The Seventh World Congress of Pediatric Cardiology was held in Barcelona in July, 2017. The central philosophy of the congress was “bridging together” all major specialties in the field. This article summarises the highlights of the meeting as it relates to ambulatory paediatric cardiology. There is a now a more unified approach to children with CHD, including assessment of neuro-developmental outcomes. The new World Heart Foundation criteria for the diagnosis of rheumatic fever remain controversial.

Coarctation of the aorta is a congenital cardiac defect that results in a variable degree of obstruction to the left side of the heart. It can present with either acute shock in the neonatal period as a critical lesion or it can appear more insidiously with hypertension or other findings later in life. This article summarises aspects of outpatient care of patients with this lesion, including clinical history and physical examination, ancillary testing, and issues associated with long-term follow-up and management. Increasing knowledge and experience with this group of patients have allowed for a higher level of evidence-based care over the long term.

Congenital anomalies of the coronary arteries, although uncommon, have the potential to cause serious myocardial damage, ischaemic cardiomyopathy, and sudden cardiac death. This article summarises aspects of care for these patients in the outpatient setting, including clinical history and physical examination findings, ancillary testing, decision-making regarding the need for surgical intervention, and recommendations for physical activity. Although there are limited data regarding some of these recommendations, it is hoped that these can be used as an initial benchmark against which further data will lead to a more evidence-based approach.

Varicella-zoster virus causes chickenpox (CP) and after reactivation herpes zoster (HZ). Vaccines are available against both diseases warranting an assessment of the pre-vaccination burden of disease. We collected data from relevant Belgian databases and performed five surveys of CP and HZ patients. The rates at which a general practitioner is visited at least once for CP and HZ are 346 and 378/100 000 person-years, respectively. The average CP and HZ hospitalization rates are 5·3 and 14·2/100 000 person-years respectively. The direct medical cost for HZ is about twice as large as the direct medical cost for CP. The quality-adjusted life years lost for ambulatory CP patients consulting a physician is more than double that of those not consulting a physician (0·010 vs. 0·004). In conclusion, both diseases cause a substantial burden in Belgium.

Laryngopharyngeal reflux (LPR), which is defined as the backflow of gastric contents into the upper aerodigestive tract, is a relatively common disorder. However, its diagnosis still poses many problems. Twenty-four-hour double-probe pH monitoring is currently the diagnostic test of choice, but it has many disadvantages. Thus, an empiric trial of antireflux therapy has been suggested as an alternative method for diagnosis. The purpose of this article is to evaluate the validity of this alternative method in the management of LPR. The study group consisted of 36 patients with symptoms and physical findings suggesting LPR. The control subjects were 23 healthy adults. Twenty-four-hour double-probe pH monitoring was performed both in the study group and the control group, and the results were compared. In addition, the symptoms and physical findings in the study group was scored by the modified reflux symptom index (MRSI) and reflux finding score (RFS) at four intervals: before the start of therapy and at the second, fourth and sixth months of the therapy. The results of the 24-hour double-probe pH monitoring showed no significant difference between the study and the control groups (p>0.05). In the study group, the MRSI before the therapy was 13.6±4.4. This index improved significantly to 4.3±1.9 at the second month; to 1.5±0.6 at the fourth month, and to 0.5±0.2 at the sixth month of the therapy (p<0.05). The RFS before the start of the therapy was 14.8±3.8; and it improved significantly to 7.7±3.8 at the second month; to 4.5±2.3 at the fourth month, and to 1.4±0.9 at the sixth month of the therapy (p<0.05). The significant improvement in the MRSI and the RFS during the course of proton pump inhibitor therapy relates the patients’ symptoms and physical findings to LPR. This implies the validity of the method, not only in the treatment of LPR, but in the diagnosis of this disorder, as well. Unfortunately, 24-hour double-probe pH monitoring has failed to differentiate LPR patients from healthy individuals.

Background and objective: To evaluate preparation and discharge times as well as the anaesthesia-related costs of out-patient knee arthroscopy performed with a combined sciatic-femoral nerve block, or a propofol-remifentanil general anaesthetic.

Methods: With Ethics Committee approval and written informed consent, 40 healthy patients were premedicated with intravenous midazolam (0.05 mg kg−1) and ketoprofen (50 mg). They were then randomly allocated to receive either a combined sciatic-femoral nerve block with 25 mL mepivacaine 2% (15 mL for the femoral nerve, 10 mL for the sciatic nerve) (PNB group, n = 20), or a general anaesthetic with a continuous intravenous infusion of remifentanil (0.1–0.3 μg kg−1min−1) and propofol (target plasma concentration 2–4 μg mL−1) with a laryngeal mask airway (GA group, n = 20).

