The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity.

Background and Objectives: The Western Cape public pediatric cardiac service is under-resourced. COVID-19 regulations are likely to have long-term effects on patient care but may provide insight into service capacity requirements. As such, we aimed to quantify the impact of COVID-19 regulations on this service. Methods: An uncontrolled retrospective pre-post study of all presenting patients over two, one-year periods; the pre-COVID-19 period (01/03/2019-29/02/2020) and the peri-COVID-19 period (01/03/2020-28/02/2021). Results: Admissions decreased by 39% (624 to 378) and cardiac surgeries decreased by 29% (293 to 208) in the peri-COVID-19 period, with an increase in urgent cases (PR:5.99, 95%CI:3.58-10.02, p < 0.001). Age at surgery was lower in the peri-COVID-19 period, 7.2 (2.4-20.4) vs. 10.8 (4.8-49.2) months (p < 0.05), likewise, age at surgery for transposition of the great arteries (TGA) was lower peri-COVID-19, 15 (IQR:11.2-25.5) vs. 46 (IQR:11-62.5) days (p < 0.05). Length of stay 6 (IQR:2-14) vs. 3 days (IQR:1-9) (p < 0.001), complications (PR:1.21, 95%CI:1.01-1.43, p < 0.05), and age-adjusted delayed-sternal-closure rates (PR:3.20, 95%CI:1.09-9.33, p < 0.05) increased peri-COVID-19. Conclusion: Cardiac procedures were significantly reduced in the peri-COVID-19 period which will have implications on an overburdened service and ultimately, patient outcomes. COVID-19 restrictions on elective procedures freed capacity for urgent cases, demonstrated by the absolute increase in urgent cases and significant decrease in age at TGA-surgery. This facilitated intervention at the point of physiological need, albeit at the expense of elective procedures, and also revealed insights into capacity requirements of the Western Cape. These data emphasize the need for an informed strategy to increase capacity and reduce backlog whilst ensuring minimal morbidity and mortality.Graphical Abstract.

COVID-19 Management in Children: Approach in Pediatric Cardiology

In children, cardiac involvement can be observed during the course of COVID-19, which is mostly mild, and COVID-19 may develop in children who have previously been known to have congenital or acquired heart disease. The subject of this article is how these children should be evaluated cardiacly, and how the follow-up and treatment of children with heart disease will be managed during the pandemic. Considering the articles and guides published in the literature, some determinations were made and the suggestions developed were presented in this article.

Impact of the Covid-19 Pandemic on the Monitoring of Children with Heart Disease in Consultation

BACKGROUND AND AIM: we report the impact of COVID-19 on the follow-up in pediatric cardiology consultations and its implications on the delay in management, especially for patients with congenital heart disease at the Mohammed VI University Hospital in Marrakech METHOD: This is a telephone survey concerning 200 patients followed in pediatric cardiology consultation at the Mother Child Hospital of the Mohammed VI University Hospital in Marrakech during the period from March 2020 to June 2020. RESULT(S): We identified 200 patients among 317 during the telephone survey, 117 were unreachable by telephone;the mean age was 5 years and 6 months with intervals ranging from 11 months to 16 years. Most of our patients had a low socio-economic level, 60% followed by an average of 39%. As for the reason why the patients missed their consultations: 38% had not been able to consult because of the confinement, 28% thought that there were no more consultations, 25% were afraid of being contaminated by the covid -19 in the hospital, 12% had no means of transport, 11% had no authorization to travel, 10% were confined to more than 200 km from the hospital, 6% were unaware that appointments were postponed and finally 2% had not been able to consult for lack of means. CONCLUSION(S): It is necessary to take measures to recover patients who have missed their consultation because of this pandemic.

Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era.

The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children's Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p < 0.05). We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients (n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10-17 yo) was associated with increased telemedicine (OR 2.04, 95%CI 1.71, 2.43) and patient portal use (OR 1.70, 95%CI 1.33, 2.17). Public insurance (OR 1.66, 95%CI 1.25, 2.20) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities.

