia in a pediatric patient after atrioventricular canal repair.

Anatomic displacement of the atrioventricular node and associated conduction tissue in atrioventricular septal defects has been previously described. In spite of the increasing use of cryothermal catheter ablation in the pediatric population, there remains very little literature regarding its use in congenital heart disease. We describe successful cryothermal modification of the slow atrioventricular nodal pathway in a 12-year-old patient with a previously repaired partial atrioventricular septal defect and inducible atrioventricular nodal reentrant tachycardia.

Adherence to guidelines for cardiovascular screening in current high school preparticipation evaluation forms.

We compared the content of the cardiac screening questions on US state high school athletic association preparticipation evaluation forms with current consensus recommendations. We reviewed the high school athletic association's approved, recommended, or required sports preparticipation form from each of the 50 US states and the District of Columbia, and compared the content of the personal and family history components with current recommendations for cardiac screening questions. We found that 85% of the preparticipation forms in current use contain all elements of the formerly recommended guidelines, but only 17% contain all elements of the new consensus guidelines.

Toward improved cosmetic results: a novel technique for the placement of a pacemaker or internal cardioverter/defibrillator generators in the axilla of young patients.

Surgical scars secondary to the placement of pacemakers or internal cardioverter/defibrillators in the infraclavicular area can be unsightly. This report describes a novel cosmetic approach for the placement of pacemakers or internal cardioverter/defibrillators. The approach involves a small infraclavicular incision for placement of the leads and then a larger incision hidden high up in the axilla.