Editorial: Imaging, diagnosis and interventional treatment of congenital heart disease in children

Mario Carminati^*

• Pediatric and Adult Congenital Cardiology, IRCCS San Donato Polyclinic, San Donato Milanese, Milano, Italy

Precise diagnosis and accurate anatomical assessment of congenital heart defects are of paramount importance to optimize the subsequent treatment, either surgical or catheter interventional and to achieve a proper follow-up (1): echocardiography was long time ago the "game changer" for the assessment of congenital heart disease (CHD);subsequently an enormous improvemnt was obtained by implementing doppler information, 3D reconstruction, transesophageal technique etc..; Magnetic Resonance and Computed Tomography were then gaining an increasing importance; angiography, that was basically the only diagnostic tool available in pre-echo era, is still used <t present, but in the majority of cases, for interventional purposes.Echocardiography became a gold standard for prenatal diagnosis, even for the assessment of very complex defects. Yun He et a. described prenatally a unilateral pulmonary artery discontinuity, found in association with Taussig Bing malformation; It is well known that early and correct prenatal diagnosis of CHD plays an important role for postnatal outcome, allowing a better planning of neonatal care, particularly for complex defects. Accurate prenatal diagnosis, particularly for complex cases, are unlikely to be achieved in all centers; Lies Dina Liastuti et al. showed how Artificial Intelligence (AI) could improve the accuracy in detecting CHD by prenatal screening in the second-trimester fetus. particularly in low income settings. In spite of these encouraging results, more extensive studies are necessary to compare AI algorithms with conventional methods and to include a broader range of patients. (Lies Dina Liastuti et al.: Diagnostic accuracy of artificial intelligence models in detecting congenital heart disease in the second-trimester fetus through prenatal cardiac screening: a systematic review and meta-analysis). Interventional treatment of many CHD has been described in a large amount of cases in children, adolescents and adults: more recently interventional option has been described for closure of patent ductus in premature babies, as an alternative to pharmacological therapy or surgical ligation; transcatheter closure gained an increasing popularity, according to improvement of available devices (Piccolo and other devices) associated with increased expertise of operators. Ahmad Chmaisse et al. reported encouraging results in improvement of pulmonary edema and respiratory status after transcatheter closure of ductus: Some questions remain open on which patients transcatheter duct closure should be performed; apparently the youngest and smallest ones are likely to benefit more of this procedure. Overall transcatheter closure became the first choice treatment in many Centers when duct closure is required in premature babies. (Ahmad Chmaisse et al.: Improvement of pulmonary edema and respiratory status after transcatheter PDA closure in the smallest and most premature infants). Transcatheter closure of patent ductus in older children is a well established procedure; however some exceedingly rare cases may occur in the clinical practice. Hua-yong Zhang et al. described a very unusual case of infective endocarditis originating from a patent ductus arteriosus, complicated by formation of an aneurysm of the pulmonary artery.The theray adopted was conservative with Vancomycin+Rifampicin for 6 weeks, with resolution of the infection and disappearance of the vegetation. At 6 months follow-up the patient underwent transcatheter closure of the duct; on CT exam the pulmonary artery aneurysm appeared relatively small, without any signs of dissection; therefore it was left alone. Controversy may rise on need of surgical repair of aneurysm or not: the Authors decided to adopt a conservative approach, limiting the invasive intervention to plug closure of the duct, so eliminating the high aortopulmonary flow, that was the cause of pulmonary artery anerurysm, in association with vessel wall damage due to infection. The follow-up, at least at mid-term, was favourable, according to Authors choice. (Hua-yong et al. A Case Report: A new therapeutic option for a rare patent ductus arteriosus child complicated with pulmonary artery aneurysm due to infectious endocarditis). Surgery or Catheter interventions improved tremendously in the past years the treatment of the majority of CHD; however we should be aware that patients, although previously treated in the best way, cannot be considered "completely cured" and we have to face with possible sequelae. Let's take the example of Coarctation of the aorta: common congenital heart defect, presenting in isolation or associated with many other defects. Surgery is considered the first choice treatment in infancy, while angioplasty and stenting (with bare metal or covered stents), gained a progressive increasing popularity in adoloescence and adults. Whatever treatment is performed, persistent hypertension remain a problem in up to 20% of patients who previously underwent repair, particularly when the repair itself is done later in life. Luisa ye et al. stressed the importance of a careful follow-up, using a multiparametric approach to assess the problem of "chronic hypertension after correction of coarctation": besides clinical examination, many other tools should be implemented routinely in patients evaluation: echocardiography, magnetic resonance and/or CT, ambulatory blood pressure monitoring, exercise stress test… In cases of persitent hypertension, in spite of adequate removal of anatomic ostruction of the aortic arch, pharmacological treatment has to be considered: Beta-blockers and ACE inhibitors are most commonly used, sometimes also calcium-channel blockers or diuretics is cases of resistant hypertension. In spite of the fact that universally accepted guidelines of treatment in this group of patients is missing, each center is committed to follow-up these patients in order to prevent hypertension induced progressive atherosclerosis and major adverse events. (Luisa Ye, Biagio Castaldi*, Irene Cattapan, Alice Pozza, Jennifer Fumanelli and Giovanni Di Salvo: Hypertension in aortic coarctation).Novel Techniques in Imaging Congenital Heart Disease: JACC Scientific Statement.Ritu Sachdeva 1 , Aimee K Armstrong 2 , Rima Arnaout 3 , Lars Grosse-Wortmann 4 , B Kelly Han 5 , Luc Mertens 6 , Ryan A Moore 7 , Laura J Olivieri 8 , Anitha Parthiban 9 , Andrew J Powell. Am Coll Cardiol. 2024 Jan 2;83(1):63-81. doi: 10.1016/j.jacc.2023.10.025.Other 6 contributing articles of the research topic are mentioned in the text.