Changes in Practice/Outcomes of Pediatric/Congenital Catheterization in Response to the First Wave of COVID.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has posed tremendous stress on the health care system. Its effects on pediatric/congenital catheterization program practice and performance have not been described. Objectives: To evaluate how case volumes, risk-profile, and outcomes of pediatric/congenital catheterization procedures changed in response to the first wave of COVID-19 and after that wave. Methods: A multicenter retrospective observational study was performed using Congenital Cardiac Catheterization Project on Outcomes Registry (C3PO) data to study changes in volume, case mix, and outcomes (high-severity adverse events [HSAEs]) during the first wave of COVID (March 1, 2020, to May 31, 2020) in comparison to the period prior to (January 1, 2019, to February 28, 2020) and after (June 1, 2020, to December 31, 2020) the first wave. Multivariable analyses adjusting for case type, hemodynamic vulnerability, and age group were performed. Hospital responses to the first wave were captured with an electronic study instrument. Results: During the study period, 12,557 cases were performed at 14 C3PO hospitals (with 8% performed during the first wave of COVID and 32% in the postperiod). Center case volumes decreased from a median 32.1 cases/mo (interquartile range: 20.7-49.0) before COVID to 22 cases/mo (interquartile range: 13-31) during the first wave (P = 0.001). The proportion of cases with risk factors for HSAE increased during the first wave, specifically proportions of infants and neonates (P < 0.001) and subjects with renal insufficiency (P = 0.02), recent cardiac surgery (P < 0.001), and a higher hemodynamic vulnerability score (P = 0.02). The observed HSAE risk did not change significantly (P = 0.13). In multivariable analyses, odds of HSAE during the first wave of COVID (odds ratio: 0.75) appeared to be lower than that before COVID, but the difference was not significant (P = 0.09). Conclusion: Despite increased case-mix complexity, C3PO programs maintained, if not improved, their performance in terms of HSAE. Exploratory analyses of practice changes may inform future harm-reduction efforts.

Upcoming Events in Pediatric Cardiology

Please check organization websites for details Feb 16-18, 2023 B 7th Annual Advances in Congenital Heart Disease Summit b Orlando World Center Marriott Orlando, FL https://www.clevelandclinicmeded.com/live/courses/CongenitalHeart23/ Feb 15-28, 2023 B CRT 2023 b Washington, DC https://crtmeeting.org/Default.aspx March 25-29, 2023 B AIUM b Orlando, FL https://www.eventscribe.net/2023/UltraCon/ June 23-26, 2023 B 34th Annual Scientific Sessions b National Harbor, MD https://www.asescientificsessions.org/register-now/ August 27-September 1, 2023 B 8th World Congress of Pediatric Cardiology and Cardiac Surgery b Washington, DC http://www.cvent.com/events/world-congress-of-pediatric-cardiology-and-cardiac-surgery/event-summary-342776c3ba39428eb9986e6f72d69b65.aspx Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Please note that due to Covid-19 pandemic, many meetings are being held virtually. [Extracted from the article]

Early experience with myocarditis and pericarditis in adolescents following vaccination against COVID-19 in latvia

Background and Aim: The European Medicines Agency has approved mRNA vaccines developed by Pfizer/BioNTech and Moderna for the vaccination of adolescents against the SARS-CoV-2 infection. Cases of myocarditis and pericarditis have been described as rare postvaccination complications. We describe the Latvian experience with adolescents suffering from myocarditis following COVID-19 vaccination. Method(s): From June to December 2021 four cases consistent with postvaccination myocarditis were admitted to the Children's Clinical University Hospital, which is the only centre with special-ized paediatric cardiology care in Latvia. The Pfizer/BioNTech vaccine had been used in all. An ECG, Holter monitoring and ECHO was done, HS Troponin I levels checked, the most common infectious causes of myocarditis were excluded, and a cardiac MRI was performed in all cases. Result(s): Case 1: 12-year-old girl, developed chest pain on postvac-cination day Nr 4 (PVD4) after the 1st dose. Holter monitoring revealed rare non-sustained ventricular tachycardia (NSVT), ECHO showed moderate mitral insufficiency, and a hyperecho-genic papillary muscle, troponin level peaked at 5339 pg/ml (PVD6), MRI (PVD 7) showed widespread myocardial oedema, transmural fibrosis. Symptoms resolved in 1 day, metoprolol suc-cinate and lisinopril were prescribed. Mitral insufficiency persists 5 months later. Case 2: 15-year-old boy, developed chest pain after the 2nd dose on PVD2 and lasted for 7 days, he was admitted on PVD11 with a peak troponin level of 19pg/ml. MRI (PVD15) showed widespread myocardial oedema. Metoprolol succinate was prescribed. Case 3: 15-year-old boy, developed chest pains on the day of the 1st dose and persisted for 35 days, he was admitted on PVD24 with peak troponin level 15ng/ml. MRI (PVD29) showed mild myocardial oedema, myocardial and pericardial fib-rosis. Case 4: 13-year-old boy, developed chest pain on PVD2, which lasted for 65 days, he had an episode of syncope. Holter monitoring showed frequent PVCs, and NSVT, on PVD34 tro-ponin level was 2,5pg/ml. The child received a course of NSAIDs and was referred to us on PVD68. MRI (PVD69) revealed wide-spread myocardial oedema, fibrosis, and pericarditis. Methylprednisolone was given, and betaxolol was prescribed. Conclusion(s): Our case series show that some cases of postvaccination myocarditis develop complications requiring long-term treatment.

