Men had markedly higher serum cTnI compared with women, although they were case matched with respect to age and cardiac risk factors. Our results may suggest there may be sex-related differences in the myocardial response to ischemia and reperfusion injury or intrinsic differences between the male and female myocardium.

Purpose of review COVID-19-related guidance has changed dramatically since the onset of the pandemic. Awareness of data regarding prevention of disease, the cardiac manifestations and treatment of acute COVID-19 and multisystem inflammatory syndrome in children, and return to physical activity following an infection allows for appropriate adjustment of current care models and guides future study. Recent findingsSevere acute respiratory syndrome coronavirus 2 transmission can be reduced using various mitigation strategies, though their effectiveness differs based on viral prevalence. The risk of severe disease during acute COVID-19 infection is low in children and adolescents, though specific risk factors have been identified. COVID-19 vaccination significantly decreases the risk of severe disease and poor outcomes. Regular physical activity positively affects well being and has been a focus of recent guidance regarding well tolerated return to activities following an infection.

We present a case of a newborn with a rare presentation of obstructed supracardiac total anomalous pulmonary venous connection who required emergent cannulation to extracorporeal membrane oxygenation (ECMO). Computed tomographic angiography of the heart was performed and using novel virtual dissection techniques aided in surgical planning and guidance. Computed tomographic angiography can be successfully performed in neonates with complex congenital heart disease on ECMO without adjustment of flows to aid in surgical management and novel virtual dissection techniques aid in complex anatomical delineation and spatial orientation with noncardiac structures. The preoperative imaging in this case allowed for appropriate and detailed presurgical planning and contributed to the excellent outcome of this patient.

Background:The ratio of early diastolic mitral inflow velocity (E) to early diastolic mitral annular tissue velocity (e'), or E/e' , is an echocardiographic measure of left ventricular filling pressure. Peri-operative changes in E/e' and association with outcomes have been demonstrated in adults undergoing surgery for aortic stenosis (AS). We sought to explore changes in E/e' and other diastolic indices in the setting of congenital AS surgery and to assess for association with post-operative outcomes among children and young adults. Methods: A retrospective, single-center study was performed among patients 6 months to 30 years of age who underwent congenital AS surgery from 2006 to 2018. Tissue Doppler indices were collected from pre-and post-operative echocardiograms.Post-operative outcomes were reviewed.Results: Sixty-six subjects with subvalvar (45%), valvar (47%), and supravalvar (8%) AS underwent surgery at a median age of 9.5 years (IQR: 4.0-14.8). Pre-operatively, the lateral E/e' ratio was 8.6 (6.7-11.0); 33% had E/e'≥10. Post-operatively, the lateral e' decreased to 9.9 cm/s (8.0-11.4), the E/e' ratio increased to 10.4 (8.3-13.1); and 53% had E/e'≥10 (p-values < 0.0001, 0.0072, and < 0.001, respectively). Pre-operative lateral e' correlated modestly with duration of intubation (ρ = −0.24, p-value 0.048) and post-operative lateral e' correlated modestly with duration of intubation and length of hospital stay (ρ = −0.28 and −0.26, p-values = 0.02 and 0.04, respectively). Conclusions:Children and young adults who underwent congenital AS surgery had echocardiographic evidence of diastolic dysfunction pre-operatively that worsened post-operatively. Lateral e' may be a sensitive indicator of impaired ventricular relaxation in these patients and may impact duration of intubation and hospital stay.

Introduction: Cardiopulmonary exercise testing (CPET) is an important tool in assessing the functional status of patients with pulmonary hypertension (PH). During CPET, ECG is used as marker of exercise induced ischemia. We hypothesize that ECG changes with exercise may be an early indicator of clinical worsening in PH and could predict adverse outcomes. Methods: Clinical, hemodynamic, and CPET data of 101 PH patients who underwent CPET between 2013 and 2019 were included. ECGs were analyzed for ST depressions and T wave inversions during the earliest CPET in this time frame, along with coincident hemodynamic data. These data were correlated to adverse outcomes, including shunt creation (atrial septostomy or POTTs shunt), lung transplantation, and death. Results: Median age was 19 y (7-40 y, IQR 12-26), 68% were female, and median follow up time was 3 y (1-8 y, IQR 1-5). Sixteen patients had an adverse outcome (8 shunt creation, 4 lung transplant, 7 death). Twenty-two patients demonstrated significant ST/T wave changes with exercise, 18 ST depressions and 9 T wave inversions. Multivariate regression, including pulmonary arterial pressure, revealed exercise induced ST/T wave changes to be an independent predictor of procedure-free survival (without lung transplantation or shunt creation) (hazard ratio 11.10, p=.006). Only 21% with ST/T wave changes demonstrated procedure-free survival vs 85% without. Conclusions: ST/T wave changes on exercise ECG are significantly associated with adverse outcomes in PH on a medium term follow up study. These ECG changes with exercise can be used as early indicators of clinical worsening in PH and predictors of adverse outcomes.