The next era in pediatric cardiology: from lesion-based repair to precision, prediction and lifelong care
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261846Keywords:
Pediatric cardiology, Congenital heart disease, Precision medicine, Fetal cardiology, Artificial intelligence, Lifelong careAbstract
Pediatric cardiology is evolving from a disease-oriented model to a more precision-oriented, predictive, long-term follow-up-oriented and practically implementable discipline across care settings. With congenital heart disease (CHD) present in approximately 1% of live births, an increasing number of children and adults are living with heart defects that have been completely repaired, incompletely repaired, palliated, or medically managed. This review follows the child’s heart from fetal diagnosis and newborn detection through precise diagnosis, intervention, prediction of late outcomes, neurodevelopmental monitoring, transition to adult CHD care and prevention of acquired cardiovascular disease. New strategies, including updated algorithms for critical congenital heart disease screening, fetal cardiac programs and selected interventions, exome/genome sequencing, 3D surgical planning, catheter-based PDA closure in infants weighing ≥700 g, ductal stenting versus shunting, AI-assisted ECG and imaging analysis, wearables for heart failure monitoring, neurodevelopmental guidance, transition programs and global surgical quality registries, will only have value when matched to a specific patient, setting, threshold, owner, action and limitation.
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References
Van der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(21):2241-7. DOI: https://doi.org/10.1016/j.jacc.2011.08.025
Centers for Disease Control and Prevention. Data and statistics: congenital heart defects. Atlanta (GA): CDC. 2025. Available at: https://www.cdc.gov/heart-defects/data/index.html. Accessed on 29 April 2026.
Centers for Disease Control and Prevention. About congenital heart defects. Available at: https://www.cdc.gov/heart-defects/about/index.html. Accessed on 29 April 2026.
Xu J, Li Q, Deng L, Xiong J, Cheng Z, Ye C. Global, regional, and national epidemiology of congenital heart disease in children from 1990 to 2021. Front Cardiovasc Med. 2025;12:1522644. DOI: https://doi.org/10.3389/fcvm.2025.1522644
Oster ME, Pinto NM, Pramanik AK, Markowsky A, Schwartz BN, Kemper AR, et al. Newborn screening for critical congenital heart disease: a new algorithm and other updated recommendations. Pediatrics. 2025;155(1):e2024069667. DOI: https://doi.org/10.1542/peds.2024-069667
Centers for Disease Control and Prevention. Clinical screening and diagnosis for critical congenital heart defects. Atlanta (GA): Centers for Disease Control and Prevention. 2026. Available at: https://www.cdc.gov/heart-defects/hcp/screening/index.html. Accessed 29 April 2026.
Abouk R, Grosse SD, Ailes EC, Oster ME. Association of US state implementation of newborn screening policies for critical congenital heart disease with early infant cardiac deaths. JAMA. 2017;318(21):2111-8. DOI: https://doi.org/10.1001/jama.2017.17627
Aypar E. Fetal cardiac interventions: a review of the current literature. J Updates Cardiovasc Med. 2025;13(1):1-7. DOI: https://doi.org/10.32596/jucvm.galenos.2025.2024-39-120
Freud LR, McElhinney DB, Marshall AC, Marx GR, Friedman KG, Del Nido PJ, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: postnatal outcomes of the first 100 patients. Circulation. 2014;130(8):638-45. DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.009032
Mendel B, Kohar K, Amirah S, Vidya AP. The outcomes of fetal aortic valvuloplasty in critical aortic stenosis: systematic review and meta-analysis. Int J Cardiol. 2023;382:25-30. DOI: https://doi.org/10.1016/j.ijcard.2023.03.050
Geng J, Picker J, Zheng Z, Zhang X, Wang J, Hisama F, et al. Chromosome microarray testing for patients with congenital heart defects reveals novel disease-causing loci and high diagnostic yield. BMC Genomics. 2014;15:1127. DOI: https://doi.org/10.1186/1471-2164-15-1127
