Focus on long-term prognosis for children with precordial interventions

  Interventional treatment of precardiac disease has been developed for more than a decade now, and currently involves not only simple precardiac diseases such as patent ductus arteriosus (PDA), atrial septal defect (ASD), ventricular septal defect (VSD), and pulmonary valve stenosis (PS), but also further develops a kind of mosaic treatment for complex precardiac diseases closely related to cardiac surgery. The advantages of this treatment are that it is not restricted by pediatric age, the catheterization is simpler, the device is easily delivered, the stent can be modified manually, and the concomitant malformations can be treated at the same time. However, in addition to the advantages mentioned above, interventional treatment may also cause some damage to the myocardium, mainly in the form of inflammatory response and increased concentration of biological markers of myocardial injury after interventional treatment. Studies on inflammatory reactions induced by interventions for pediatric precardiac disease have not been reported in China. Some studies have confirmed that myocardial troponin (cTnI), a marker of myocardial injury, changes reversibly before and after the intervention, but no in-depth analysis has been performed on the differences between different conditions at different times of operation, and the maximum time period for observing the marker changes is only 3 days after the operation. In fact, there are still some children with elevated markers until one week or even longer after surgery. Therefore, it is difficult for the available studies to reveal the full picture of the inflammatory response and myocardial injury induced by the intervention. This shortcoming may mislead clinical interventionalists to be aware of the various advantages and benefits of interventional therapy, while neglecting to pay attention to the risk factors that may trigger myocardial injury in the perioperative period, so that a certain percentage of patients with various myocardial diseases triggered by interventions will appear years or decades later. This is a well-known concern in the current field of pediatric precordial interventions. Therefore, it is necessary to explore whether interventional injuries and inflammatory responses are always transient and reversible? What factors and variables contribute to the evolution of transient and reversible changes into long-term and irreversible lesions under specific conditions, leading to serious long-term cardiac complications in the intervening child, so as to objectively evaluate the characteristics and role of precardiac interventions. To provide a strong theoretical basis for a more rational approach to pediatric precordial interventions.