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Introduction The optimal surgical approach for right ventricular outflow tract obstruction in Tetralogy of Fallot aims to preserve the native pulmonary valve annulus, as this is associated with better long-term outcomes. Pediatric humanitarian patients often present with a delayed diagnosis and lack access to preoperative palliative treatments, reducing the likelihood of pulmonary valve annulus preservation and potentially compromising long-term outcomes. This study aims to identify independent predictors of successful pulmonary valve-sparing repair in pediatric humanitarian patients undergoing corrective surgery for Tetralogy of Fallot. Methods Between January 2019 and May 2023, pediatric humanitarian patients with Tetralogy of Fallot underwent surgical correction at our center. We performed a comparative analysis of preoperative, intraoperative, and postoperative variables, followed by univariate and multivariate logistic regression to identify independent predictors of pulmonary valve-sparing repair. Results A lower body mass index (OR = 0.711; p  = 0.021; 95% CI = 0.533–0.949), a larger pulmonary valve annulus measured in centimeters (OR = 28.653; p  = 0.008; 95% CI = 2.360-347.890) and a higher Z-score of pulmonary valve annulus (OR = 1.606; p  = 0.023; 95% CI = 1.067–2.418) were identified as independent predictors of pulmonary valve-sparing repair. Conclusion Successful pulmonary valve-sparing repair was associated with lower BMI and a larger pulmonary valve annulus (both measurements in centimeters and Z-score). These findings may help guide clinical and policy strategies to promote more equitable and effective surgical care in resource-limited settings.

Background: Tetralogy of Fallot is a congenital heart defect that requires early surgical correction. However, in developing countries, many patients undergo delayed treatment due to limited healthcare resources. This study aims to identify risk factors for postoperative complications in humanitarian patients undergoing late Tetralogy of Fallot repair, defined as surgery performed after 12 months of age. Methods: A retrospective analysis was conducted on 115 humanitarian paediatric patients with a median age of 1444 days (approximately 4 years) who underwent complete Tetralogy of Fallot correction. In this humanitarian programme, patients from developing nations underwent surgical repair at our tertiary referral centre in a high-resource country. Postoperative complications were monitored within the first 30 days after surgery. Two multivariable logistic regression models were used to analyse pre/perioperative (Model 1) and postoperative (Model 2) risk factors for complications. Results: Complications occurred in 24.3% of patients. No deaths were recorded. In Model 1, smaller pulmonary valve annulus (OR = 0.066; p < 0.01) and the use of right ventricle to pulmonary artery conduit (OR = 13.252; p < 0.01) were significantly associated with a higher risk of complications. In Model 2, prolonged invasive ventilation time (OR = 1.068; p < 0.01) and extended hospitalisation time (OR = 1.093; p = 0.04) were significantly associated with complications. Conclusions: Late surgical correction of Tetralogy of Fallot in humanitarian paediatric patients can be performed with low mortality but carries a significant risk of postoperative complications. The predictive models provide useful tools for proactive clinical monitoring, personalised management, and optimisation of hospital resources.