Onorato AC, Gosselin R, Chaudhari BP, Alvarado C, White P, Garg V, et al. Diagnostic yield of exome and genome sequencing for critically ill pediatric cardiac patients. Transl Pediatr. 2026;15(2):44. DOI: https://doi.org/10.21037/tp-2025-1-877
Pidaparti M, Geddes GC, Durbin MD. Clinical genetic and genomic testing in congenital heart disease and cardiomyopathy. J Clin Med. 2024;13(9):2544. DOI: https://doi.org/10.3390/jcm13092544
Landstrom AP, Kim JJ, Gelb BD, Helm BM, Kannankeril PJ, Semsarian C, et al. Genetic testing for heritable cardiovascular diseases in pediatric patients: a scientific statement from the American Heart Association. Circ Genom Precis Med. 2021;14(5):e000086. DOI: https://doi.org/10.1161/HCG.0000000000000086
Valverde I, Gomez G, Gonzalez A, Suarez-Mejias C, Adsuar A, Coserria JF, et al. Three-dimensional printed models for surgical planning of complex congenital heart defects: an international multicentre study. Eur J Cardiothorac Surg. 2017;52(6):1139-48. DOI: https://doi.org/10.1093/ejcts/ezx208
Yahiro DS, Cruz MP, Ribeiro BFC, Teixeira LM, Oliveira MFRM, Souza ALAAG, et al. Impact of 3D printing on cardiac surgery in congenital heart diseases: a systematic review and meta-analysis. Arq Bras Cardiol. 2024;121(12):e20240430. DOI: https://doi.org/10.36660/abc.20240798i
Batteux C, Haidar MA, Bonnet D. 3D-printed models for surgical planning in complex congenital heart diseases: a systematic review. Front Pediatr. 2019;7:23. DOI: https://doi.org/10.3389/fped.2019.00023
Sathanandam SK, Gutfinger D, O'Brien L, Forbes TJ, Gillespie MJ, Berman DP, et al. Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheter Cardiovasc Interv. 2020;96(6):1266-76. DOI: https://doi.org/10.1002/ccd.28973
Petit CJ, Romano JC, Zampi JD, Pasquali SK, McCracken CE, Chanani NK, et al. Rationale and design of the randomized COmparison of Methods for Pulmonary blood flow Augmentation: Shunt versus Stent (COMPASS) trial: A Pediatric Heart Network study. Catheter Cardiovasc Interv. 2024;104(4):637-47. DOI: https://doi.org/10.1002/ccd.31109
American College of Cardiology. Past, present, and future of transcatheter pulmonary valves. 2025. Available at: https://www.acc.org/latest-in-cardiology/articles/2025/05/05/17/03/past-present-and-future-of-transcatheter-pulmonary-valves. Accessed on 29 April 2026.
Mayourian J, Asztalos IB, El-Bokl A, Lukyanenko P, Kobayashi RL, La Cava WG, et al. Electrocardiogram-based deep learning to predict left ventricular systolic dysfunction in paediatric and adult congenital heart disease in the USA: a multicentre modelling study. Lancet Digit Health. 2025;7(4):e264-74. DOI: https://doi.org/10.1016/j.landig.2025.01.001
Garcia-Canadilla P, Isabel-Roquero A, Aurensanz-Clemente E, Valls-Esteve A, Miguel FA, Ormazabal D, et al. Machine learning-based systems for the anticipation of adverse events after pediatric cardiac surgery. Front Pediatr. 2022;10:930913. DOI: https://doi.org/10.3389/fped.2022.930913
Liastuti LD, Nursakina Y. 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. Front Cardiovasc Med. 2025;12:1473544. DOI: https://doi.org/10.3389/fcvm.2025.1473544
Gearhart A, Anjewierden S, Buddhe S, Tandon A. Review of the current state of artificial intelligence in pediatric cardiovascular magnetic resonance imaging. Children. 2025;12(4):416. DOI: https://doi.org/10.3390/children12040416
Rudd NA, Ghanayem NS, Hill GD, Jacobs JP, Jacobs ML, Lofland GK, et al. Interstage home monitoring for infants with single ventricle heart disease: education and management: a scientific statement from the American Heart Association. J Am Heart Assoc. 2020;9(16):e014548. DOI: https://doi.org/10.1161/JAHA.119.014548
ClinicalTrials.gov. WeRoaM: Wearable Remote Monitoring in Heart Failure. NCT06969560. Available at: https://clinicaltrials.gov/study/NCT06969560. Accessed on 29 April 2026.
