Abstract Introduction: Transient ischaemic attack after patent foramen ovale closure presents diagnostic challenges. Patient information: A 17-year-old male with homozygous MTHFR polymorphism underwent successful patent foramen ovale closure under nitrous oxide anaesthesia. Clinical findings: Post-procedure, he experienced neurological deterioration and loss of consciousness with elevated homocysteine levels (43 mmol/L). Conclusion: Nitrous oxide-induced methionine synthase inhibition may precipitate transient ischaemic events in genetically susceptible patients.
Abstract Background: Exercise testing is an established tool for assessing cardiorespiratory function, guiding management, and predicting outcomes in children, adolescents, and adults with congenital and/or paediatric acquired heart disease. Despite its widespread use, substantial variability exists among clinical paediatric exercise laboratories in testing protocols, calibration techniques, data interpretation, and reporting, limiting multicentre collaboration and data comparability. Objective: To describe the formation of a registry focused on pediatric exercise testing. Methods: The Pediatric Exercise Data Analytics and Learning Network was established in 2023 by six institutions as the first multicentre paediatric-focused exercise testing registry in the United States dedicated to patients with heart disease. The Pediatric Exercise Data Analytics and Learning Network has two primary actions: 1) develop and maintain a multicentre registry with uniform data definitions to support quality improvement and research; and 2) establish a learning network to advance education and knowledge sharing through standard operating procedures, benchmarking dashboards, and collaborative initiatives. Integration with Cardiac Networks United links the Pediatric Exercise Data Analytics and Learning Network’s functional exercise testing data with existing longitudinal heart disease registries, creating opportunities for high-impact quality improvement and research. To foster objectives, the Pediatric Exercise Data Analytics and Learning Network aims to build a diverse network of both individual and hospital members who will work collaboratively to improve the consistency and value of paediatric and congenital exercise testing, advance quality improvement and research, and enhance long-term outcomes for patients with heart disease. Conclusion: This document describes the formation of PEDAL including organizational structure, database creation, and future directions.
Abstract Spiral atrial septal defects may complicate transcatheter closure and increase the risk of device embolisation. We describe a 5-year-old boy with pulmonary stenosis and a secundum atrial septal defect in whom an initially implanted 9 mm device embolised. At repeat intervention, balloon sizing revealed a bilobed, peanut-shaped configuration with a double waist, suggestive of a spiral atrial septal defect. A 15 mm device was subsequently implanted, achieving stable closure. The “Peanut Sign” may serve as a useful marker for identifying spiral atrial septal defects and guiding appropriate device selection.
Abstract Background: Intravenous magnesium sulphate is routinely administered in paediatric cardiac ICUs for the correction of hypomagnesemia. Its physiologic effects in critically ill children have not been clearly characterised. We aimed to describe circulatory and oximetric responses following intravenous magnesium sulphate administration. Methods: A single-centre retrospective, descriptive cohort study of paediatric cardiac ICU patients aged 1–12 years who received intravenous magnesium sulphate. Temporal responses in physiologic indices were characterised using locally estimated scatterplot smoothing and restricted cubic spline regression adjusted for patient characteristics. Results: 57 magnesium administrations were analysed. Blood pressure demonstrated early and minor relative declines followed by a progressive increase above baseline. Modelled venous resistance reached a nadir of 7.2% below baseline (95% bootstrap confidence interval −24.77% to 25.19%) and modelled mean circulatory filling pressure reached a nadir of 2.2% below baseline (95% bootstrap confidence interval −10.85% to 8.55%) at 124 minutes. Regional oxygen saturation remained above baseline throughout most of the observation period, reaching a maximum increase of 2.6% (95% bootstrap confidence interval −0.38% to 7.55%) at 480 minutes among 30 administrations with regional oxygen saturation data, while modelled oxygen extraction showed a sustained reduction below baseline. Conclusion: Findings suggest modest, coordinated changes in venous and arterial vascular physiology, with preserved regional oxygenation. Wide confidence intervals indicate uncertainty and heterogeneity in physiologic response patterns. These findings provide novel insight into the temporal circulatory response to magnesium sulphate in critically ill children and support prospective studies to further characterise these responses and establish causal relationships.