Purpose Children with congenital heart disease (CHD) from low- to middle-income countries (LMIC) are suspected to have a high prevalence of antibiotic-resistant microorganisms (ARMOs) carriage, but data are currently lacking. Carriage of ARMOs could impact the post-operative course in pediatric intensive care unit (PICU). The aim of the study was to assess the prevalence of ARMOs carriage in children with CHD from LMIC and its impact on post-operative outcomes. Methods This was a retrospective monocentric study from 01/2019 to 12/2022. Included patients were children (0–18 years) from a LMIC admitted after CHD surgery and with AMRO screening performed the week before. Infections and post-operative evolution were compared based on ARMOs carriage status. Findings Among 224 surgeries (median age 38.5 months (IQR 22–85.5)), ARMOs carriage was evidenced in 95 cases (42.4%). Main organisms isolated were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli (75/224) 33.5%)) and ESBL- K. pneumoniae (30/224) 13.4%)). Median mechanical ventilation duration was 1 day (IQR 0–1), PICU stay 3 days (IQR 2–4) and hospital stay 6.5 days (IQR 5–10). A total of 17 infectious episodes occurred in 15 patients, mostly consisting in hospital-acquired pneumonia (HAP) (12/17). Only two infections were caused by a colonizing ARMO. Occurrence of infections and patients’ outcome were similar between ARMO carriers and non-carriers. Higher use of carbapenems (6 (6.3%) vs 1 (0.8%), p  = 0.04) and a trend to a higher use of vancomycin (14 (13.7%) vs 9 (6.9%), p  = 0.04) in case of ARMOs carriage. Applying current guidelines, negative swab screening could have led to sparing most of empirical vancomycin therapy (11/12) for HAP based on current guidelines. Conclusion Prevalence of AMROs carriage is high in children from LMIC and has a limited impact on patients’ outcome. However, ARMOs carriage leads to higher consumption of antibiotics. Screening may help saving use of broad-spectrum antibiotic in non-carrier patients.

Introduction CO 2 -derived variables, veno-arterial CO 2 content gradient (ΔCCO 2 ) and the ratio of ΔCCO 2 with arterio-venous oxygen difference (AV-DO 2 ) (ΔCCO2/AV-DO 2 ), may have a potential role as indicators of low cardiac output and anaerobic metabolism, respectively. We sought to describe and evaluate the association of CO 2 -derived variables with patients’ outcomes in the post cardiopulmonary bypass (CPB) period in children. Methods Prospective, single-center, study enrolling children post-CPB with paired arterial and venous blood gases for determination of lactate, O 2 extraction, ΔCCO 2 , and ΔCCO 2 /AV-DO 2 at admission (H0), and at 6 (H6), 12 (H12) and 24 (H24) hours. Different clinical patterns were defined based on the presence of an anaerobic context or a hypoperfusion context, using both O 2 and CO 2 -derived variables. The presence of anaerobic metabolism was defined with a lactate > 2 mmol/l and ΔCCO 2 /AV-DO 2  > 1.8; the presence of hypoperfusion was defined with an O 2 extraction > 30% and ΔCCO 2  > 6 mL. The potential association of duration of amine support and mechanical ventilation was tested with CO 2 -derived variables and specific clinical patterns. Results A total of 51 patients with a median age of 36 (IQR 11–85) months were included. Median admission ΔCCO 2 was 9.3 mL (IQR 5.6–11.4) with 72% above 6 mL. Median ΔCCO 2 /AV-DO 2 was 2.1 (IQR 1.5–2.4) with 58% above 1.8. Admission ΔCCO 2 showed a significant association with the duration of mechanical ventilation (R2 21.6, p value = 0.001) but not with the duration of vasoactive support. Neither H0 ΔCCO 2 nor H0 ΔCCO 2 /AV-DO 2 improved outcome prediction by a model including lactate and O 2 extraction. Anaerobic metabolism context showed a significant association with prolonged vasoactive support [28.4 (CI 95% 12.2–44.6) p  = 0.001] and mechanical ventilation duration [1.4 (95% CI 0.62–2.3) p  = 0.003]. In hypoperfusion context, neither duration of vasoactive support nor mechanical ventilation appeared different in the subgroups analysis. Conclusion CO 2 -derived variables may improve outcome prediction after cardiac surgery in pediatric patients. Further evaluation in larger multicentered trials is necessary to improve its validation.

Infective endocarditis due to Kingella kingae is a rare but serious invasive infection that occurs mostly in children. Recent advances in nucleic acid amplification testing as well as in cardiac imaging have enabled more accurate diagnosis. A good understanding of the epidemiology and virulence factors remains crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, pathophysiological insights, complications, and therapy regarding Kingella kingae endocarditis in children and adults. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.