The congenital cardiology cloud-proof of feasibility of the first telemedical network for pediatric cardiology in germany

Background and Aim: Recent technological developments offer a multitude of new options for innovative approaches in patient care. Especially during COVID-19-pandemic, use of telemedical infrastructure has worldwide become a crucial part of pandemic containment. For an optimate interplay based on data secure exchange of diagnostical data (DD) between patients with com-plex congenital heart disease, ambulatory care and hospital care, we successfully implemented the first telemedical network for pediatric cardiology in Germany, the Congenital Cardiology Cloud (CCC). This study proofs the CCCs feasibility and analyses its technical characteristics as well as its implementation in routine clinical work. Method(s): Analysis of implementation and technical characteristics comprised numbers of incoming/outgoing data, related file types, treatment options for tele medically processed patients and patient classification with respect to severity of disease. Proof of feasibility was made by the analysis of successful telemedical transmissions of discharge documents at the end of observation period (03/2020-10/2020). Result(s): Analysis of bilateral telemedical traffic showed a number of 1178 files for a total of 349 patients, favouring transmissions towards the clinic (782 files). Incoming traffic was predominantly characterised by diagnostical data (88%), consisting of a multitude of file types, whereas 94% of the dispatched data corresponded to discharge letters. Number of teleconsultations counted up to 61 during observation period, with a necessary subsequent treatment in 90% of the presented cases. Tele medically processed patients generally showed to be more complex (severe chronic heart dis-ease 42% vs. 24%). From a total number of 422 discharged patients, 323 had a successful telemedical transmission of their discharge documents, resulting in a rate of success of 97,6% at the end of observation period (pic 1). Conclusion(s): Implementation of the first telemedical network for pediatric cardiology in Germany proofs recent technological developments to successfully enable innovative patient care, con-necting the ambulatory and hospital sector for a joint patient advice. Transferred diagnostical data facilitates mutual assessment and predominantly involves more complex cases, resulting in a subsequent necessary hospitalization. The introduction of possible governmentally guided refinancing concepts will show its long-term feasibility.

Effects of COVID 19 pandemic on children attending to emergency units with chest pain

Background and Aim: Chest pain is a one of the most common com-plaints in children admitted to the Hospitals. Although it was among the most common reasons for referral to the pediatric car-diologist before COVID-19 era, this tendency is changed during covid pandemic. The primary objective of this study was to inves-tigate the aetiological causes, clinical characteristics and the follow up symptoms in terms of changing habits of parents and children admitted to the ED for acute chest pain during pandemic. Method(s): We reviewed the medical records of children under the age of 18 who presented with chest pain as the chief complaint from 1 January 2020 to 1 April 2021, at Istanbul University-Cerrahpasa Pediatric Emergency Clinic retrospectively from the hospital data-base. The study population comprised 128 boys and 119 girls. Result(s): All the children underwent ECG examination. While the ECG results of 239 children were normal, 6 sinus tachycardia, 1 supra-ventricular tachycardia and 1 incomplete left bundle branch block were observed. 33 patients had an echocardiography. Eight patients with an abnormal Echo result already had been examined and diag-nosed prior to their emergency admission. Blood samples were taken from 48 children for troponin. 17 samples wereabove the cut-off value which was set to 0.004 g/dl A total of 32 SARS-Cov2 swab samples were taken from suspicious cases and analyzed with RT-PCR. Consequently, 8 of these children were Covid-19 positive. 7 patients had no history of chronic disease, while 1 patient had ALL. All of these patients had mild symptoms and none of them required hospitali-zation. The total number of children who were referred to a pediatric cardiologist for a further examination together with the follow-up patients of the pediatric cardiology department is 52 Conclusion(s): In conclusion, Chest pain is a common referral com-plaint in children and is rarely due to cardiac diseases. To date car-diac reasons of chest pain was the major concern of patients and families attending the ED. However we found that Patient/family concerns regarding 'vulnerability to the severe covid infection has emerged as an important discourse during the pandemic on attend-ences to ED because of chest pain.