Results: The median (range) preparation time was 16 (10–28) min in the PNB group and 13 (8–22) min in the GA group (P = 0.015). Ten PNB patients were directly discharged to the day-surgery unit after the procedure as compared with one GA patient (P = 0.003). Discharge from the postanaesthesia care unit (PACU) required 5 (5–20) min in the PNB group and 23 (7–95) min in the GA group (P = 0.001). Home discharge criteria were fulfilled after 277 (150–485) min in the PNB group and 170 (100–400)min in the GA group (P = 0.005). Costs related to the time spent in the PACU were lower for the PNB group (€1.10, range 0–22) compared with the GA group (€30, range €0–176) (P = 0.0005). There were no differences in total costs: PNB group €158 (range €105–194) versus GA group €160 (range €101–238) (P = 0.61).

Conclusions: In patients undergoing out-patient knee arthroscopy, the length of stay in the PACU can be shorter after a sciatic-femoral nerve block with a small volume of mepivacaine 2% compared with a propofol-remifentanil anaesthetic, and there is an increased likelihood that they will bypass the first phase of the postoperative recovery.

The objective of this study was to assess the relation between the intensity of single moods and of mood combinations on blood pressure (BP) and heart rate (HR). The subjects were 203 healthy registered nurses, all women, who were studied on two work and two off days. Ambulatory BP and HR were recorded every 20 min. On each occasion subjects rated their moods on a 5-point scale. Graded increases in BP and HR were shown with higher ratings of negative moods and decreases for a mood related to energy level. Little change was observed for a positive mood. These effects depended on concurrent changes in other moods. A positive mood countered the effects of a negative mood, whereas two negative moods resulted in unique patterns of BP and HR. The energy level mood moderated the cardiovascular effects of positive and negative moods. Ambulatory methods provide a way of probing into the nature and consequences of everyday emotional experiences.

In a double-blind, randomized, controlled study, 61 patients who received a standardized anaesthetic for day case arthroscopic knee surgery were studied. Group T (n=31) received tramadol 1.5 mg kg−1, and group F (n=30) received fentanyl 1.5 μg kg−1 at the induction of anaesthesia. All patients also received 20 mL of intra-articular bupivacaine 0.5% at the end of surgery. Assessments were made of pain at rest and on movement, analgesic requirements and side-effects at hourly intervals up to 6 h and by means of a postal questionnaire at 24 h and 48 h post-operatively. Group F had higher pain scores than group T at 4 h only [VAS 3.3 (1.6–5.5) vs. 2.4 (1–4), P=0.039, respectively; median (interquartile range)]. There were no other significant differences between the groups in terms of pain scores, supplemental analgesic requirements or incidence of side-effects. We conclude that tramadol offers little benefit clinically compared with fentanyl when used at induction of anaesthesia for day case arthroscopic knee surgery. Further studies are indicated in patients with more severe pain to determine the role of tramadol in post-operative analgesia.

The increasing use of ambulatory surgery requires methods of anaesthesia that allow patients to be discharged soon after the operation is completed. Spinal anaesthesia is usually simple and quick, and the incidence of post-spinal headache has been reduced by using non-cutting small-gauge needles. Limiting the spread of spinal anaesthesia, as long as it still provides analgesia for surgery, should reduce the haemodynamic effects and speed recovery. Restricted spinal anaesthesia, intended to be unilateral using 0.18% hypobaric bupivacaine via a 25G or 27G Whitacre unidirectional needle, was compared with epidural anaesthesia (using a mixture of lignocaine and prilocaine) in 64 matched-pair patients undergoing ambulatory arthroscopy. Motor blockade, assessed for the specific myotomes L2 to S1, was significantly more unilateral in the spinal group. Two patients in the spinal group and nine patients in the epidural group were treated for hypotension (P < 0.05). One patient in the spinal group developed a post-spinal headache. One patient in the epidural group rated the anaesthesia poor.

A sensitive electronic monitor (Mini-Motionlogger, Ambulatory Monitoring Inc.) attached to the wrist was used to record movements during two 24-hr days of ambulatory blood pressure (BP) and heart rate (HR) recording in 65 women and 54 men between the ages of 55 and 79 years, all of whom were in good health. The objective was to examine the relationship between various measures of physical activity and ambulatory BP and HR during waking and sleeping periods and during various diary-defined behaviors. For waking and sleeping periods, neither the mean nor the variability of the activity measure was associated with the mean or variability of the ambulatory BP and HR measures in between-subjects correlational analyses. Within-subject analyses showed little evidence of significant covariation between activity and BP or HR during either waking or sleeping conditions with most participants showing a slightly positive association. The activity measure discriminated between behaviors associated with little effort (watching television) versus more energetic behaviors (walking). Activity accounted for a relatively small amount of the difference in BP or HR related to overall state (wake, sleep), posture (stand, sit), and social condition (being with family vs. being with friends). The utility of electronic activity monitoring for studies of BP and HR in natural settings is discussed.