Animal pericardial patches are widely used in adult and pediatric cardiac surgery. A search is ongoing for a new material with optimal surgical properties that will reduce intraoperative bleeding and the occurrence of restenosis, calcification, and pseudoaneurysms in long-term observation. One product of interest is the CardioCel bovine pericardial patch. Evaluation of the short-term results of CardioCel bovine pericardial patch implantation during pediatric cardiac surgery. The study included 8 patients who underwent surgical correction of congenital cardiac defects between January 2015 and February 2016. Pericardial patches were used to repair supravalvular aortic stenosis and reconstruct the aortic arch and pulmonary arteries. The age of the patients ranged from 10 days to 14 years. There were no hospital deaths. The new material exhibited satisfactory durability and elasticity during surgery, facilitating optimal adaptation of the patch to the patient's tissues. No significant bleeding was reported from the suture site. The median duration of follow-up was 58 days. During the follow-up, there were no symptoms of pseudoaneurysm formation, patch thickening, or calcification in the areas where the pericardial patches were implanted. No clinical or laboratory symptoms of infection were observed in locations where the new material was applied. Satisfactory surgical properties of the patch were observed intraoperatively. Positive results using the new pericardial patch were obtained in short-term follow-up.

To perform the preliminary tests of coarctation of aorta repair trainer, evaluate the surgical properties of the simulation and to assess and enhance residents' skills. Single patient's angio-CT anatomy data were converted into magnified 3D-printed model of aortic coarctation with hypoplastic aortic arch, serving for creation of a mould used during wax copies casting. Wax cores were painted with six layers of elastic silicone and melted, yielding phantoms that were consecutively fixed in a mounting with and without a thoracic wall. Simulation included: proximal and distal aortic arch clamping, incision of its lesser curvature, extended end-to-end anastomosis with 7-0 suture. A head-mounted camera video recording enabled anastomosis time and mean one suture bite time evaluation. Leakage assessment was done by a water test. Two residents performed nine simulations each. Last four runs were performed with thoracic wall attached. All phantoms performed well, enabling tissue-like handling and cutting, excellent suture retention, and satisfactory elasticity. Median anastomosis times were 22'33″ and 24'47″ for phantoms without and with thoracic wall (p = not significant (NS)). Median times needed to pass suture through one side of anastomosis and regrasp needle were, respectively, 9″ and 13″ (p < 0.001). Median total number of leakages per phantom equalled 2 for both difficulty levels. There were no significant inter-resident differences in all assessed parameters. This medium-fidelity aortic coarctation repair trainer showed its feasibility in replication of major critical steps of the real operation. Objective surgical efficiency parameters could be obtained from each simulation and compared between trainees and at different adjustable difficulty levels.

CO -derived variables, veno-arterial CO content gradient (ΔCCO ) and the ratio of ΔCCO with arterio-venous oxygen difference (AV-DO ) (ΔCCO2/AV-DO ), may have a potential role as indicators of low cardiac output and anaerobic metabolism, respectively. We sought to describe and evaluate the association of CO -derived variables with patients' outcomes in the post cardiopulmonary bypass (CPB) period in children. Prospective, single-center, study enrolling children post-CPB with paired arterial and venous blood gases for determination of lactate, O extraction, ΔCCO , and ΔCCO /AV-DO at admission (H0), and at 6 (H6), 12 (H12) and 24 (H24) hours. Different clinical patterns were defined based on the presence of an anaerobic context or a hypoperfusion context, using both O and CO -derived variables. The presence of anaerobic metabolism was defined with a lactate > 2 mmol/l and ΔCCO /AV-DO  > 1.8; the presence of hypoperfusion was defined with an O extraction > 30% and ΔCCO  > 6 mL. The potential association of duration of amine support and mechanical ventilation was tested with CO -derived variables and specific clinical patterns. A total of 51 patients with a median age of 36 (IQR 11-85) months were included. Median admission ΔCCO was 9.3 mL (IQR 5.6-11.4) with 72% above 6 mL. Median ΔCCO /AV-DO was 2.1 (IQR 1.5-2.4) with 58% above 1.8. Admission ΔCCO showed a significant association with the duration of mechanical ventilation (R2 21.6, p value = 0.001) but not with the duration of vasoactive support. Neither H0 ΔCCO nor H0 ΔCCO /AV-DO improved outcome prediction by a model including lactate and O extraction. Anaerobic metabolism context showed a significant association with prolonged vasoactive support [28.4 (CI 95% 12.2-44.6) p = 0.001] and mechanical ventilation duration [1.4 (95% CI 0.62-2.3) p = 0.003]. In hypoperfusion context, neither duration of vasoactive support nor mechanical ventilation appeared different in the subgroups analysis. CO -derived variables may improve outcome prediction after cardiac surgery in pediatric patients. Further evaluation in larger multicentered trials is necessary to improve its validation.