Application of remote videoconferencing to home monitor and support patients with major congenital heart disease during the COVID-19 pandemic

Background and Aim: The COVID-19 pandemic presented unique challenges to global healthcare provision. Face-to-face outpatient care was dramatically reduced as a consequence. This study imple-mented a remote videoconferencing call (VC) service delivered by a mobile app to continue close monitoring of our most vulnerable patients in their home environment. The patient cohort was fol-lowed up at a regional paediatric cardiology centre. Method(s): Patient recruitment began in September 2020, concluding in December 2021. Most participants were identified in the new-born/infant period and consisted of a mixture of cyanotic and acya-notic congenital heart disease. All study participants required regular, frequent outpatient monitoring in usual circumstances. Parents/guardians of identified patients received written and verbal explan-ation of study aims and objectives prior to giving written consent. The videoconferencing interface was delivered by PEXIP Infinity Connect Mobile app and conducted by experienced medical and/or nursing staff. This app was already a well established method of communication within the Regional Paediatric Cardiology Team. Primary outcome measures included admissions to hospital and avoidance of hospital attendances. Clinical proformas including growth parameters and clinical observations was recorded at each vir-tual appointment. Patient and parent related research data was col-lected at the first, fourth and eighth appointment. A select number of patients were given home saturation monitors and weight scales. Result(s): A total of 32 patients were enrolled. 164 VCs were deliv-ered (patient mean = 5.8). The average age at recruitment was 10.8 weeks. 18 patients had surgical intervention during the study period. There were 11 admissions to hospital directly resulting from the VC;the commonest indication was abnormal oxygen sat-urations (45%). 33 hospital attendances were avoided;the com-monest concern reported by parents was difficulty related to infant feeding (36%). Conclusion(s): Qualitative and quantitative measurement tools showed reduction in parental anxiety. The study was well received by par-ticipating families. There was prompt identification of unwell chil-dren on VCs as well as providing advice to prevent unnecessary hospital attendance. Videoconferencing technology proved very user friendly and proved to be a very valuable adjunct to the pro-vision of good patient care during challenging circumstances.

Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth.

Purpose of Review: Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric telehealth (TH) and practice based on lessons learned from the pandemic, scientific data from newer technological innovations in pediatric cardiology, and how TH is shaping global pediatric cardiology practice. Recent Findings: In 2020, the global pandemic of COVID-19 led to significant changes in healthcare delivery. The lockdown and social distancing guidelines accelerated smart adaptations and pivots to ensure continued pediatric care albeit in a virtual manner. Remote cardiac monitoring technology is continuing to advance at a rapid pace secondary to advances in the areas of Internet access, portable hand-held devices, and artificial intelligence. Summary: TH should be approached programmatically by pediatric cardiac healthcare providers with careful selection of patients, technology platforms, infrastructure setup, documentation, and compliance. Payment parity with in-person visits should be advocated and legislated. Newer remote cardiac monitoring technology should be expanded for objective assessment and optimal outcomes. TH continues to be working beyond geographical boundaries in pediatric cardiology and should continue to expand and develop.

Coronary Artery Dilation in Pediatric Patients with Asymptomatic or Mild COVID-19 Infection