Peng DM, Edelson JB, Gureddygari HR, Duganiero T, Lynch A, McQueen M, et al. Capturing physiological data in children with heart failure using wearable digital technology: lessons from pilot project. CJC Pediatr Congenit Heart Dis. 2025;4(4):226-30. DOI: https://doi.org/10.1016/j.cjcpc.2025.03.007
Sood E, Newburger JW, Anixt JS, Cassidy AR, Jackson JL, Jonas RA, et al. Neurodevelopmental outcomes for individuals with congenital heart disease: updates in neuroprotection, risk-stratification, evaluation, and management: a scientific statement from the American Heart Association. Circulation. 2024;149(13):e997-1022. DOI: https://doi.org/10.1161/CIR.0000000000001211
Marino BS, Lipkin PH, Newburger JW, Peacock G, Gerdes M, Gaynor JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management. Circulation. 2012;126(9):1143-72. DOI: https://doi.org/10.1161/CIR.0b013e318265ee8a
Ware J, Butcher JL, Latal B, Sadhwani A, Rollins CK, Brosig Soto CL, et al. Neurodevelopmental evaluation strategies for children with congenital heart disease aged birth through 5 years: recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young. 2020;30(11):1609-22. DOI: https://doi.org/10.1017/S1047951120003534
Centers for Disease Control and Prevention. Transitioning from pediatric to adult health care. 2026. Available at: https://www.cdc.gov/heart-defects/living-with/transitioning-from-pediatric-to-adult-medical-care.html. Accessed on 29 April 2026.
Pediatric Heart Network. WE BEAT CHD. Available at: https://www.pediatricheartnetwork.org/studies/we-beat-chd/. Accessed on 29 April 2026.
Moons P, Bratt EL, De Backer J, Goossens E, Hornung T, Tutarel O, et al. Transition to adulthood and transfer to adult care of adolescents with congenital heart disease: a global consensus statement. Eur Heart J. 2021;42:4213-23. DOI: https://doi.org/10.1093/eurheartj/ehab388
Gurvitz M, Krieger EV, Fuller S, Davis LL, Kittleson MM, Aboulhosn JA, et al. 2025 ACC/AHA/HRS/ISACHD/SCAI guideline for the management of adults with congenital heart disease. Circulation. 2025;153(8):e115-251. DOI: https://doi.org/10.1161/CIR.0000000000001432
Single Ventricle Outcomes Network. SV-ONE network. Available at: https://www.svone.org. Accessed on 29 April 2026.
Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. DOI: https://doi.org/10.1542/peds.2017-1904
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Summary report. Pediatrics. 2011;128(5):S213-56. DOI: https://doi.org/10.1542/peds.2009-2107C
Jone PN, Tremoulet A, Choueiter N, Romero Domínguez S, Harahsheh AS, Mitani Y, et al. Update on diagnosis and management of Kawasaki disease: a scientific statement from the American Heart Association. Circulation. 2024;150:e481-500. DOI: https://doi.org/10.1161/CIR.0000000000001295
Ehrhardt MJ, Leerink JM, Mulder RL, Visscher H, Kremer LCM, Van der Pal HJH, et al. Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer. Lancet Oncol. 2023;24(3):e108-20. DOI: https://doi.org/10.1016/S1470-2045(23)00012-8
WHO. Rheumatic heart disease. Available at: https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease. Accessed on 29 April 2026.
Pediatric Heart Network. CAMP study. Available at: https://www.pediatricheartnetwork.org/studies/. Accessed on 29 April 2026.
International Quality Improvement Collaborative for Congenital Heart Disease. IQIC program. Available at: https://iqic.chboston.org. Accessed on 29 April 2026.
Society of Thoracic Surgeons. Congenital Heart Surgery Public Reporting. Available at: https://publicreporting.sts.org/chsd. Accessed on 29 April 2026.
European Congenital Heart Surgeons Association. Congenital Database history. Available at: https://www.echsa.org/congenital-database-history. Accessed on 29 April 2026.
Health Technology Assessment Council, Philippines. Newborn pulse oximetry as a screening test for critical congenital heart disease among asymptomatic, apparently healthy newborns. 2025. Available at: https://hta.dost.gov.ph. Accessed on 29 April 2026.
World Society for Pediatric and Congenital Heart Surgery. World Database for Pediatric and Congenital Heart Surgery. Available at: https://wspchs.org/world-database-for-pediatric-and-congenital-heart-surgery/. Accessed on 29 April 2026.
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