The efficient geological data management in Poland is necessary to support multilevel decision processes for government and local authorities in case of spatial planning, mineral resources and groundwater supply and the rational use of subsurface. Vast amount of geological information gathered in the digital archives and databases of Polish Geological Survey (PGS) is a basic resource for multi-scale national subsurface management. Data integration is the key factor to allow development of GIS and web tools for decision makers, however the main barrier for efficient geological information management is the heterogeneity of data in the resources of the Polish Geological Survey. Engineering-geological database is the first PGS thematic domain applied in the whole data integration plan. The solutions developed within this area will facilitate creation of procedures and standards for multilevel data management in PGS. Twenty years of experience in delivering digital engineering-geological mapping in 1:10 000 scale and archival geotechnical reports acquisition and digitisation allowed gathering of more than 300 thousands engineering-geological boreholes database as well as set of 10 thematic spatial layers (including foundation conditions map, depth to the first groundwater level, bedrock level, geohazards). Historically, the desktop approach was the source form of the geological-engineering data storage, resulting in multiple non-correlated interbase datasets. The need for creation of domain data model emerged and an object-oriented modelling (UML) scheme has been developed. The aim of the aforementioned development was to merge all datasets in one centralised Oracle server and prepare the unified spatial data structure for efficient web presentation and applications development. The presented approach will be the milestone toward creation of the Polish national standard for engineering-geological information management. The paper presents the approach and methodology of data unification, thematic vocabularies harmonisation, assumptions and results of data modelling as well as process of the integration of domain model with enterprise architecture implemented in PGS. Currently, there is no geological data standard in Poland. Lack of guidelines for borehole and spatial data management results in an increasing data dispersion as well as in growing barrier for multilevel data management and implementation of efficient decision support tools. Building the national geological data standard makes geotechnical information accessible to multiple institutions, universities, administration and research organisations and gather their data in the same, unified digital form according to the presented data model. Such approach is compliant with current digital trends and the idea of Spatial Data Infrastructure. Efficient geological data management is essential to support the sustainable development and the economic growth, as they allow implementation of geological information to assist the idea of Smart Cites, deliver information for Building Information Management (BIM) and support modern spatial planning. The engineering-geological domain data model presented in the paper is a scalable solution. Future implementation of developed procedures on other domains of PGS geological data is possible.

The paper presents the management of a child born with pulmonary valve atresia, a single (double-inlet) ventricle, right ventricular hypoplasia, and perimembranous septal defect. The first stage of treatment consisted in a Blalock-Taussig shunt. Control angiography performed 1 year after surgery confirmed that the anastomosis was correct, and there was no narrowing at the connection. The first stage of treatment was complicated by the occlusion of the left pulmonary artery, as diagnosed during cardiac catheterization before the planned bidirectional Glenn anastomosis. A decision was made to perform surgery through a left thoracotomy without a cardiopulmonary bypass in order to restore the continuity of the left pulmonary artery.