Background: COVID-19 infection and Multisystem Inflammatory Syndrome in Children (MIS-C) in hospitalized pediatric patients have been associated with cardiac manifestations . Generally, children have asymptomatic or mild COVID-19 infection and MISC is rare. We examined the cardiac implications of asymptomatic or mild COVID-19 infection in non-hospitalized children to better define this outcome. Methods: We queried the electronic medical record for patients ≤18 years-old referred for outpatient pediatric cardiology evaluation following COVID-19 infection from 5/1/2020 - 4/30/2021. We excluded patients without a confirmatory COVID test (PCR or serology), who had been hospitalized for any condition related to COVID-19 (including MIS-C), or with history of cardiac disease that could affect coronary artery dimension. We recorded electrocardiogram (EKG) and echocardiogram (ECHO) findings, and laboratory studies performed during a preceding emergency department or most recent cardiology clinic visit. Results: Of 277 records reviewed, 134 met inclusion criteria (Figure 1);mean age 9.6 +/- 5.4 years, 53% male. 131 patients had a normal or minor variant on EKG and ECHO (Table 1). Three patients had coronary artery (CA) abnormalities on ECHO: 1) 7-year-old male with history of mild COVID-19 infection;borderline left main CA dilation (Z-score +2.1 on largest measurement). Plan for close follow-up and repeat ECHO. 2) 16-year-old male with positive COVID serology;dilated right CA (Z-score +2.3);started on aspirin. Plan for close follow-up, repeat ECHO, and possible CT angiography. 3) 8-yearold male with history of mild COVID-19 infection;dilated left main CA (Z-score +2.6);started on aspirin;CT angiography confirmed enlarged left main CA. Plan for close follow-up and repeat ECHO. Prior to COVID-19 this patient had an ECHO with normal CA dimensions (Z-score -0.4). Conclusion: While cardiac disease in children with COVID-19 infection is uncommon, we report three pediatric patients who may have developed CA dilation following confirmed mild or asymptomatic COVID-19 infection. Current return to play guidelines recommend cardiology evaluation after moderate to severe COVID-19 infection, as studies have reported myocarditis in young healthy athletes. Our study adds to the body of literature on COVIDrelated cardiac disease and may have important implications for post-COVID surveillance in young healthy children following minimal illness. Data collection is ongoing.

Adaptations of Pediatric Cardiology Practice During the COVID-19 Pandemic

Background: During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, pediatric heart centers were forced to rapidly alter the way patient care was provided in order to minimize interruption to patient care as well as exposure to the virus. In this study, we used a survey-based approach to characterize the changes that occurred in pediatric cardiology practices across the country during and just following the initial peak of COVID-19. Methods: In this survey based descriptive study we characterize changes that occurred within pediatric cardiology practices across the United States and describe provider experience and attitudes towards these changes during the pandemic. decision making during this period. This survey was emailed to an existing list serve of American Academy of Pediatrics Section on Cardiology and Cardiothoracic Surgery (AAP:SOCCS) members. Recipients of the survey included pediatric cardiologists, cardiothoracic surgeons, and fellows-intraining. The questionnaire was initially distributed in June 2020 and was active through August 2020. Results: Surveys were returned by 79 participants across 28 states. Areas of practice of respondents included general cardiology, non-invasive imaging, electrophysiology, heart failure/transplant, interventional cardiology, and adults with congenital heart disease. Common changes that were implemented included decreased numbers of procedures, limiting visitors, and shifting towards telemedicine encounters. There was a high level of satisfaction among providers with telemedicine encounters and a variety of platforms were utilized. Echocardiography was less likely to be performed during the pandemic as compared to prior to the pandemic in nearly all clinical scenarios presented. More than half of respondents expressed concerns about financial stability with regards to personal or practice situation but most were not frequently concerned about their personal safety. Conclusion: Pediatric cardiology practice across the country was heavily impacted by COVID-19 and required many adaptations including minimization of non-essential procedures and increasing use of telemedicine. Providers were generally satisfied with telemedicine and utilized several platforms. Financial concerns were common;however, most participants were not frequently concerned about personal safety. Inter-institutional collaboration could be useful in creating standardized protocols based on shared experiences that could be rapidly implemented in future public health crises. Experience with Telemedicine. A) Barriers to implementing telemedicine. B) Provider rated effectiveness of telemedicine. C) Home monitoring devices used as part of telemedicine program. D) Provider satisfaction vs perceived patient satisfaction with telemedicine encounters. Likelihood of Performing Echocardiography Prior to and During COVID-19 Pandemic. Participants were asked to rate the likelihood for each scenario as always, frequently, occasionally, or never. Responses were converted to a 5-point scale. Pre- and post- responses were analyzed using Wilcoxon signed-rank test. Significant decreases in likelihood of echocardiography were found in nearly all situations.

Cerebral Infarction Following Correction of Aortic Coarctation Surgery in Children

Background: Coarctation of the aorta (CoA) is a congenital heart defect. Due to the narrowing of the descending aorta, blood flow mainly reduces after the stenosis, and CoA can occur at any region in the thoracic and abdominal aorta. Cardiac surgeons and cardiologists are familiar with postoperative complications of CoA;however, there are also some other complications that have not been reported to date. Case Presentation: The present study investigated three cases of CoA undergoing reconstructive surgery. Nevertheless, a couple of days after the surgery, they manifested symptoms suspected of cerebral infarction. Ischemic infarction was observed after performing brain computed tomography. Additionally, we discuss possible pathophysiology and reasons that can lead to this problem. Conclusions: In this case report, we presented three cases of CoA patients who underwent reconstructive surgery and manifested cerebral infarction as an adverse effect of the reconstructive surgery.

