Multisystem Inflammatory Syndrome in Children (MIS-C) was a new condition with clinical features overlapping with Kawasaki disease (KD) observed during the COVID-19 pandemic. Differences emerged that supported distinguishing between the two conditions, including distinct cardiac presentations and sequelae. The study objective was to compare echocardiographic findings between MIS-C and KD utilizing prospectively collected longitudinal cohort data from a multicenter consortium and the Kawasaki Disease Research Center. Pre-COVID KD cases (2017–2019) and MIS-C cases (April 2020-March 2022) were analyzed for differences in coronary artery (CA) Z-score and left ventricular ejection fraction (EF) during admission and follow up. Relative risks (RRs) were calculated between disease category and cardiac presentation (diminished EF and aneurysm status). We analyzed 480 subjects (MIS-C n=262; KD n=218). KD subjects had a higher risk of CA aneurysm (RR= 1.86; 95
Congenital heart disease care depends on specialised expertise distributed across clinicians, disciplines, patients and families. But bringing knowledgeable individuals together does not guarantee that their distinct contributions shape a decision. In complex congenital heart disease, multidisciplinary deliberation must reconcile anatomy, physiology, procedural feasibility, longitudinal risk and patient priorities, often amid uncertainty. We distinguish a team’s possession of expertise from its collective capability to make that expertise usable. This distinction affirms, rather than questions, individual clinical judgement, professional responsibility and shared accountability for patients. We propose a testable conceptual framework in which relevant expertise becomes accessible, is expressed and understood, receives appropriate weight, and can revise the team’s understanding or decision. Congenital cardiology examples include choices between catheter-based and surgical intervention, anticipation of intensive-care needs, and consideration of treatment burden and family goals. Constructive disagreement may reveal overlooked information or competing interpretations, while patients and families contribute essential knowledge about daily life and acceptable trade-offs. Existing team-science research supports the framework’s rationale, but its ability to improve congenital heart outcomes has not been demonstrated. We outline a developmental cycle—map, observe, practise, review, adapt and re-map—through which programmes might examine how expertise enters decisions, identify missed contributions and learn across changing membership. Evaluation should combine prospective measures of decision quality and implementation with appropriately risk-adjusted clinical outcomes, patient and family experience, and longer-term trajectories. The objective is not consensus for its own sake, but better use of knowledge already available to care teams.
To evaluate how prenatal risk stratification impacts transfer times to the cardiac unit for newborns with d-transposition of the great arteries (d-TGA) in a high-volume, free-standing children’s center. This is a retrospective study examining all prenatally diagnosed d-TGA newborns at a single center without in-house delivery capacity from 1/1/2013 to 3/1/2026. We evaluated two time periods based on implementation of level of care (LOC) assignments at our center (2013–2018 versus 2018–2026). The primary outcome was time from birth to arrival in the cardiac intensive care unit (CICU). Univariable and multivariable models were performed to include fetal echocardiographic and clinical covariates. Of 106 d-TGA newborns, 52 (49
Dilated cardiomyopathy (DCM) is a leading cause of pediatric heart failure and carries a substantial risk of death or heart transplantation. In low- and middle-income countries, limited access to advanced heart failure therapies and transplantation highlights the need for simple, reliable tools to identify children at highest risk. Therefore, this study aimed to identify independent predictors of mortality and develop a practical bedside risk score for mortality prediction in children with DCM. We conducted a retrospective cohort study of children with DCM treated at Dr. Sardjito Hospital, Indonesia, between 2016 and 2025. Clinical, electrocardiographic, and echocardiographic variables were evaluated for association with mortality. Independent predictors were incorporated into a point-based risk score using the Spiegelhalter–Knill-Jones method. Discriminative performance was assessed by receiver operating characteristic analysis and internal validation. Among 109 children with DCM, mortality was 33.9
Sickle cell disease (SCD) encompasses a spectrum of genotypes, most commonly Hemoglobin (Hgb)SS and HgbSC. Diastolic dysfunction (DD) is common in SCD and impacts morbidity and mortality. We sought to evaluate if the rates of DD differed by SCD genotype and by hydroxyurea (HU) use among youths. This was a retrospective study of patients with HgbSS and HgbSC who received an echocardiogram, stratifying genotype and HU use. DD was assessed using mitral valve (MV) E/A ratio < 0.8 or > 2, septal E’ < 7 cm/s, lateral E’ <10 cm/s, E/e’ Average > 10; and LA: Aortic root (LA: Ao) ratio > 1.3:1. DD was defined as a diastolic aggregate score ≥ 2 of 5. Multivariable regression models adjusted for age were used to estimate the associations of DD with HU use by genotype. 39