Disproportionate Negative Career Impact of the COVID-19 Pandemic on Female Pediatric Cardiologists in the Northeast United States.

The COVID-19 pandemic has had a dramatic impact on practicing physicians, with effects in clinical practice, academic pursuits, research endeavors, and personal lives. Women in medicine have been uniquely impacted. We examined the impact of the pandemic on the careers of pediatric cardiologists in the Northeast with an anonymous online survey. Participants reported demographic data, information on work hours, administrative burden, career satisfaction, academic productivity, and burnout. We approached 490 cardiologists and received 127 completed surveys (response rate 26%; 49% female). Among all respondents, 72% reported increased burnout, 43% reported decreased career satisfaction, and 57% reported decreased academic productivity. In multivariable ordinal regression analysis, when compared to male physicians, females were 2.4 times more likely to report decreased overall career satisfaction (p = 0.027), 2.6 times more likely to report decreased academic productivity (p = 0.028), and 2.6 times more likely to report increased feelings of burnout "to a large degree" (p = 0.022). Among all respondents, decreased career satisfaction was independently associated with increased household responsibility (OR = 4.4, p = 0.001). Increased administrative burden was independently associated with decreased academic productivity (OR = 2.6, p = 0.038). Open-ended responses highlighted loss of community due to remote work and blurring of the boundaries between work and home. Conversely, respondents appreciated flexibility to work remotely. In conclusion, the majority of pediatric cardiologists in the Northeast experienced negative career impacts due to the COVID-19 pandemic. Important gender differences emerged, with female physicians disproportionately reporting increased burnout, decreased career satisfaction, and decreased academic productivity.

The Year in Review: Anesthesia for Congenital Heart Disease 2021.

This review focuses on the literature published during the calendar year 2021 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Four major themes are discussed, including cardiovascular disease in children with COVID-19, aortic valve repair and replacement, bleeding and coagulation, and enhanced recovery after surgery (ERAS).

Admission serological markers can be used to predict significant cardiac involvement in children with paediatric multisystem inflammatory syndrome

Introduction: Paediatric multisystem inflammatory syndrome (PIMS) began to present in April 2020 midway through the covid-19 pandemic. Occurring 2-4 weeks after initial covid-19 infection, patients presented with persistent fever, evidence of inflammation and single or multiorgan dysfunction1. The Yorkshire and Humber congenital heart disease network is made up of the Leeds congenital heart unit and 18 peripheral hospitals2.With limited local paediatric cardiology availability, the vast majority of children presenting with PIMS required transfer to Leeds. This presentation aims to describe the cohort of children that were seen within the network as well as to identify any markers of significant cardiac involvement which could beusedto reduce the frequency of unnecessary inter hospital transfers. Methods: This was a retrospective case notes review of all patients treated within the Yorkshire and Humber network with symptoms of PIMS between 1st May and 30th November 2020. Patients were classified as to whether or not they had significant cardiac involvement (defined as at least one of: inotrope requirement, ejection fraction <50%, pericardial effusion, coronary artery changes and significant ECG abnormalities). Cardiac markers were analysed at presentation and throughout the hospital admission including plasma NT pro-BNP, LDH, CRP, d-dimer and troponin. Statistical tests (Fisher's exact test for categorical variables, ttest for continuous variables) were used to identify which factors were indicative of significant cardiac involvement (SCI). Results: 22 patients met the inclusion criteria (Table 1). 14/22 patients (63.6%) were judged to have SCI. Markers that were found to be indicative of SCI included CRP and plasma NT pro-BNP (Table 2). Furthermore, when using a threshold of 2000ng/L, plasma NT pro-BNP was found to be 71% sensitive and 80% specific for SCI. In addition, when combined with a CRP threshold of 100mg/L, there was a positive predictive value of 85% and negative predictive value of 75%. Conclusions: PIMS is an important new syndrome affecting paediatric patients across the Yorkshire and Humber region. A significant proportion of the affected patients have cardiac involvement and require management in a specialist centre. Early identification of these patients using serological markers facilitates rapid treatment preventing long term sequelae whilst also reducing unnecessary interhospital transfers.

Impact of COVID-19 on Congenital Heart Disease interventional cardiology: a Survey on behalf of Italian Society of Congenital Heart Disease (SICP

Introduction: Among all western countries, Italy was the first to be strongly affected by COVID-19 pandemic, and one of the first to apply the “hard” lockdown. In order to limit the in-hospital infections and to re-distribute the healthcare professionals, all healthcare elective activities were reduced or cancelled, and among them, cardiac percutaneous interventions in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergent ones. The aim of this paper is to describe the impact of COVID-19 pandemic on Pediatric and ACHD cath lab activity during the so called “hard lockdown” in Italy. Methods: On behalf of the interventional working group of the Italian Society of Pediatric Cardiology, 11 out of 12 Italian Institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated to the survey. The institutions were distributed over all the national territory, 5 in the northern regions, 3 in the central and 3 in the southern ones. The data from each center were collected using a self-completion questionnaire containing 41 multiple choices questions. Results: Most of the hospitals were affected by the COVID-19 pandemic, either actively, with direct management of infected patients, or passively due to decrease of routinely clinical activities. The majority of institutions stated a change in the cath lab usual workflow plan and accessibility. Most of the centers had to cease at least temporarily the Cath lab practice, and the overall reduction of procedures number ranged between 50% and 75%. This reduction was more pronounced for teenagers and ACHD compared to neonates and children. Interestingly, there was an evident discrepancy in the management of the lock-down, irrespective of the number of COVID-19 positive cases registered, with higher reduction in Southern Italy compared to the most affected Regions Conclusions: COVID-19 pandemic has significantly affected the activity of 11 different pediatric cardiology and ACHD units all over Italy. Cath lab services were deeply impacted due to decline in outpatient clinic consultations and referrals from local hospitals. ACHD cath lab procedures suffered the biggest drop. However, overall activity reduction was not consistent with the severity of outbreak in the different Italian regions.

The Impact of COVID-19 on paediatric cardiology trainees in the UK

Introduction: In March 2020 the UK reported its first coronavirus related death. The weeks following saw rapid and frequent changes to the delivery of healthcare;face-to-face appointments were limited, elective procedures cancelled, and concerns about the availability of PPE began to surface. The potential impact of changing personal and professional circumstances on junior doctor well-being has been alluded to in statements from all UK Royal Colleges. We present results from the first part of a planned longitudinal prospective cohort study tracking trainee experiences during the pandemic. Methods: In May 2020, two months after than start of the pandemic, all UK paediatric cardiology trainees were invited to participate in an electronic survey. Questions addressed the work environment, training experiences and personal circumstances. Individual interviews were also conducted with 4 trainees. Results: 30/45 (67%) paediatric cardiology trainees from 7/10 U.K training regions (Liverpool, Cardiff and Belfast were not represented) completed the survey. Respondents were mostly aged 30-40 (77%), 48% female and 6 (20%) from ethnic minority backgrounds. The majority were working full time 27 (90%) and in higher/sub-speciality training 23 (77%). Most felt safe at work (89%) with access to appropriate PPE. Perceptions of workload intensity varied by region. 79% received formal teaching at 50%-100% of pre-pandemic levels. However, 93% reported reduced opportunities for sub-speciality training;61% characterised this as very significant. Well-being was almost unanimously negatively affected. Conclusions: Even during the first wave of the pandemic, the majority of U.K paediatric cardiology trainees felt safe at work. Workload intensity varied, reflecting changes in the configuration of cardiac services;in 1 London Centre and the East-Midlands, surgical/ interventional activity was paused. Higher/sub-speciality training was most impacted;where elective activity provides most experience. Well-being was virtually unanimously negatively impacted. COVID-19 has been the defining global healthcare crisis of the modern era. There has been a measurable impact on paediatric cardiology trainees;fewer cardiac catheterisations', restricted fetal screening, and a more emergency-driven case mix. Consideration of adjustment to training duration may be required pre-certification and our follow-up survey will aim to evaluate the longer-term implications of the pandemic on training.

Adaptations of paediatric cardiology practice during the COVID-19 pandemic.

During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, paediatric heart centres were forced to rapidly alter the way patient care was provided to minimise interruption to patient care as well as exposure to the virus. In this survey-based descriptive study, we characterise changes that occurred within paediatric cardiology practices across the United States and described provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardising responses to future public health crises.